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LA injections for trigger points - ethical question

Discussion in 'General Issues and Discussion Forum' started by Leah Claydon, May 16, 2013.

  1. Leah Claydon

    Leah Claydon Active Member


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    Physio's in my clinic regularly treat trigger points with manual therapy to good affect. I've been reading about trigger point injection therapy with and without steroid. I've read that mepivicaine diluted with water to 0.25% without steroid is commonly used.

    Given that UK podiatrists holding LA certificates commonly use mepivicaine at 3% - would it be permissible for them to use this for injection therapy for trigger points (lower limb only) observing MSDs, best practise etc? Or would this throw up a whole barrow load of medico-legal issues?

    Are there any courses on trigger point injection therapy for podiatrists that anyone knows of? Would podiatrists holding LA certificates be permitted to inject superficial lower limb trigger points without specific further training?

    Thoughts anyone?
     
  2. Ian Linane

    Ian Linane Well-Known Member

    "Are there any courses on trigger point injection therapy for podiatrists that anyone knows of?"

    Personally no. Have to say that as there are various ways of treating TrPs, including dry needling, injection therapy might well be low down on my list. Not a comment on its effectiveness it just seems there are simpler ways.
     
  3. W J Liggins

    W J Liggins Well-Known Member


    Best to check with your insurance carrier (or professional body if you obtain your insurace through that route). Anything else is simply guesswork.

    Bill Liggins
     
  4. Angela Foster

    Angela Foster Member

    I treat trigger points with manual therapy, chinese cupping and acupuncture. Any other needling other than dry needling seems very over the top.
     
  5. musmed

    musmed Active Member

    Dear Angela

    Using L/A is not over the top.
    The original techniques taught by Travell and Simons was to use 0.1ml of L/A per trigger point.
    For 10 years I used L/A. It no doubts works that bit better than just dry needling.
    I switched over to the acupuncture needles in 1999. The elite athletes preferred this technique because they could back to training that day but they all agreed that the injections were better but they had to take 2 days off training.
    I stopped using the L/A technique because:
    it was messy
    they tend to bleed
    you have a pile of rubbish left over after treatments and it gets expensive when using long needles.

    Currently I use mainly 30mm, 40mm, 75mm and 100mm by 0.3mm diameter needles.
    I started this in 1988.

    have fun. Nothing works better and quicker.

    Regards
    Paul Conneely
    from the sunny south coast of aus. getting colder only 5 and 6.30am today

    www.musmed.com.au
     
  6. davidh

    davidh Podiatry Arena Veteran

    Hi,

    First of all, the question is a good one.

    As Bill says, check with your professional body, or insurance company of you don't belong to one.

    As a practicing Expert Witness in Podiatry I can see several possible medico-legal issues straight away - the biggest being the question - why would you inject a drug if you can obtain similar results with dry needling, or non-invasive methods?

    Of course clinical negligence is not a problem until something goes wrong.
     
  7. musmed

    musmed Active Member

    But what result do you want?
    Use a non painful one that works instantly and painlessly or one that is painful eg ischaemic compression with dubious outcomes?

    poser: you hurt me when you could have used a non painful method. Can I sue you too?

    What if you had attended a Travell and Simons accred workshops and they teach something that has a proven track record over 70 years of using L/A?

    Regards

    Paul Conneely
    beautiful days, nights cold, winters coming
    so is the rain!!!

    www.musmed.com.au
     
  8. davidh

    davidh Podiatry Arena Veteran

    Hi Paul,

    Here in the UK if a technique is not normally used by a Podiatrist (in this case) for that specific condition - trigger points, questions would be asked.
    If the technique is in common use for that condition, and proof would have to be provided that this was so, then the technique and practice of that technique would probably not be questioned.

    In Civil law the training, track record, and length of time the technique has been around are all less important than whether the technique is in common usage.
     
  9. musmed

    musmed Active Member

    Wonderful answer
    It explains why important things are not taught in universities.
    it is simply that the people in charge would have to learn something new, and some of these things take a long time to become proficient in and thus it becomes so easy to POO POO them and not teach them.
    a classic example is mobilisations of the foot and ankle.

    Thus 10000's of people miss out on a chance to become foot pain free.

    Maybe the next hundrds years will help....

    Never mind, only teach what you think you know.
    regards
    Paul Conneely
    www.musmed.com.au
    night time here . cold so no further info cause I do not know anything.............
     
  10. davidh

    davidh Podiatry Arena Veteran

    Hi Paul,

    First of all I think that your statement that important things are not taught in Universities is a little sweeping. I can think of plenty of important things taught to undergrads.

    Secondly, I am happy to admit there are new techniques out there waiting to be discovered. The problem is that the days are long-gone when we could simply say "this sounds like a good plan" and start doing some invasive technique on our patients which has not been properly tested. The recent dry-needling for VP treatment seems innocuous, but it may well still throw up some clinical negligence claims........

    In the 70's I remember a technique described verbally for treating intransigent verrucae. It involved pan-jetting a sclerosing agent (sodiumtetradecalsulphate if I remember rightly) directly into the VP. Some of the people at that weekend workshop were undoubtedly brave enough to go out and try it. The theory was that it allowed the virus access directly to the dermis and the body developed an overall resistance (something like that). The point is that the theory was plausable but unproven.

    Google Bolam Principle to get a better idea of why tried and tested is legally safe.
     
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