Athletic tape, acupuncture needles, and a TheraBand Flexbar. What do they have in common? Combining old school, ancient and new age treatments can save money and provide better patient satisfaction.
While I’d like to say I always use strong research evidence to justify my plan of care, no one can fully because existing research is either limited, poorly done, or non-existent. Each therapist then has to determine what other treatments to utilize, based on extrapolating the best evidence available.
I have a law enforcement patient referred for medial epicondylitis (tendonitis) otherwise known as “golfer’s elbow.” The best evidence out there suggests that his problem is actually not an inflammed tendon, but a degraded tendon. Rest, ice, stretching and anti-inflammatories fix anything that’s inflammed, and they haven’t worked.
What to do…I know that a simple set of strength training exercises with a piece of rubber will more than likely fix everything, but will take months. While he initially noticed some improvement, after a week or so, he didn’t notice anything. Because I tested his grip strength with a dynamometer, I know that he has improved, and was able to tell him that…without arguing with him.
His needs are different than mine, though. He needs to do punching bag training and one hand lifting for his work. While I abhor fads and trends (for their own sake) I also know from experience that 10% of a fad in physical therapy ends up becoming research-validated treatment and the rest of it was just marketing.
Dry needling of trigger points (TDN) has demonstrated limited efficacy in the research literature, with highly variable anecdotal reports from patients. While I believe (based on my review of contemporary research) most of what appears to be muscular pain should be addressed primarily by restoring normal joint mechanics, I also know that in some situations muscular tissue can be the primary source of pain. TDN can address that directly and quickly.
While I know that taping has demonstrated limited efficacy in the research literature, it does show short term benefit, based on how long the tape can hold its tension.
In this patient I opted to start a trial of TDN (I selected pronator teres and the medial head of triceps brachii based on innervation and proximity), and within a few minutes his grip strength (measured in a standardized position, the average of three trials) improved by about 15%. Tape applied near the elbow (I opted to tape flexor group ulnarlywith compression, to spread the workload of that muscle group) relieved his pain with provocative activities, as evidenced by testing and retesting the same activity immediately before and after tape application.
He felt better after that treatment, so we returned to TDN today and I issued him a roll of athletic tape with instructions to quickly provide himself some support before punching. He already has what he needs for home strength training for the next few months, and I should be able to release him in a couple of visits to work on his long term solution.