Fifty eight year old female patient presented on referral from GP with chronic abdominal pain and daily nausea of 12 months duration. Patient had reduced physical activity which aggravated pain. Patient had undergone multiple diagnostic tests, including Blood tests, Colonoscopy, CT, Abdo, and Pelvic Uls. Seen by Gastroenterologist, General Surgeon, and Gynaecologist.
Myofascial examination revealed:
TPs in Rectus Abdomimus External oblique, and iliopsoas, provocative palpation reproduced complaint of pain including nausea.
A course of six sessions of dry needling Myofascial release resulting in 90% reduction in symptoms, patient then commenced on physical conditioning / well being program.
Case Study 2
Thirty two year old female patient, referred by G.P. Patient suffered a severe hyper-extension injury to the cervical spine whilst skate boarding at age 14. Since that time has complained of regular headaches. Had been varyingly diagnosed as Migraine, or a cluster headache.
Over the last 12/12 headaches, frequency and intensity increased, no longer relieved by medication. Headaches directly related to her work. Long periods of time spent in static cervical postures. Patient describes the headaches as feeling intracranial has undergone, C.T., M.R.I., and brain scan; all normal.
Myofascial examination revealed:
Active TPs in Semispinalis, Capitus, Suboccipitals. 15 month history of dental pain reproduced by temporalis trigger points.
Patient attended for a course of treatment including dry needling of symptomatic trigger points. A complete resolution of headaches was achieved after four sessions and the patient was instructed in postural and muscle stretching exercises. On review one month post discharge the patient had maintained her headache free status.
Case Study 3
Forty five year old male Trauma & Emergency Physician referred by LMO for management of chronic daily headache.
Initial headache came on immediately after exertion whilst running on treadmill. Pain intensified over 48hrs to extreme levels; patient was unable to get out of bed due to pain. Admitted to hospital, a battery of tests performed. Including CT, Lumbar puncture, blood tests for temporal arthritis. All tests came back negative.
Pain settled into chronic daily headache. Aggravated by stress, prolonged screen time / disturbed sleep. Various medications tried, with no significant improvement.
Myofascial examination revealed:
TPs identified in upper trapz, S.C.M., Masseter and Temporalis.
Intra Oral examination:
Significant evidence of bruxing with dental wear, particularly posterior molars bilaterally. On questioning, a 20 year history of bruxing! Referral to Dental prosthetist for a night splint. Treatment of active TPs & dry needling
Long term plan:
Gym programme, walking & cycling programme. A course of Myofascial pain management undertaken including dry needling of active TPs. After completion of six week programme, patient was headache free. Review 3/12 post discharge patient continued to be headache free.
Case Study 4
Forty six year old female market gardener was referred by ENT specialist for treatment of chronic right jaw pain, which has been previously diagnosed as infection of the parotoid gland by her GP. More recently the pain had extended into the face and involved temporal and frontal headaches.
Referral to the ENT for sinus investigation as several courses of antibiotics had failed to clear the sinus infection. ENT examination revealed normal sinuses, precautionary, u/s of the parotoid gland was normal. Biopsy was deferred as ENT provisional diagnosis was A typical / facial pain of Myofascial origin.
Pain developed 2 weeks after plastic surgery, facelift. Began as a tight feeling under the jaw line 5 years ago. Pain has progressed since then. Patient also complained of earache, toothache and pain on mastication.
Multiple trips to the dentist, including removal of tooth due to pain. Prescribed an occlusal splint, which did not help. Seen a new dentist 6/12 ago, who diagnosed TMJ dysfunction, but advised against the splint as no evidence of bruxism, (coincidentally had advised patient to seek myofascial treatment).
TPs in digastric reproduced her complaint of mandibular pain. Active TPs in the SCMs, which reproduced facial pain. Masseter TPs reproducing TMJ. pain and toothache. Initial treatment of diagastric TPs resolved her mandibular pain. A further course of treatment to affected head and neck muscles resolved her headaches and persistent dental pain. A review at six weeks post discharge revealed no further reoccurrence of her head and neck pain.
Case Study 5
Twenty two year old female administration officer referred by her physiotherapist for treatment of chronic right sided headaches, shoulder & scapula pain, of 18months duration. Pain developed in the nape of the neck, overtime developed to include, TMJ and temporal pain s well as dental sensitivity. Medical investigations were NAD, including C.T. Cervical spine, C.T. brain. Dental evaluation was NAD, no evidence of bruxing referred to physiotherapy.
Some short term relief achieved by standard physiotherapy intervention. Referred by Physio for course of dry needling.
O/E active M.T.Ps identified in right levator scap., upper trapz and lateral pterygoid and masseter muscles.
Involved a course of six sessions of dry needling. Review 3 weeks post treatment. Patient remained symptom free. N.B. Patient represented 12/12 later for treatment, chronic abdominal pain, the patient continued to be headache free.
Medical Evaluation of abdominal pain was NAD, and included evaluation bygastroenterologist and gynecologist. Patient described a deep dull ache similar to her old headaches / shoulder pain.
Myofascial Evaluation Active M.T.Ps identified in the rectus abdominus and external oblique muscles. Patient underwent a course of dry needling leading to complete resolution of symptoms.
Supplimentary history 4 weeks before the development of the abdominal pain patient had been breaking up concrete in her backyard with a sledge hammer thought she had strained an abdominal muscle. Was in acute pain for 1 week which settled. Subsequently abdominal pain redeveloped after using an extension roller painting the ceiling, the pain was not as acute more of a dull deep ache.
N.B Eventual medical diagnosis was I.B.S? (Irritable bowel syndrome). Subsequent myofascial evaluation and treatment belied this diagnosis.