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![travell and simons heel pain patterns travell and simons heel pain patterns](https://www.researchgate.net/profile/Bernadette-Jaeger/publication/262682165/figure/fig1/AS:951297264066560@1603818350368/The-solid-red-shows-the-most-common-referred-pain-pattern-from-a-trigger-point-marked_Q320.jpg)
Historically, trigger points were treated by injection of various substances using a hypodermic needle. Any and all of these impairments may be addressed by treating the trigger points with dry needling. Trigger points may result in impairments including pain, range of motion restrictions, muscle inhibition, and changes in muscle activation patterns and motor control (8). We also know that electrical activity is increased near a trigger point, resulting in motor endplate noise (7).
![travell and simons heel pain patterns travell and simons heel pain patterns](https://eliminateheelpain.com/wp-content/uploads/2015/07/trigger-point-referral-pain-chart-300x249.jpg)
We know from in-vivo microdialysis of the area in and around the trigger point that concentrations of specific nociceptive chemicals are higher inside a myofascial trigger point, including adenosine triphosphate (ATP), bradykinin (BK), 5-hydroxy- tryptamine (5-HT, serotonin), prostaglandins, and potassium (K+) (6). This acidic environment results in a chemical cascade that will change the thresholds and permeability of specific nociceptors. This results in ischemia, decreased oxygenation to the tissue, and a lowering of pH, resulting in an acidic environment. Blood flow to the muscle fibers is restricted, causing a back-up or retrograde blood blow. With various constructs of muscle overload, an energy crisis occurs. Trigger points may develop in muscle for a variety of reasons, including, but not limited to trauma, concentric muscle overload, eccentric muscle overload, prolonged postural overload, and repetitive low-load muscle activity (5). The pain from a myofascial trigger point may remain local or may refer to a different and remote part of the body. Physical therapists are responsible for knowing the rules and laws in the state in which they practice.Ī trigger point (TrP) is a discrete and palpable nodule within a taut band of muscle that is exquisitely tender with mechanical stimulation (5). Although the APTA defines dry needling as within the scope of PT practice, regulations vary by state and PTs are not allowed to practice dry needling in all states (4). Dry needling techniques performed by physical therapists are different in both theory and practice from techniques performed by acupuncturists (1).
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Typically, dry needling is performed to target myofascial trigger points in muscle and is based on the work of Janet Travell, MD, David Simons, MD, and others (2) however, in recent years, techniques have evolved to also target tendon, fascia, and scar tissue (3).
Travell and simons heel pain patterns skin#
The American Physical Therapy Association (APTA) defines dry needling (DN) as “a skilled intervention utilized by physical therapists that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments” (1).