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Keywords

Clinical Practice in Athletic Training

Abstract

Introduction: Parkinson’s Disease (PD) is a common neurodegenerative disorder that affects a person’s ability to produce dopamine and control motion of the body. PD affects 1% of people over the age of 65, but the disease can occur earlier and later in life. The uncontrollable movement of any body part involved with PD is referred to as a tremor. Pathophysiology of PD causes the thalamus to have a decreased activation of the frontal cortex, thus decreased motor activity. Patients commonly have dystonia mostly in the foot resulting in striatal toe. Optional pain relief is a tenotomy of the extensor hallicus longus (EHL). Patient Information: A 60-year-old active female educator, with a diagnosis of Parkinson’s disease at age 40, presented with hyperextension of the left great toe following a Botulinum Toxin (Botox) injection treatment for muscular spasticity in the left calf that was also causing a foot slap during ambulation. Botox injections were administered over three times for musculoskeletal spasticity (included the left calf) and for the bladder. Following the Botox injection to the left calf, the patient reported of a building discomfort of the EHL and a more notable drop foot when walking. A tenotomy was a medical option the patient did not want. Clinical measurements of her toe at the first metatarsophalangeal joint on the first day follows: at rest 15° in extension; Flexion AROM 10°, PROM 30°; Extension 15°, PROM 30°; pain scale 5:10. Interventions: Previous treatments tried with minimal effect included prescriptive medications, acupuncture, therapeutic massage, medicinal marijuana, and meditation techniques. Meditation is the only continued treatment. No gold standard exists for the treatment and management of PD. However, where the common route is to administer Botox, it resulted in causing the striatal toe. Due to the symptoms of the striatal toe and the known effects of dry needling, it was decided to begin this treatment plan. Three trigger / tender points were identified along the distal portion of the EHL and one was placed in the extensor digiti brevis (EDB) section of the first toe. Using a 0.16 x 25MM Blue Tip filiform needle, needles were inserted at the trigger / tender point sites until resistance was reached and then were wound to full resistance to mechanotransduce the tissue. Treatment lasted 10 minutes for each session. Both the EHL and EDB sites created trigger point twitching with each treatment. Following the dry needling treatment, measurements were taken. Marginal changes in measurement occurred post-treatment. Greater measurement changes occurred between treatments. The patient was provided an at-home rehabilitation program. Outcomes: After receiving five treatments that were intermittently administered over a threemonth period, the patient reported decreased pain, a “quiter” gait, a more relaxed toe at rest, and a decreased pain score. The last measurement taken follows: At rest 4° in extension; Flexion AROM 15°, PROM 30°; Extension 19°, PROM 35°; pain scale 3:10. Clinical Bottom Line: Dry needling has been shown to alter the “pain matrix.” Marked improvements of decreased dystonia of the EHL and EBD can be obtained using dry needling.

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