Dry Needling: The Back
Abbreviations: 1
Levator Scapulae: 2
Rhomboids: 3
Infraspinatus: 4
Supraspinatus: 5
Teres major: 6
Teres minor: 7
Latissimus Dorsi: 8
Quadratus Lumborum: 9
Serratus Posterior Superior: 11
Serratus Posterior Inferior: 12
Paraspinals/ Multifidus: 13
Trapezius: 15
Abbreviations:
● Abom = abdominis/ abdominals ● Med = medial
● Abd = abduction ● Min = minor
● Accel. = accelerate ● MOI = mechanism of injury
● ACJ = acromioclavicular joint ● Movts = movements
● Ant = anterior ● MS = multiple sclerosis
● Anterolat = anterolateral ● OA = osteoarthritis
● Artic = articular ● Opp = opposite
● Ax = assessment ● || = parallel
● Bilat = bilateral ● Pec = pectoralis
● BL = bilateral ● Posterolat = posterolateral
● Btw = between ● Prop = proprioception
● Caud = caudal/ly ● PT = Physiotherapist
● ℅ = complains of (complaint) ● Pt = patient
● Contralat = contralateral ● r/f = referral
● EOR = end of range ● Rhom = rhomboids
● ER = external rotation ● ROM = range of motion
● Esp = especially ● Scap = scapula
● Extern = external ● SCJ = sternoclavicular joint
● Exam = examine ● SIJ = sacroiliac joint
● # = fracture ● SL = side lying
● Fxn = function ● Sp = spinous
● GHJ = glenohumeral joint ● Spont = spontaneous
● Glut = gluteus ● Supraspin = supraspinatous
● Interscap = interscapular ● thr = through
● Ipsilat = ipsilateral ● T maj = teres major
● IR = internal rotation ● T min = teres minor
● Jt = joint ● TP = transverse process
● Lev scap = levator scapulae ● TrP = trigger point
● Ligs = ligaments ● Tx = thoracic
● LLD = leg length discrepancy ● Unilat = unilateral
● LTR = local twitch response ● Vert = vertebra/e
● M = muscle ● w/ = with
● Maj = major ● w/o = without
, Levator Scapulae:
Origin Insertion Innervation Function
CI to CIV transverse Upper portion medial C3 to C4 and dorsal Elevates scapula
processes border of scapula scapular nerve (C4, C5)
Signs and Symptoms:
- Pain at the angle of the neck
- Painful “stiff neck”
- Unable to perform full:
- ipsilat rotation due to pain on contraction
- Contralat rotation due to painful muscle tension
- Neck flexion (blocked at end of movement)
- Pt tends to hold the neck rigid (compensating by turning the eyes or body)
Patient Examination: Referred pain:
Observe:
- neck and shoulder postural asymmetries
- Active head/neck rotation
Activation and perpetuation of TrPs:
- ergonomics / occupational stresses e.g.
- sitting in chair w/ armrests too high
- Walking w/ cane too long
- Sleeping with neck tilted, shortening lev scap
- Lev scap may be overloaded when TrPs inhibit the fxn of serratus anterior
Trigger point examination Needling
1. Central TrP - Contralat SL w/ pillow supporting the head
- At the angle of the neck - 30-40mm needle
- Contralateral SL w/ neck supported or in 1.
supine (better for upper traps relaxation) - Pt faces away from PT
- Face and neck slight contralat rotation - Pt body angled across the plinth near the PT
(to tighten and lift lev scap) - Arm rests on side of body w/ elbow bent for balance
- Upper traps must be slackened - More tension: full medial rotation w/ hand across the
2. Attachment TrP back w/ scapular winging
- Where the muscle attaches to the - PT presses aside the free border of upper traps +
superior angle of the scapula palpates lev scap
- Contralat SL - Fix the TrP against a transverse process
- Cross-fiber palpation +/- 1.5 cm above - Direct needle anteriorly toward TrP but away from
superior angle of scapula ribcage.
- Initially feels indurated and tender 2. Needle if soreness persists after 1
→ gritty (like gravel) or scar-like when - Scapula abducted – pt bends forward w/ round shoulders
stressed for some time to stretch and thin out the traps
- Enthesopathy from sustained TrP - Rub a finger transversely across M fibers
tension - Insert 40 mm needle upward aiming to be parallel to the
rib cage
Entrapment: No
Differential Diagnosis:
Bursitis and articular dysfunction
Decr neck movt (whereas with upper traps TrPs pt
continuously tries to stretch neck)
Related TrPs:
● Splenius cervicis likely involved with “stiff neck”
syndrome
● Scalenus medius and iliocostalis cervicis
● Strong neck lateral flexion likely due to SCM
TrPs
Abbreviations: 1
Levator Scapulae: 2
Rhomboids: 3
Infraspinatus: 4
Supraspinatus: 5
Teres major: 6
Teres minor: 7
Latissimus Dorsi: 8
Quadratus Lumborum: 9
Serratus Posterior Superior: 11
Serratus Posterior Inferior: 12
Paraspinals/ Multifidus: 13
Trapezius: 15
Abbreviations:
● Abom = abdominis/ abdominals ● Med = medial
● Abd = abduction ● Min = minor
● Accel. = accelerate ● MOI = mechanism of injury
● ACJ = acromioclavicular joint ● Movts = movements
● Ant = anterior ● MS = multiple sclerosis
● Anterolat = anterolateral ● OA = osteoarthritis
● Artic = articular ● Opp = opposite
● Ax = assessment ● || = parallel
● Bilat = bilateral ● Pec = pectoralis
● BL = bilateral ● Posterolat = posterolateral
● Btw = between ● Prop = proprioception
● Caud = caudal/ly ● PT = Physiotherapist
● ℅ = complains of (complaint) ● Pt = patient
● Contralat = contralateral ● r/f = referral
● EOR = end of range ● Rhom = rhomboids
● ER = external rotation ● ROM = range of motion
● Esp = especially ● Scap = scapula
● Extern = external ● SCJ = sternoclavicular joint
● Exam = examine ● SIJ = sacroiliac joint
● # = fracture ● SL = side lying
● Fxn = function ● Sp = spinous
● GHJ = glenohumeral joint ● Spont = spontaneous
● Glut = gluteus ● Supraspin = supraspinatous
● Interscap = interscapular ● thr = through
● Ipsilat = ipsilateral ● T maj = teres major
● IR = internal rotation ● T min = teres minor
● Jt = joint ● TP = transverse process
● Lev scap = levator scapulae ● TrP = trigger point
● Ligs = ligaments ● Tx = thoracic
● LLD = leg length discrepancy ● Unilat = unilateral
● LTR = local twitch response ● Vert = vertebra/e
● M = muscle ● w/ = with
● Maj = major ● w/o = without
, Levator Scapulae:
Origin Insertion Innervation Function
CI to CIV transverse Upper portion medial C3 to C4 and dorsal Elevates scapula
processes border of scapula scapular nerve (C4, C5)
Signs and Symptoms:
- Pain at the angle of the neck
- Painful “stiff neck”
- Unable to perform full:
- ipsilat rotation due to pain on contraction
- Contralat rotation due to painful muscle tension
- Neck flexion (blocked at end of movement)
- Pt tends to hold the neck rigid (compensating by turning the eyes or body)
Patient Examination: Referred pain:
Observe:
- neck and shoulder postural asymmetries
- Active head/neck rotation
Activation and perpetuation of TrPs:
- ergonomics / occupational stresses e.g.
- sitting in chair w/ armrests too high
- Walking w/ cane too long
- Sleeping with neck tilted, shortening lev scap
- Lev scap may be overloaded when TrPs inhibit the fxn of serratus anterior
Trigger point examination Needling
1. Central TrP - Contralat SL w/ pillow supporting the head
- At the angle of the neck - 30-40mm needle
- Contralateral SL w/ neck supported or in 1.
supine (better for upper traps relaxation) - Pt faces away from PT
- Face and neck slight contralat rotation - Pt body angled across the plinth near the PT
(to tighten and lift lev scap) - Arm rests on side of body w/ elbow bent for balance
- Upper traps must be slackened - More tension: full medial rotation w/ hand across the
2. Attachment TrP back w/ scapular winging
- Where the muscle attaches to the - PT presses aside the free border of upper traps +
superior angle of the scapula palpates lev scap
- Contralat SL - Fix the TrP against a transverse process
- Cross-fiber palpation +/- 1.5 cm above - Direct needle anteriorly toward TrP but away from
superior angle of scapula ribcage.
- Initially feels indurated and tender 2. Needle if soreness persists after 1
→ gritty (like gravel) or scar-like when - Scapula abducted – pt bends forward w/ round shoulders
stressed for some time to stretch and thin out the traps
- Enthesopathy from sustained TrP - Rub a finger transversely across M fibers
tension - Insert 40 mm needle upward aiming to be parallel to the
rib cage
Entrapment: No
Differential Diagnosis:
Bursitis and articular dysfunction
Decr neck movt (whereas with upper traps TrPs pt
continuously tries to stretch neck)
Related TrPs:
● Splenius cervicis likely involved with “stiff neck”
syndrome
● Scalenus medius and iliocostalis cervicis
● Strong neck lateral flexion likely due to SCM
TrPs
