Rob Stanborough, PT, DPT, MHSc, MTC, CMTPT, FAAOMPT
Dry needling for scars and fascia is one of the techniques taught in the Myopain Seminars DN-2 course, the Advanced DN Dissection Course, and reviewed during the DN-3 course and the Clinical Pearls & Review course. Several video examples can be found in the “scar/fascia” section of the Video/Audio page on the Myopain Seminars website. The results are quite impressive.
Our dry needling technique differs from standard trigger point dry needling. The therapist first palpates the scar tissue and the area around the scar for painful and hardened tissue, which can be referred to as densifications or tissue hardenings. Needles are placed in a few of these hardenings. Since fascia is a 3-dimensional tissue, using many needles is unnecessary. At Myopain Seminars, we maintain that fewer needles are usually preferred when treating scars. The needles are rotated, causing collagen fibers to grab hold and wrap around the needle.
I have used the analogy of how cotton candy is wrapped around the paper cone at the county fair when explaining the process to my patients. As the needles are spun, the collagen fibers are tensed, causing deformation of the extracellular matrix, which produces a “mechanical signal” to the surrounding cells, which is why this technique is a mechanical signaling approach. While the exact mechanisms are not yet known, fibroblasts, one of the most prominent cells in connective tissue, are stretched, and they start to align themselves with the pull of the collagen fibers, producing a cytoskeletal rearrangement. The clinical result is nearly always increased connective tissue mobility and decreased pain.
I recently encountered a patient status post a total hip replacement. During the first few weeks, the patient progressed as expected. Despite the “normal” post-op soreness, he was fully ambulatory, mostly without his walker, and compliant with his recovery. However, after several weeks, he noticed increased swelling of the entire left lower extremity, significant guarding of the lateral quadriceps, and hypersensitivity along the same region. He could barely touch his lateral quadriceps and was referred again to PT.
Upon evaluation, the surgical scar was drawn in considerably and was firm and tender to palpation. Four 30mm x 30 mm fascial needles were inserted into a few densifications and rotated. The hardenings happened to be on either side of the incision, which is not always the case. The needles were rotated about every 30 seconds for approximately 15 minutes, followed by soft tissue manipulation of the lateral quads, gentle hip/knee flexion/extension, and ambulation.
Prior to treatment, the patient was unable to achieve the Thomas test position due to pain at the incision site and referred pain from the scar down the lateral thigh. After three treatments, his hypersensitivity and swelling were resolved. The guarding and firmness of the lateral quad were pretty much resolved. The patient resumed normal, full weight-bearing, non-assisted ambulation. The scar was no longer firm and sunken in.
Many patients can be helped with the Myopain Seminars scar tissue needling technique. Jan Dommerholt has co-authored a paper on the treatment of a total hip replacement scar and another case report about the treatment of a scar following penile surgery. In both cases, the treating physical therapists combined the Myopain Seminars approach with another approach known as subcision needling during which many needles are placed underneath the actual scar. In our experience, the subcision approach does not improve the outcomes significantly.
