Spinal Cord Mechanism Involving the Remote Effects of Dry Needling on the Irritability of Myofascial Trigger Spots in Rabbit Skeletal Muscle Yueh-Ling.

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Spinal Cord Mechanism Involving the Remote Effects of Dry Needling on the Irritability of Myofascial Trigger Spots in Rabbit Skeletal Muscle Yueh-Ling Hsieh, PT, PhD, Li-Wei Chou, MD, MSc, Yie-San Joe, MD, Chang-Zern Hong, MD Archives of Physical Medicine and Rehabilitation Volume 92, Issue 7, Pages 1098-1105 (July 2011) DOI: 10.1016/j.apmr.2010.11.018 Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 Study flow diagram. Contra, contralateral; GAS, gastrocnemius; Ipsi, ipsilateral. Archives of Physical Medicine and Rehabilitation 2011 92, 1098-1105DOI: (10.1016/j.apmr.2010.11.018) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 2 Sites of EPN recording, dry needling for all animals, and area receiving surgical transection for animals in groups II, III, and IV. Archives of Physical Medicine and Rehabilitation 2011 92, 1098-1105DOI: (10.1016/j.apmr.2010.11.018) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 3 A series of changes in the EPN amplitude measured at MTrS of BF before, during, and after dry needling manipulation at gastrocnemius (GAS) in group I. (A) Time course of EPN amplitude. (B) Sample recordings of EPN responses in 2 rabbits of group I. †P<.05; showed significant differences among the 4 subgroups. *P<.05; showed the significant differences compared with the values at preneedling level in subgroups with dry needling at ipsilateral and contralateral GAS. Archives of Physical Medicine and Rehabilitation 2011 92, 1098-1105DOI: (10.1016/j.apmr.2010.11.018) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 4 A series of changes in the EPN amplitude measured at MTrS of BF before and after tibial nerve transection surgery and before, during and after dry needling manipulation at gastrocnemius (GAS) in group II. (A) Time course of EPN amplitude. (B) Sample recordings of EPN responses in 2 rabbits from group II. †P<.05; showed significant differences among the 4 subgroups. *P<.05; showed the significant differences compared with the values at preneedling level in subgroups with dry needling at ipsilateral and contralateral GAS. Archives of Physical Medicine and Rehabilitation 2011 92, 1098-1105DOI: (10.1016/j.apmr.2010.11.018) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 5 A series of changes in the EPN amplitude measured at MTrS of BF before and 30 to 120 minutes after lumbar transection surgery as well as before, during, and after dry needling manipulation at gastrocnemius (GAS) in group III. (A) Time course of EPN amplitude. (B) Sample recordings of EPN responses in 2 rabbits from group III. #P<.05; showed significant differences compared with the values at pretransected levels. Archives of Physical Medicine and Rehabilitation 2011 92, 1098-1105DOI: (10.1016/j.apmr.2010.11.018) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 6 A series of changes in the EPN amplitude measured at MTrS of BF before and 30 to 120 minutes after thoracic transection surgery as well as before, during, and after dry needling manipulation at gastrocnemius (GAS) in group IV. (A) Time course of EPN amplitude. (B) Sample recordings of EPN responses in 2 rabbits from group IV. †P<.05; showed significant differences among the 4 subgroups. *P<.05; showed significant differences compared with the values at preneedling level in subgroups with dry needling at ipsilateral and contralateral GAS. #P<.05; showed significant differences when compared with the values at pretransected levels. Archives of Physical Medicine and Rehabilitation 2011 92, 1098-1105DOI: (10.1016/j.apmr.2010.11.018) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 7 Schematic drawing of the proposed neural mechanisms for remote effect on proximal MTrS in response to dry needling at distal MTrS. (1) Strong irritation to nociceptors in the MTrS by dry needling at gastrocnemius. (2) Afferent input from gastrocnemius to dorsal horn (L6-S2 sensory neuron) probably in the MTrS circuit. (3) Ascending projection to upper (L5-6) sensory neurons probably in another MTrS circuit (in dorsal horn). (4) Impulse via interneuron to L5-6 motoneuron (anterior horn) corresponding to BF. (5) Increase in efferent output to neuromuscular junction in the BF. (6) Increase in EPN amplitude. (7) Strongly activated motoneuron also activates inhibitory interneuron to increase recurrent inhibition on firing rate. (8) Suppression of efferent output from motoneuron. (9) Depression of EPN amplitude. (10) The excitability of inhibitory interneuron can also be influenced by descending inputs, thereby altering the overall excitability of the motoneuron pool and efferent as well as the irritability of MTrS at BF. Archives of Physical Medicine and Rehabilitation 2011 92, 1098-1105DOI: (10.1016/j.apmr.2010.11.018) Copyright © 2011 American Congress of Rehabilitation Medicine Terms and Conditions