Originally posted on August 25, 2011

If you’ve ridden a bike long enough, you’ve heard of road rash – that superficial abrasion of the epidermal layer of skin. It can be quite painful because nerve endings in the dermal layer are exposed when the upper layer of skin comes off.

How do you treat road rash? Wound care practices used to be to clean it with hydrogen peroxide and let it scab. Ouch! Besides being painful, it’s inefficient. The new skin has to tunnel underneath the scab, so the wound can only heal from the edges in.

The newer, preferred technique of wound care is to keep the wound moist and covered. Not only are the nerve cells covered, but also the scab can’t crack or stick to sheets or clothes and require healing to start all over again.

Keeping a wound moist decreases healing time by half. Faster healing occurs because the skin can migrate inward more easily and little islands of skin grow from the inside of the wound out, creating an efficient environment for healing.

Just clean the wound gently with plain water or saline and soap to remove all debris and cover the wound. For the first couple of days the wound tends to leak fluid and will require daily dressing changes. When a dressing is removed, gently cleanse the area with body temperature warm water, let it dry and re-dress. Usually after day 2, the dressing can stay in place for 3 to 7 days, or until the wound is healed.

The best dressing is one that does not stick to the abraded surface. For the first few days, use impregnated gauze or a telfa style dressing (nonstick gauze) held in place with a gauze roll or a stretchy gauze tube. Once the abrasion is less leaky, place a semi permeable dressing (such as Tegaderm) on the wound. The dressing should cover 1-2 inches beyond the margins of the injury. A semi permeable dressing is perfect because it is permeable to water vapor and oxygen but impermeable to water and bacteria. It also covers the exposed nerve endings, minimizing pain. This dressing should be changed only if it is no longer adhering or leaks fluid.

If money is not an issue, use a hydrocolloid dressing, such as Duoderm right away. This type of dressing is more absorptive and forms a gel like mass that keeps fluid in place. Hydrocolloid dressings also provide a thermal barrier that keeps wounds warm. Because warmth facilitates good blood flow, a warm wound heals more quickly. Every time a dressing is removed, exposure to cooler air delays healing.

Once the wound has a new pink layer of skin, it can be dressing free. New skin is fragile, so avoid sun exposure and excessive friction. Loose clothing is ideal, but if the area is exposed to sun, use very protective sunscreen, ideally containing zinc oxide.

Please call Margell Abel, MPT, ALTA’s own Wound Care Specialist, with further questions 303-444-8707 Ext. 110 or contact us at our email address, info@altatherapies.com.

Originally published on June 28, 2011

A Brief History Of TDN

In the early 1940′s, Janet Travell, M.D. began treating myofascial trigger points (MTrP) by injecting them with analgesic medication.  The medication would then help decrease the sensitivity of the trigger point and ultimately eliminate the individual’s pain.  After further research, it was discovered that not only did the medication help provide pain relief but the mechanical stimulation of the MTrP by a needle provided immediate pain relief as well.  With the help from Dr. David Simons, Janet Travell, M.D. further developed the method of diagnosing and treating MTrP and the use of trigger point dry needling (TDN).

Since Dr. Travell’s work, several other conceptual models have been developed to further advance this treatment technique. One technique was developed by, Dr. Chan Gunn. Dr. Gunn’s model, named the “radiculopathy model”  establishes the idea that  myofascial pain syndromes or painful conditions affecting ones musculoskeletal system results from peripheral neuropathy or  radiculopathy. This occurs because the impulses traveling down the nerves are being altered due to malfunctions at it’s respective spinal levels, which then presents itself as painful or tender muscles. Dr. Gunn determined that treating the muscles  themselves as well as the muscles around their  spinal level, helped decrease pain and sensitivity. He named his treatment technique “Intramuscular Stimulation” to differentiate his philosophies from trigger point dry needling.  Today, TDN and intramuscular stimulation are used synonymously because of the similarities and history behind each technique.

What Is A Myofascial Trigger Point?

It is a hyper irritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia. The spot is painful on compression and can give rise to characteristic referred pain, tenderness and autonomic phenomena (Travell and Simons, 1992). In other words, trigger points are those areas or knots in the   muscle that can be very tender or painful when pressed or squeezed.

What Is Trigger Point Dry Needling?

Trigger point dry needling or TDN is a technique that uses small solid filament needles (acupuncture needles) to release tight muscles and/or deactivate trigger points.  This loosening or deactivation will help desensitize supersensitive structures and restore normal motion and function to the muscle.

When the needle is inserted into the muscle and through the trigger point, the muscle may involuntarily contract or twitch causing a local twitch response.  This local twitch response is the desired response to the treatment but if one does not occur, benefits can still be seen and felt.  Typically, the patient and therapist may notice a release or loosening of the muscle following a twitch response.

TDN causes a mechanical and biochemical change within the tissue, which is key to removing muscle irritation and improving healing.  This is due to a local inflammatory response, and decreasing the spontaneous electrical activity that is responsible for the development of trigger points.

It is important to understand that NO medication or fluid is injected or inserted into the skin by the needles. That is why this technique is referred to as dry needling.

Is This Treatment Considered Acupuncture?

No. The only similarities between acupuncture and TDN is the use of acupuncture needles.  Traditionally, acupuncture is a superficial treatment that focuses on restoring and improving the flow of energy throughout the body. On the other hand, TDN is directly targeting trigger points or tight muscles, which are a part of the body’s neuromuscular system.

What To Expect From TDN

• Deep aching, cramping or pressure sensation when the needle is inserted
• You may experience a reproduction of your pain or referral of symptoms into distant body parts
• There may or may not be soreness following treatment. Soreness typically lasts 24-48 hours
• It may feel as if you just completed an intense workout of the treated muscles
• Sweating, chills, laughing, nausea, and emotional sensations are commonly seen during treatment

What To Do Following Treatment

• Drink large quantities of water that day
• Use heat rather than Ice
• Stretch of do mind exercise
• If a pain reliever is needed, use Tylenol rather than NSAID’s so that the healing response is not inhibited
• Massage the needled areas
• Take a hot bath or a hot tub to minimize post-treatment soreness

Who Can Perform TDN

TDN is being performed within the United States, Europe, New Zealand, and Australia by physical therapists, physicians, chiropractors and acupuncturists.

Currently, there are 18 states that include TDN within their physical therapy practice acts.

Here at Alta Physical Therapy, Charlie Merrill, MSPT has been trained and certified in the dry needling technique. Charlie has over 5 years of experience and have treated conditions that include acute sprains and strains, tendonitis, as well as back, neck, shoulder, elbow, hip and leg pain.

If you would like further information on Trigger Point Dry Needling please feel free to visit Alta Physical Therapy at www.altatherapies.com. You can access the triggerpoint dry needling information directly at

http://www.altatherapies.com/service/2/Trigger-Point-Dry-Needling-TDN/

or ask Charlie if TDN would work for you.

What Is It?
Shin Splints is pain caused by an injury to the anterior or posterior tibialis muscle where it attaches to the shinbone (tibia). Pain is generally felt along the front or inside edge of the tibia and is common in athletes who run and jump.  Repetitive motions such as running and jumping can cause the anterior or posterior tibialis muscles to pull away from the tibia, resulting in inflammation and discomfort.  Problems that mimic shin splints are compartment syndrome (CS) and stress fractures, which tend to significantly worsen as you run forcing you to stop.  Shin splints are not typically so severe in intensity.

What Causes It?
Shin splints usually result from overuse.  Repeated and excessive dorsiflexion movements of the foot (foot pulled up to the shin) can cause damage and tearing where the anterior tibialis muscle attaches to the tibia.  Excessive pronation will also strain the tibialis muscles as they try to stop your arch from collapsing.  Shin splints commonly occur after sudden changes in training.  Increasing running speed, distance and running on hard or angled surfaces can also contribute.  Shin splints can also occur from running in racing flats or in worn shoes.  Following is a list of predisposing factors:

• Taking up new activities such as jogging, sprinting or sports with quick stops and starts

• Imbalances in foot alignment such as excessive pronation

• Running downhill, especially fast while trying to decelerate by heel striking

• Muscle imbalances in the leg and foot

• Tight calf muscles or lower leg muscles with too many trigger points

• Excessive heel striking with each step

• Running too many days in a row without proper recovery

• Poor running form such as over-striding or improper leg alignment

• Sciatic or tibial nerve tension, which may stem from your low back

How Can I Fix It?
Most cases of shin splints respond to rest and activity modification.  Restoring proper mechanics, muscle balance, and strength to the leg and foot are the keys to long-term recovery.  Determining and eliminating the causes are important first steps.

• Decrease running mileage, hills, and intensity to below your pain threshold

• Decrease heel striking by shortening your stride and relaxing your feet

• Substitute cycling, swimming, elliptical, etc. if you can do them pain free

• Use ice packs or a frozen ice cup to massage the shin (if acute), and heat (if chronic)

• Stretch your calves to decrease stress on the shin muscles

• Strengthen your lower leg/foot muscles to decrease pronation

• Replace your shoes if they are worn out (more than 500 miles or 6 months old)

• Trigger point dry needling to your shin and calf muscles to release tension

• The Physical Therapists (PT) at ALTA can evaluate your injury, nerve tension and running mechanics.

• Deep tissue massage to the lower leg muscles using a foam roll or rolling pin

Originally posted on Jun 24, 2010

What Is It?
A common area for runners to develop bursitis is on the side of the hip. A large tendon (the IT Band) passes over the boney prominence of the hip bone.  The bursa normally protects the bone from the friction of the tendon gliding over it during the normal running stride.  Hip Bursitis results when the friction becomes too great and the bursa starts to take on fluid.  The swelling (the itis part of bursitis) is normally accompanied by pain that you can touch right over the top and back of the bony part of your hip.

What Causes It?
The bursa can become inflamed because of friction from over use which is aggravated by muscular imbalance, tightness around the hip, or misalignment in your back or legs.  A direct trauma to the bursa can also result from a fall or even from sleeping in a funny position.  Following is a list of predisposing factors:

• Weak gluteals and hip rotators resulting in faulty leg alignment

• Poor Core Strength results in inefficiency in your running stride

• Referred pain from the low back and/or sciatic nerve

• Excessive foot pronation changes the alignment of the leg during running

• Repetitively running on the same side of an uneven/cambered road

• Trigger Points in low back and hip muscles can affect their performance

• Sitting with legs crossed – you likely do it more than you realize

• Crossing over with each stride or excessively wide hips and pelvis

• Inflexibility in the hips, hamstrings, gluteals and IT Band

• Asymmetry/Dysfunction in your spine/pelvis or stiffness in your hip joint

How Can I Fix It?
Hip Bursitis can occur from a combination of factors. A proper diagnosis and training approach is the key to resolving the pain.  This will allow you to treat the cause of the problem rather than just the symptoms.

• Strengthening hip muscles to correct pelvic and leg alignment

• Improving Core Strength to improve running efficiency

• Addressing Foot mechanics with the proper shoes or orthotics

• Consider a physical therapy evaluation for spine and pelvis dysfunction

• Have your running biomechanics and footwear evaluated using video

• Appropriate stretching of your hips, hamstrings, gluteals and IT band

• Trigger point dry needling to your hip muscles to release tension

• Modify your training routine – consider frequency, duration, and terrain

• Direct anti-inflammatory medications early (Iontophoresis, Ice) and heat later

• Sleep with a pillow between your legs if you sleep on your side

• Use a foam roll to massage your IT Band, quads, hamstrings, and gluteals

• Make an effort to completely stop crossing your legs

Originally published on Jun 24, 2010

What Is It?
The patella, or kneecap, can be a source of knee pain when it fails to function properly. Alignment issues and overload of the patellar joint can lead to wear and tear of the cartilage on the back side of the bone.  Chondromalacia patella is a common knee problem that results from poor alignment and movement (tracking) of the patella relative to its groove on the femur.  Runners with kneecap problems often have cartilage that has been worn, while runners with the more common patello-femoral pain syndrome (PFPS) are in the earlier stages of the condition.  Both conditions have numerous possible causes and are very treatable.

What Causes It?
Excessive wear and tear can occur because of the high compression forces on the joint. The cartilage, or slippery surface on the underside of the kneecap, can wear unevenly, roughen, and eventually degenerate in athletes whose kneecaps track poorly.  Runners, Soccer players, snowboarders, cyclists, tennis players, and ballet dancers are affected most often.

Following is a list of predisposing factors:

• Weak quadriceps (usually the inner one), or tight quadriceps (usually the outer one)

• Poor strength in the gluteal muscles resulting in poor knee alignment

• Poor biomechanics with running

• Running too many days in a row without proper recovery

• Sports that involve a lot of cutting

• Excessive Supination or Pronation,

• Worn shoes that result in poor cushioning or instability

• Tightness especially in the IT Bands, hamstrings, quadriceps and gluteals

• Trigger points in the IT Bands, hamstrings, quadriceps and gluteals

How Can I Fix It?
Chondromalcia Patella responds best when treated early! Restoring the proper muscular balance, strength and flexibility to the knee are the keys to long-term recovery.  However activity modification is an important first step.

• Decrease running mileage, hills, and intensity to below your pain threshold

• Substitute cycling, swimming, elliptical, etc. if you can do them pain free

• Improve patellar tracking. Use of McConnell or Kinesiotape can be helpful

• A PT can help you with taping and kneecap alignment

• Correct the imbalance of the quadriceps musculature

• Stretch  and use a foam roll on the IT Bands, hamstrings, quadriceps and gluteals

• Strengthen your gluteals and core musculature

• Replace your worn shoes with an appropriate pair for your foot structure

• Trigger point dry needling to your quadriceps and the tendon