Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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I must admit that I am always looking for new ways or tools to enhance my practice and work as a sports physical therapist. I recently completed the necessary hours of training to perform dry needling in the state of North Carolina. I trained with Myopain Seminars and have nothing but great things to say about their courses.
For those unfamiliar with trigger point dry needling (TDN), it is a treatment gaining traction in the therapy world. Dry needling is a treatment that involves a very thin needle being pushed through the skin to stimulate a trigger point. Dry needling may release the tight muscle bands associated with trigger points and lead to decreased pain and improved function for those suffering from pain related to muscular dysfunction.
Trigger points may ultimately refer pain to other sites, and research indicates that TDN can reduce acidity in the muscle and clear out pain propagating chemicals. The picture below is an example of me performing trigger point dry needling to the upper trapezius of a 16 y/o female.
This particular client had been suffering from an inability to lift the arm above shoulder height and marked shoulder pain since September 2013. She also mentioned having headaches at school. Clinically, she was diagnosed with multi-directional instability and scapular dyskinesis by the referring MD. We began working on a scapular stabilizer and rotator cuff strengthening program in late November that was helping to diminish pain and increase function. However, she continued to c/o pain in school, stiffness and headaches.
I work with many runners in our clinic. I often see restrictions in the soleus. While the running community is warming up to soft tissue mobilization, many runners are still resistant to embrace it routinely and engage in it more so only when they are hurt or lacking flexibility.
STM (soft tissue mobilization) should be part of every runner’s maintenance program. Why? Simply put, repetitive stress takes its toll on the body. Rolling or releasing the tissue increases blood flow, eliminates trigger points, and facilitates optimal soft tissue mobility and range of motion.
In the diagram below, you can see common trigger points in the soleus. The X represents the trigger point & the red shaded area is the referred pain caused by the trigger point.
In the case of the soleus, restricted dorsiflexion could lead to other biomechanical compensations with running. Initially, this often creates a dysfunctional and non-painful (DN) pattern. Over time, this may eventually become a dysfunctional and painful (DP) pattern forcing runners to seek medical care. The terms DN and DP come from Gray Cook’s Selective Functional Movement Assessment (SFMA).
The gait cycle is certainly altered from dysfunction in this muscle. If ankle joint dorsiflexion is compromised (a common effect of soleus restrictions), there can be increased strain on the quads and altered movement in the hip. Overpronation and excessive hip adduction and internal rotation are common compensations seen with running. Other signs and pathology that may be associated with a soleus trigger point may include:
- Plantar fasciitis
- Heel pain
- Shin pain
- Knee or hip pain
- Back pain
As such, restoring mobility is important. A recent study revealed that immediate improvement in ankle motion can be attained with just a single treatment (click here for the abstract).
So how do you effectively resolve soft tissue issues in this area? I suggest using a foam roller or better yet the footballer and baller block in the Ultimate 6 Kit for Runners by Trigger Point (see pic below)
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