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Trigger points & Podiatry

Discussion in 'General Issues and Discussion Forum' started by Ian Linane, Apr 5, 2005.

  1. Ian Linane

    Ian Linane Well-Known Member


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    Has anyone any experience of using trigger point techniques in treating foot conditions? Was it useful?

    thanks
    Ian
     
  2. George Brandy

    George Brandy Active Member

    Trigger Points

    I use Trigger Point acupuncture sometimes in combination with traditional podiatry, sometimes as 1st line treatment. I haven't been using this technique for long, approx. 2 years, so it is difficult to give an accurate success rate but so far TP acupuncture has proved between 70-80% successful.

    Am presently treating a lady in her mid 60's with pain between 3rd and 4th mets. Pressure applied to the trigger point creates a shooting pain along dorsum of both of 3rd and 4th toes followed by a dull ache at the trigger point and tingling in 3rd and 4th toes. Patient has a history of pustular psoraisis and suspected psoriatic arthropathy. In the time it will take for confirmed dx of arthropathy and probable neuroma, TP acupuncture has reduced pain in week 1 from a VAS score 10 to VAS score 1 in week 3. Pt's life quality improved and now time to plan for long term podiatric management.

    George
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    It should be part of the ddx for any soft tissue/musculoskeletal symptom.
     
  4. C Bain

    C Bain Active Member

    Enquiry to George re. acupuncture?

    Hi George,

    I hope you don't mind me asking, but is your treatment with needles/pressure/electric?

    Always interested in treatments and training from the Chiropodists stand point!

    Regards,

    Colin. (Not trained in it myself, missed the opportunity during my training in chiropody?).
     
  5. George Brandy

    George Brandy Active Member

    I use serin acupuncture needles.
     
  6. C Bain

    C Bain Active Member

    Thank you George!!!

    Regards,

    Colin.
     
  7. Ian Linane

    Ian Linane Well-Known Member

    Thanks george, craig etc.

    Didn't get this skill in my training and a few years ago did a short introductory course (using massage finger pressure) but have had little chance to use the skill. Would be interested in any UK based training on it.

    Cheers
    Ian
     
  8. Craig Payne

    Craig Payne Moderator

    Articles:
    6
  9. Ian Linane

    Ian Linane Well-Known Member

    Hi Craig

    Thank you for the info. It's very much appreciated.

    Regards

    Ian
     
  10. George Brandy

    George Brandy Active Member

    Myofascial Techniques

    Craig,

    Have had time to go through the web site this evening. Fascinating. Cannot understand why this technique isn't taught in Universities within the UK.

    This is basically the tecnique I use within my clinic whilst dodging the flak from the traditional Chinese trained acupuncturists. Maybe it is time I marketed myself as the only Podiatrist within the NW Uk using dry needling techniques to relieve myofascial pain. There are others but we are dominated by those that have invested large amounts of money and can shout louder.

    At the end of the day, results speak volumes.

    George
     
  11. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    One really interestig trigger point issue starting to do some work on is the ones that occur in quadratus plantae and mimick plantar fasicitis.

    I had one physiotherapist, who uses and teaches this, tell me the number one reason for foot orthoses failing in plantar fasciitis, is that they did not fail, but the change in muscle mechanics caused a trigger point(s) to develop (ie the plantar fasciitis got better, but the symptoms still there due to triggers points) - I have no idea if he is right, just have not had time to pursue it.
     
  12. George Brandy

    George Brandy Active Member

    I did everything I could for a patient that had suffered plantar fasciitis. NSAIDS, orthotics, ice etc.

    I did the TP acupuncture course.

    1 needle straight into the TP she got 50% better

    1 week later another needle and she got better 100%

    I got told off for not doing the course sooner.

    I will be intested in the research results.

    George
     
  13. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I should have also added, and this is not specific to trigger points, all podiatry courses are under pressure to teach more. We are frequently accused of "why do you not teach more of X" - to which I usually respond "what should we drop to fit it in?" - in reality, there will be less content and more process in the future in academic courses.

    Trigger points are covered with our students in one lecture and one tutorial. All other modalities get the same. It then becomes a matter of the student pursuing it if they want to and having a patient when on a clinic and a clinician with interset .....same with every method.
     
  14. Ian Linane

    Ian Linane Well-Known Member

    Hi George and Craig

    George. Where did you gain your training for dry needling techniques? Do you also use the finger pressure approaches?

    Craig. I have to agree with you about PF response failure to orthoses. I have often referred a PF patient after orthoses fitting to a physio for soft tissue work. The two approaches together appears to gain good results.

    Reminded of a quote:

    " he who treats the site of pain is lost"

    Thanks for the input

    cheers
    Ian
     
  15. George Brandy

    George Brandy Active Member

  16. Ian Linane

    Ian Linane Well-Known Member

    Hi George

    Will do and thank you very much. :)

    Ian
     
  17. johnmccall

    johnmccall Active Member

    Anthony Campbell

    I'm with George on this. I've just attended a course run by Anthony Campbell in South Shield, UK. Great fun and Anthony has a very pragmatic and relaxed approach. Go for it!

    I'm really interested in trying firm finger pressure over TPs and 'treatment areas' (to treat diabetic neuropathy thus avoiding needling). Anyone tried this? Any good anecdotal results?

    Cheers
    John
     
  18. Dyn Parry

    Dyn Parry Member

    John, try dry needling with EAP (using TENs attached to needles) of your DN / neuropathic pts; have had some success, myself, with painful neuropathic patients! Acupressure benefits are shortlived & better for other conditions such as MFS and fibromyalgia. I usually practice a more segmental approach needling bone, muscle & nerve root at the appropriate spinal level that is supplying the affected dermatomes, myotomes, sclerotome etc, however, you could needle proximal & distal points associated with affected dermatome, as well as traditional TCM points (e.g. Bl-50 with Bl-60 etc) within the affected limb.
    Regards
    Dyn

    ==================
    Dyn Parry
    PHYSIO & PODIATRIST
    Licensed Acupuncturist
     
  19. Laurie Foley

    Laurie Foley Member

    Laurie Foley

    Further to the discusion on TriggerPoint therapy, I have found that acupressure ( in my case finger pressure) of Gactroc,soleus TPs very helpful in helping relieve heel pain and plantar fascial pain. This makes daily muscle stretching easier for the patient, an integral part of PL fascial therapy.
    My awareness levels of the value of TP therapy are high as my partner is a physio who practices this type of therapy daily on chronic musculo-skeletal patients of all types. :)
     
  20. Roger Kingston

    Roger Kingston Welcome New Poster

    Trigger Point treatment

    Myofascial trigger points MFTPS) or periosteal trigger points (PTPS) are invaluable diagnostically and therapeutically.

    MFTPS - as initially researched and developed by Janet Travell.
    PTPS - as initially researched and by Lawrence Jones.

    MFTPS - usually indicative of a soft tissue pathology or dysfunction.

    PTPS - usually are indicative of trauma or dysfunctional joint / ligamentous complex - with a neural basis.

    On palpation of a sensitive area one or both will usually be found. Diagnostically it is important to differentiate and form a tissue - pathology assessment.

    In terms of treatment - its very simple:

    1. Apply direct pressure till sensitivity decreases. (pts tend not to tolerate this in an acute)
    2. Stick an acupuncture needle in (only if appropriately trained)
    3. Inject with marcaine.
    4. Lazer
    5. Strain Counter Strain Technique - osteopathic technique - probably the most effective and most patient tolerable approach.

    There are 2 books worth reading if you want to add this approach to your repetoire:

    1. Positional Release Therapy by D'Ambrogio
    ISDN: 0-8151-0096-5

    2. Myofascial Pain and Dysfunction - The Lower Limb - by Janet Travell
    ISDN: 0683 08365-1




    Further training in strain counter strain can be arranged via me!

    Hope this helps,



    Roger Kingston
     
  21. Virginia Hall

    Virginia Hall Active Member

    trigger points

    Our practice has used this technique for a long time. It has been really useful with thoses hard to fix people. We use a very patient freindly approach.
    1 Stretch and spray
    2 laser (no needles)
    3 moist head pack
     
  22. Roger Kingston

    Roger Kingston Welcome New Poster

    Trigger point treatment

    Thanks for the comment Viginia,

    I have no experience of spray and stretch but know that Travell used it extensively to good effect. Lazer or heat will have an eff4ect but the best results (I have seen) are with direct pressure over the TP and positioning the part in a position that switches the pain off - hold for 90 secs (or longer - up to 10 mins in a neurological contracture) before release occurs.

    It really is brilliant for the chronics!


    Roger Kingston :D
     
  23. Virginia Hall

    Virginia Hall Active Member

    Roger are you talking about Jones Strain- Couterstrain technique?

    Ta Virginia
     
  24. Roger Kingston

    Roger Kingston Welcome New Poster

    Trigger Points

    Yes Virginia,

    Strain Counter Strain / Jones Technique - absolutely brilliant. See the book reference slightly higher up the chain.

    Roger
     
  25. dawesy

    dawesy Member

    Just curious George, (excuse me if this comes across as being a stupid question) where did you insert the needle, as traditional trigger points for the insertion of the plantar fascia is in the soleus musculature... is this where you needled? Or into the insertion? And did you put the needle in and leave it there? Just very intrigued by this technique, doing reading on it currently but this thread has been of great interest.

    Cheers.
     
  26. joanne eardley

    joanne eardley Welcome New Poster

    trigger points/periosteal needling

    I have just joined the site, as I wanted to ask if any one had any specific research papers on trigger point acupuncture, in particular periosteal needling. I did my podiatric acupuncture course 2 years ago with Anthony Campbell and have had excelllent results with plantar fasciitis. I am now doing a post graduate course in reasearch methodology/project management and am embarking on acupuncture research. This is proving to be quite involved, as there is little work/research with robust methodology. I would love to prove that acupuncture is an effective treatment for plantar fasciitis, as I have had such remarkable and fast results with its use. Like every thing these days you have to "prove" its efficacy. It is difficult to get a control group with sham acupuncture, as I am not sure waht to use. Do i use a different site on the foot, other than the site of greatest tenderness, or do i just use a superficial needling at the same point? the ethics are a nightmare too! Any ideas any one. I would be grateful for any pointers in any direction.

    many thanks
    Jo
     
  27. admin

    admin Administrator Staff Member

    ... thats exacty the wrong approach to research that you are wanting to take (Research Methods 101).
     
  28. joanne eardley

    joanne eardley Welcome New Poster

    acupuncture research

    ok, I will rephrase and say that i am setting out to prove whether acupuncture is an effective treatment for plantar fasciitis or not. I will keep my own prejudices out of it, sorry :(
     
  29. admin

    admin Administrator Staff Member

    Research is not about prooving anything - its about answering research questions and testing hypotheses.
     
  30. Ian Linane

    Ian Linane Well-Known Member

    Accupuncture HPC

    Any UK pods using acupucture for trigger points encountering extra hurdles with HPC checks etc. How is your insurance cover on this modality.
    Cheers
    Ian
     
  31. joanne eardley

    joanne eardley Welcome New Poster

    insurance

    Hi Ian, i have not encountered any problems so far. As far as i am aware, i am covered by my podiatry insurance, which was checked when i completed the course 2.5 yrs ago. The course i took is a recognised course by the society of Chiropodists and Podiatrist, and as long as i don't go above waist level, I am insured. The trust i work for, have accepted this and we have a protocol for podiatrists having done the course, to practice in the Trust. It is becoming more and more popular.

    Jo
     
  32. Ian Linane

    Ian Linane Well-Known Member

    Thanks Jo

    I am a grandparented individual but have done pressure trigger point stuff at a simple level a couple of years ago. I'll chase my insurance through.

    Ian
     
  33. ashfordpod

    ashfordpod Member

    I have been using low level laser on myofascial trigger points for some years with great success. The most astonishing success was on my son who suffered from disabling "groin strain" following soccer injuries in his mid teens.
    Locating and lasering the trigger points in his adductor longus gave almost immediate cure.
     
  34. trophikas

    trophikas Active Member

    Re: Trigger Point treatment

    Gday Roger

    You wrote in regards to Jones strain Counter strain " Further training in strain counter strain can be arranged via me!" Where abouts are you based? Do you run a course? I have recently used this technique on 5 pts with 1st PMA pain (2 of whom had sesamoiditis confirmed via xrays) and have so far had a 100% success rate. As such, Im pretty keen to learn more about it.

    Regards

    MrT
     
  35. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    New views of myofascial trigger points: etiology and diagnosis.Simons DG.
    Archives of Physical Medicine and Rehabilitation
    Volume 89, Issue 1, January 2008, Pages 157-159

    Identification and quantification of myofascial taut bands with magnetic resonance elastography.
    Chen Q, Bensamoun S, Basford JR, Thompson JM, An K-N.
    Archives of Physical Medicine and Rehabilitation
    Volume 88, Issue 12, December 2007, Pages 1658-1661

    Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.
    Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH.
    Archives of Physical Medicine and Rehabilitation
    Volume 89, Issue 1, January 2008, Pages 16-23

     
  36. tracygill

    tracygill Member

    Hiya has anyone done any research or compiled any case studies in using trigger points (ATAs) or with acupuncture that I can use (and cite)? I am a second year Podiatric research student and would welcome any feedback as evidence for podiatry using acupuncture or trigger points as an adjunt to podiatry treatment is non-existant. There is plenty of acupuncture research per se but not actual podiatric ones..

    Can anyone help
    Thanks Tracy:dizzy:
     
  37. Ian Linane

    Ian Linane Well-Known Member

    Hi tracy

    A friend of mine did a study for her degree comparing the results of acupuncture for treating PF with acupuncture and orthoses combined in the treatment of PF. If this is what you are looking for then I can ask her if I can give you her email.

    You could try Anthony Campbell to see if any Pods who have studied with him have given him research data. Whilst I use the modality I have not done a study on it.

    Cheers
    Ian
     
  38. tracygill

    tracygill Member

    Hi Ian ,

    That was quick reply! I would be very grateful if I could have that contact email as any information will help me on the right road.
    Ta!
     
  39. Dear Ian
    Just a note to your enquiry about Trigger Points.

    I am an osteopath with a special interest in Foot Conditions.
    I have had much success with treating a variety of Foot syndromes using my Foot Mobilisation Techniques with Myofascial Trigger Point treatment.
    For instance trigger points in a muscle may be the cause of weakness in the muscle.
    I have found that Podiatrists are very interested in my courses.
    Yours
    BJ
     
  40. betafeet

    betafeet Active Member

    Hi Ian
    Paul Turner is giving a talk on ‘Musculo Skeletal Trigger Points’ at Bucks Branch Meeting of SCP at Duke of Edinburgh Hall, Stoke Mandaville Hosp Aylesbury (directions on web site www.buckspodiatry.org) on 20th June 2010 7.30 pm, SCP members welcome for joining fee of £5.00 for year, others welcome at an extra charge.

    Jude
     
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