Todd Hooks, PT, ATC, OCS, SCS, MOMT, MTC, CSCS, CMTPT, NREMT-1, FAAOMPT
As a physical therapist in a PT practice heavily focused on manual therapy, including dry needling, I see patients referred with both acute and chronic conditions. Occasionally, patients have already seen other healthcare providers without sufficient results. Recently, a 40-year-old female personal trainer who ran track in college came to see me. Eleven years ago, she had a SLAP repair. Six other physical therapists offered her treatments, including shoulder strengthening, functional training, soft tissue mobilization, and dry needling. Finally, one of her neighbors, who I had treated non-operatively for a rotator cuff tear, told her “You got to go see my guy.”
When the patient presented to therapy, she was frustrated and skeptical, and she admitted that she did not want to come because of all the prior failed therapies. She complained of an inability to achieve full active shoulder elevation and not being able to perform a push-up due to weakness. She also could not perform a pull-up because she could not fully extend her arms while hanging and because of weakness in her shoulder, limiting her ability to perform a pull-up. The patient complained of posterior and lateral shoulder pain that diffusely extended into her forearm. The patient’s orthopedic surgeon diagnosed her with chronic regional pain syndrome; however, the patient did not feel she had that.
Clinical assessment of the patient demonstrated an inability to achieve full active shoulder elevation with scapular substitution noted. She demonstrated posterior cuff weakness into external rotation (manual muscle test 4/5). In addition, the patient had TrPs in the infraspinatus and teres minor musculature.
Trigger point dry needling was performed on the teres minor and infraspinatus muscles, allowing the patient to perform a full active shoulder elevation without scapular substitution during the first visit. This treatment was performed again on her second visit, and she could perform a push-up and hang from a pull-up bar with arms fully extended without pain. The patient was seen for five visits for dry needling to her teres minor and infraspinatus, soft tissue mobilization, and shoulder strengthening.
Upon discharge from physical therapy, she could do 20 push-ups and perform a pull-up. The ability or inability to properly recognize trigger points and the influence they can have on pain and functional mobility can greatly impact a patient’s treatment and outcome. Although it took the patient 11 years to find me, now she tells people “You got to go see my guy”!!!!
