Author: Ciara Shields

What is dry needling?
Dry needling is a technique which involves the insertion of a single use, sterile, acupuncture needle into a myofascial (muscular) trigger point. A trigger point is a tight band within a muscle which can cause and contribute to pain within the body. Research has shown that biochemical changes occur in these trigger points and that the insertion of the needle reverses these biochemical changes, which results in reduced pain.

Which conditions can be treated with dry needling?
Dry needling can be beneficial in the treatment of several musculoskeletal problems. Below is a list of conditions that can be treated using dry needling:
• Back and neck pain
• Cervicogenic headache
• Shoulder impingement or rotator cuff injuries
• Pelvic pain
• Buttock and leg pain (including sciatica)
• Muscle strains (e.g. hamstring strain)
• Knee pain
• Calf tightness/cramps
• Achilles tendon pain

What is the difference between dry needling and acupuncture?
Dry needling and acupuncture use the same type of needles, however, different techniques are utilised. Acupuncture is a form of alternative medicine and a key component of traditional Chinese medicine involving thin needles inserted into the body at acupuncture points. Dry needling is based upon Western medicine principles and involves the insertion of thin needles into trigger points. These trigger points are different to traditional acupuncture points.

How does dry needling work?
Research studies have shown that inserting needles into trigger points causes biochemical changes which alleviate pain. For dry needling to be successful it is essential that a local “twitch” response is elicited when the needle is inserted into the myofascial trigger point.

Is it painful?
Upon insertion of the needle into the skin you may feel a small pin prick. Once the local twitch response is elicited the patient may experience a brief painful reaction. Patients often describe this painful reaction as a cramping sensation. It is important to remember that a local twitch response is necessary for a therapeutic effect to occur and therefore it is a desirable reaction.

Are there any side effects?
After dry needling it is common to experience some post treatment soreness. This soreness can last from 30 minutes to 2 days. Once this pain has subsided the patient should experience an improvement in their initial symptoms.

Are the needles sterile?
Yes. We only use sterile, single use, disposable needles.

Are there any reasons why I should not have dry-needling?
The following people should not have dry needling:
• People who are on blood thinning medication
• Those who have a history of epilepsy
• Women who are in their first trimester of pregnancy

What can I do after treatment?
Your physiotherapist will advise you to use heat after treatment to help reduce any post treatment soreness. Dry needling will be combined with other treatment techniques such as manual therapy and your physiotherapist will advise you on the best exercises to perform in conjunction with your treatment.

Have all physiotherapists undergone dry needling training?
Dry needling is currently not part of the physiotherapy undergraduate degree. It is a post graduate qualification. Here at IONA Physiotherapy, Aileen has undertaken several dry needling courses. If you would like to book an appointment with Aileen please phone (01) 7979545.

Rory McIlroy recently sustained a lateral (outer aspect of ankle) sprain while playing soccer with friends. Unfortunately for Rory, this will keep him out of this year’s British Open Championship. According to media reports, he sustained a ruptured ATFL and a tear of his joint capsule. So, how does such an injury occur, what is an “ATFL” , how is it diagnosed and what would physiotherapy rehabilitation typically involve? Read on…….

Mechanism of Injury
Lateral ankle sprains commonly occur in sports such as football, hurling, soccer, basketball, tennis and gymnastics. These injuries can occur when the athlete is twisting or lands awkwardly. The typical mechanism of injury is where the ankle is rolled so that the sole of the foot points inwards. In this position the ligaments on the outside of the ankle becomed stretched. Depending on the force of the injury, different ligaments can get over stretched and result in a ligament sprain/tear. Different grades of ligament sprain exist and range from a grade 1 to a grade 3. A grade 1 injury is a mild ligament tear, a grade 2 is a moderate ligament tear, and a grade 3 is a severe (ruptured) ligament tear.

Anatomy
“ATFL” stands for anterior talofibular ligament. This ligament runs from a bone in the outer aspect of the lower leg called the “fibula” to a bone in the foot known as the “talus” and offers stability to the ankle joint. The joint capsule is a leathery type substance that offers further stability to the ankle joint. According to twitter reports, it is these two structures that Rory has injured – a complete rupture of his ATFL (grade 3) and a tear of his joint capsule.

Diagnosis
In the event of an ankle injury a chartered physiotherapist will complete a thorough assessment to determine the extent of the injury and which structures are involved. Gait, ability to weightbear, range of motion, swelling, bruising, propriocetion, and tenderness on palpation will form part of the assessment. In severe lateral ankle sprains the patient may also have suffered a fracture. If the Physiotherapist suspects a fracture an x-ray will be advised. Most lateral ankle sprains do not require an MRI scan. In severe lateral ankle sprains an MRI scan may be requested to determine the extent of the injury. If after 4-6 weeks progress is slower than expected, then an MRI scan may be requested to determine associated injuries.

Rehabilitation (this is a general overview and not prescriptive, optimum management is based on individual assessment.)
Stage 1 (0 – 72 hours) – The main aim of stage 1 is to reduce inflammation and pain. This is achieved by:
• RICE – rest, ice, compression, and elevation
• Anti-inflammatories – gel or tablets
• Crutches – if the patient is unable to weight bear with a good gait pattern
• Camboot – in severe cases to immobilise the ankle and reduce inflammation

Stage 2 (72 hours – 2 weeks) – The main aim of stage 2 is to regain range of motion and achieve a normal gait pattern
• Massage to reduce muscle tightness
• Manual therapy to reduce joint stiffness
• Exercises to improve range of motion and proprioception
• Increase weight bearing on the injured leg

Stage 3 (2 – 6 weeks) – The aim of this stage is to regain proprioception and strength
• Strengthening exercises
• Progression of exercises to improve proprioception
• Gradual return to activity

Stage 4 – The main aim of this stage is to return to sport and prevent recurrence in the future
• Sport specific exercises to regain full strength, proprioception, and coordination
• Running program
• Agility program

What is TPI?
Titleist Performance Institute (TPI) is the world’s leading educational organization dedicated to the study of how the human body functions in relation to the golf swing. TPI was founded in 2003 and over the last 12 years it has studied thousands of golfers of all abilities. From these studies, TPI has collected an enormous amount of data on golfers such as size, shape, age, and fitness level. From this data, TPI has learned how a correctly functioning body can allow a player to swing a golf club in the most efficient way possible.

TPI has also examined how physical limitations in a player’s body can adversely affect the golf swing and potentially lead to injury. The group at TPI do not believe that there is only one correct way to swing a club, rather they believe in an infinite number of swing styles. However, they do believe that there is one efficient way for every player to swing and this depends on the physical capabilities of the player.

What is TPI screening?
Physical capabilities will differ for each golfer and therefore the most efficient swing is not the same for every golfer. To determine physical capabilities, a golfer must first be screened. This screen will begin with a client history and a discussion about current health. Then the golfer’s swing will be recorded using a high speed camera. Following this, the player will be assessed on 12 tests which focus on movement quality, physical fitness, and strength. Once the screen is completed, the results are used to develop a plan for this player. This plan may include fitness training, physiotherapy treatment, and coaching of swing mechanics and biomechanics.

Golfers whose game is limited by pain
Players who present with pain will undergo physiotherapy assessment and treatment. Once the pain has resolved the player will then undergo TPI screening. This screening will help in the development of an exercise plan for the player which will make their swing more efficient, improve their game, and reduce golf-related injuries.

Golfers who wish to improve their game
Players who wish to improve their game will undergo TPI screening. From this screening an exercise program will be developed. This exercise program will help the player develop a correctly functioning body which will lead to a more efficient swing and lower scores. Hands-on treatment may or may not be appropriate depending on the findings of the screen. Hands-on treatment can be very effective at increasing shoulder turn, spinal mobility, and hip mobility.

Do I have to be a Professional Golfer?
No. Golfers of all abilities will benefit from TPI screening. Everyone from professionals to weekend golfers can develop a more efficient swing and lower their scores.

Where does the screening take place?
The screening will take place within IONA Physiotherapy, Cian House, 1 Cian Pk, Drumcondra, Dublin 9.

A common question that we are often asked in clinic is whether ice or heat is apppropriate to use on an injury and if so, which. In this blog we will outline the rational behind choosing ice or heat and give some common clinical examples.

When ice is placed on an area it causes constriction or narrowing of blood vessels. This in turn, leads to a reduction in swelling and inflammation because a constricted blood vessel allows less leaking of fluid and inflammatory chemicals through the wall of the blood vessel into the surrounding tissues. In an acute injury (e.g. ankle sprain/ ligament injury to knee), where there is a risk of swelling, the injured part will benefit from ice. You can use a packet of frozen peas wrapped in a damp tea towel or an ice pack for ten minutes at a time. Ten minutes is sufficient to allow the tissues to reduce in temperature and the blood vessels to constrict. Be careful with ice, too long can cause frostbite!

Heat has the opposite effect to ice. Heat causes blood vessels to dilate or get larger, allowing more blood flow into the area and even more importantly, muscle relaxation. Heat is useful for more chronic conditions that are due to overuse, such as a muscular ache around the top of the back and shoulders from prolonged sitting at a computer in a poor position. In fact heat is often helpful for back pain, particularly when there is muscle spasm present. When muscle spasm is present as a symptom of back pain, the continuous contraction of the muscle in spasm starts to generate pain in its own right. Reducing that spasm (e.g with heat) can help with the pain. You could use a towel or facecloth soaked in warm water or a hot water bottle/ hot pack (warm, not hot.) Never put heat on an acute injury (such as an ankle sprain) as it will make the swelling worse. Think of what happens to your feet on a warm day- they swell and are more difficulty to get into your shoes.

Applying ice or heat is a first aid measure and a step towards recovery. However it is important to receive appropriate advice and treatment for your injury in order that you make a full recovery. Contact IONA Physiotherapy if you have had an injury, we would be delighted to help.

There is overwhelming evidence that exercise has very wide-ranging health benefits, and many health professionals argue that the absence of regular exercise is the biggest public health issue of our time. Most of us recognise that smoking, diabetes and obesity are bad for our health. “Smokadiabesity” is a slightly humorous word sandwich term that has been coined to describe the serious situation when all three factors coexist in an individual, and few would argue that the prognosis for such a diagnosis appears grim. What may surprise many is that when a large population was studied in the Aerobics Centre Longitudinal Study (very large study based in Dallas, Texas- where patients have been followed since 1970), it was found that individuals were at greater risk of premature death due to lack of regular physical activity than “smokadiabesity.” This has profound implications for us all. It is obviously important that traditional parameters such as weight, blood pressure, cholesterol etc. are measured, but it is just (if not more) important that we measure how much physical activity we take, and make improvements if we are below par! The minimum recommended is 30 minutes of walking 5/week, according to Professor Steven Blair, University of South Carolina, who is considered a leading expert in the field of exercise and health.

At IONA Physiotherapy, we are passionate about the importance of exercise in maintaining health. We can help if you need an injury treated so that you can get back to your activity/sport, or if you need advice on just getting started! Whichever end of the spectrum your fitness lies, remember that exercise is definitely good for you, exercise is medicine.

Injury can occur when a high load is applied a small number of times (e.g. fall off the top of a ladder) or a small load is applied numerous times (e.g. long distance running.) It is the latter that can lead to overuse injuries. Individual tolerance levels vary, meaning that some people can develop an overuse injury at smaller loads and less repetition than others.

The type of training you are doing is also hugely important. Certain activities involve loads that are variable in terms of direction of the load (e.g. tennis players continually change direction depending on where on the court the ball is in play.) Conversely runners tend to run in the same direction, repeating the same motion again and again, loading the same tissues with each step.

One factor that will influence your ability to tolerate your training regime and avoid an overuse injury is flexibility and this naturally reduces with age. You may have got away without paying enough attention to stretching when you were younger but you are unlikely to always get away with this! For example, one factor that can predispose runners to developing plantar fasciitis is inadequate flexibility of their calf muscles. Other factors which influence your tolerance include your biomechanics, muscles strength, training regime, training environment etc. Patellofemoral Pain Syndrome (Runner’s knee) is a good example of this- as pain may occur due to a problem with the biomechanics of the foot, inadequate muscle strength (core, gluts and quads muscles), increasing the level of training too quickly or training on the wrong type of surface (e.g. running on a slope with one foot up and one foot down the slope.)

It is important if you develop an overuse injury that you observe “relative rest.” In other words, that you reduce the load on the injured tissue to a painfree level- through modification of your training regime and/or improving your biomechanics (tape/orthotics/specific exercises etc.) Don’t take complete rest and a wait and see approach! Such an approach does not address the underlying problem and just leads to loss of strength and fitness. At IONA Physiotherapy we can diagnose what the injury is, why it occurred and implement an effective treatment plan. Contact us at 01 7979545 for further details.