Hello! I am Manoj, A physiotherapist from Kurnool. I attended the Dry needling workshop of Physilife academy by Dr. Subjanjan Das sir in September 2021 Hyderabad.
In this guest blog, I want to talk about one of my patients, a 31 years old Male, who was diagnosed with bilateral avascular necrosis of the femur.
The patient underwent bilateral core decompression surgery 7 weeks ago and he started to ambulate last week. For the last four days, the patient experienced severe pain in the right lateral thigh. On examination, it was found that the pain was because of the IT band tightness.
The iliotibial tract is a major lateral stabilizer. It provides attachments to Tensor Fasciae Latae and Gluteus maximus and prevents buckling of the knee in standing. As reported by the patient, the IT band was involved prior to the surgery, presumably as the hip biomechanics was compromised. Post operatively with the weight-bearing this was manifested as pain in the lateral thigh. Post-surgery IT band tightness is not uncommon (Ref 1.) Left untreated scar tissues can build up on the undersurface of the ITB, tethering it to the underlying structures(Ref 2).
The pain was intense, with a VAS score of 7 and tenderness of grade 3. Because of this pain, the patient was demonstrating an antalgic gait. The orthopedic surgeon advised the patient to undergo Dry Needling, instead of prescribing a muscle relaxant.
I have applied electro dry needling ( ETOIMS- Electrical Twitch Obtaining Intra Muscular Stimulation) for the IT band which has documented efficacy in producing analgesia in musculoskeletal (Ref 3) and post operative (Ref 4) conditions. After one session the tightness was reduced significantly, the pain score came down to 5 and the tenderness came down to 1. After the second session, the patient’s gait also became normal. At the same time, the pain got completely resolved and the patient had no further complaints over the IT band.
This patient is an emergency physician by profession. He was highly impressed with the needling technique as he had great relief. He continues his rehab and is recovering steadily.
I thank Dr. Subhanjan Das sir and Physilife for helping me in incorporating these advanced techniques into my practice.
Dr. ANDELA MANOJ KUMAR, PT
+91 7207250304
Consultant Physiotherapist
Medicover Hosptial, Kurnool, AP
References:
1. Takagi K, Inui H, Taketomi S, Yamagami R, Kono K, Nakazato K, Kawaguchi K, Kage T, Tanaka S. Iliotibial band friction syndrome after knee arthroplasty. Knee. 2020 Jan;27(1):263-273.
2. Papavasiliou A. V. and Bardakos N. V. Complications of arthroscopic surgery of the hip. Bone & Joint Research 2012 1:7, 131-144
3. Chu J, Yuen KF, Wang BH, Chan RC, Schwartz I, Neuhauser D. Electrical twitch-obtaining intramuscular stimulation in lower back pain: a pilot study. Am J Phys Med Rehabil. 2004 Feb;83(2):104-11. doi: 10.1097/01.PHM.0000107485.86594.8B. PMID: 14758296.
3. Hyung Sun Kim, Jinyoung Park, Joon Seong Park, Jung Hyun Park, Sang Hoon Shin, Jae Eun Park, Sang Won Hwang, Do Young Kim,
A new treatment modality for the postoperative muscular pain management in pylorus preserving pancreaticoduodenectomy: a double-blind randomized control trial, HPB, Volume 21, Supplement 2,2019,Pages S350-S351
Great job good diagnosis
So great to hear this .. Should thank subhanjan sir for giving guide on dry needling .