Yellow flag- belief that pain and activity are harmful. Pain IS NORMAL. If pt.

is in bed he will do more

harm to himself, no danger in activity.

Contraindication:

If not myofascial pain- don’t needle. If no improvement after 2nd treatment- don’t continue.

The stronger the better with needle insertion

Post needling massage- helps the patient, they want contact.

Gastrocnemius- passes the knee (2 joints)

Unlike soleus- doesn’t pass the knee

Newer PPTs – to ask

Calf stretch at night- doesifelxion with pillow

Physical exam gastrocnemius + sloleus ( missing in old ppt)

Dorban.co.il – exercises for plantar fasciitis

Rectus Femoris passes 2 joints (compared to 1 of rest of quads)- therefore 2 movements (hip felx and
knee extention)

MAIN SYMPTOM- KNEE PAIN DULL ACHE INSIDE KNEE

Vastus medialis might have twitch with no pain

Go over antagonist muscles- biceps/triceps..

2nd day

-TrPs on the ppts are X’s and the red dots are referred pain

-hasmsting standing up Sx is not clinically relevant- remove from card

-piriformis- catching oneself fall – ‫ – כמעט נפילה ועוצר תצמו‬activation of TrP

- piriformis physical exam passive hup internal rotation- ‫ ב‬30 ‫השריר השמאלי מקוצר ומוגבל‬PPT

- piriformis dry needling is on lateral and medial side NOT IN CENTER – SCIATIC NERVE (can see on
ppt)

- pes anserinus bursitis (common cause of knee pain)

- gluteus minimus + med – physical find the trochanter hands towards ASIS, knuckle=minimus

Hand out= includes medius

Multifidi- patients point to an area they have a “tumor”

-NEVER NEEDLE DIRECTLY DOWNWARDS (perpendicular to the skin)

-in post operation in the area -> send to a professional

ALL Muscles- enter perpendicular to skin and then change angle accordingly.

This way the skin is penetrated properly

Multifi + Erector Spinae -> aim towards lamina of the spine

Multifidi dry needling – place fingers on spinal process and move laterally- then needle lateral to
finger.

Erector Spinae dry needling- ask the patient on prone position to raise back- erector spinae will be
seen (large, can place 4 fingers). Needle at 45 degrees caudally and 45 degrees medially

Top talent physiotherapist tip-

1. Find a taut band by lightly stroking the skin. If you try hard its actually harder to find.
2. Touch the patient, it makes them feel comfortable and safe.

Watch the videos on the drive