Ask patient to point with one finger where the most intensive pain is.
Find the point of maximum tenderness.
Reproduction (recognition) of pain: Press over the maximum tender point
and ask: is this the pain you are complaining about?
Quantify the tenderness (degree of sensitization) by algometer.
B. Diagnosis of Sensitized Spinal Segment (SSS):
I. Dermatomal Hyperalgesia:
Paper clip scratch test (use of sensory diagnostic tracks)
Skin pinch and roll: Test sensitization of subcutaneous tissue.
Electric skin conductance: Objective quantitative testing.
Dorsal and ventral primary ramus hyperalgesia needs to be diagnosed
II. Sclerotomal Hyperalgesia:
Palpation for tenderness of supraspinous/interspinous ligaments
Palpation for tender spots (TsP) and MTrPs at attachment sites, and enthesopathies
C. Myotomal distribution of:
Trigger points/tender spots by palpation and algometry
Taut bands by palpation and tissue compliance meter which renders quantified, objective results
Muscle spasm/reduced stretch range by palpation
D. Sympathetic hyperactivity:
Increased electrical skin resistance
Orange Peel skin
3. Treatment: Concentrate on the sensitized spinal segment corresponding to the immediate cause(s) of pain (MTrPs, TsP, and muscle spasms) and the associated supraspinous/interspinous ligament nociceptive irritative focus. The injection techniques to be described desensitize the dorsal horn, eliminate the SSS and eradicate the peripheral pain generators.
INJECTIONS: for immediate and long-term relieve of pain:
PARASPINOUS BLOCK to desensitize the SSS.
PREINJECTION BLOCK to anesthetize the painful sensitive area to be infiltrated.
NEEDLING & INFILTRATION OF THE ENTIRE TAUT BAND (TB), to break up the entire underlying pathology of the TrPs/TSs.
Alternative methods to desensitize the segment
spinal manipulation of the identified segment,
needling of the identified segment,
specific and selective range of motion movement to mobilize the identified segment.
post injection physical therapy:
A. Modalities – heat or cold; electric stimulation (sinusoid surging and tetanizing currents)
B. Exercises - Relaxation exercises followed by stretching:
General (eye movement + expiration + pulling in of belly and holding for 2 seconds)
Specific for the involved myotome, in which the pain generating TrPs/TSs and MSp are located; relaxation by activation of antagonist muscle(s) (RAA). Active relaxation: elimination of gravity. Stretch only when muscle is relaxed + stretching by gravity. Dry needling, post isometric relaxation, spretch and spray, deep transerse friction,
C. Specific postural correction: Loss of cervical and/or lumbar sacral lordosis, extension and flexion deficiencies.
4. Diagnosis and removal of perpetuating and etiological factors:
PHYSICAL EXAMINATION reveals:
Mechanical overload of body parts, overuse, and cumulative trauma disorders,
Deficiency of muscle function (loss of flexibility, weakness). (Kraus)
Postural deficiencies such as loss of cervical or lumbar lordosis.(Robin McKenzie)
The Pentad of discopathy radiculopathy paraspinal spasm and supraspinous ligament sprain: Spinal segmental sensitization., that consist of segmental hyperalgesia, and TrPs/TSs and MSp in the myotome.
Endocrine disorders, particularly, low thyroid or estrogen supply to the muscles (normal blood levels are sometimes insufficient)