1. Myofascial Dry Needling Thorax and Abdomen

2. Overview Anatomy of the Thorax and Abdomen
MDN of muscles in the Thorax and Abdomen:
Trapezius
Pectoralis Major and Minor
Rhomboids
Serratus Posterior Superior
Serratus Posterior Inferior
Serratus Anterior
Erector Spinae
Multifidus and Rotatores
Latissimus Dorsi
Rectus Abdominis
Lateral Abdominals
External Obliques

3. Anatomy: Thorax
Deadman, P., Al-Khafaji, M., & Baker, K. (1998)

4. Anatomy: Thorax
Deadman, P., Al-Khafaji, M., & Baker, K. (1998)

5. Anatomy: Upper Abdomen
Deadman, P., Al-Khafaji, M., & Baker, K. (1998)

6. Trapezius
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

7. Trapezius MDN TrP 1 & 2, patient seated or supine
Secure TrP/ taut band with a pincer hold between fingers and lift the fibres away from the lung
An anterior or posterior approach may be taken as long as the TrPs are needled obliquely away from the lung
Patient prone or side lying for the other TrPs
The needles should be inserted obliquely/transversely in a lateral direction away from the lung
Consider using SDN protocol (5mm max depth)

8. Pectoralis Major 1
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

9. Pectoralis Major 2
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

10. Pectoralis Minor
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

11. Pectoralis Major and Minor
MDN
Patient in supine position
Arm may be rested on a pillow in an abducted position
Muscles overlying the chest wall should never be needled perpendicularly for fear of penetrating the pleura and producing a pneumothorax
The needles should be inserted on an oblique/transverse angle from medial to lateral
When needling the superior TrP in pec minor, the needle should be angled towards the coracoid process to avoid the neurovascular bundle

12. Rhomboids
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

13. Rhomboids MDN Patient in prone position
Arm may be hanging over the side of the massage table
Muscles overlying the chest wall should never be needled perpendicularly for fear of penetrating the pleura and producing a pneumothorax
The needles should be inserted on an oblique/transverse angle from medial to lateral towards the medial border of the scapula
The needles should be directed over the rib

14. Serratus Posterior Superior
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

15. Serratus Posterior Superior
MDN
Patient in a side lying position on the opposite side with the scapula brought well forward (TrP lies beneath the scapula)
Muscles overlying the chest wall should never be needled perpendicularly for fear of penetrating the pleura and producing a pneumothorax
The needles should be inserted on an oblique/transverse angle from medial to lateral parallel to the rib cage
The needles should be directed over the rib

16. Serratus Posterior Inferior
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

17. Serratus Posterior Inferior
MDN
Patient in a side lying position on the unaffected side
Muscles overlying the chest wall should never be needled perpendicularly for fear of penetrating the pleura and producing a pneumothorax
The needle should be inserted on an oblique/transverse angle in a superior direction towards the tenth rib and not the intercostal space

18. Serratus Anterior
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

19. Serratus Anterior
MDN
The patient is side lying with the shoulder extended and elbow flexed
The TrP is located and held between two fingers
The TrP is needled obliquely directed over the rib to avoid pneumothorax

20. Erector Spinae
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

21. Erector Spinae MDN Patient in prone position
The needles should be inserted on an oblique/transverse angle from medial to lateral or lateral to medial, parallel to the rib cage
The needles should be directed over the rib and not in the intercostal space to avoid pneumothorax

22. Multifidus and Rotatores
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

23. Multifidus and Rotatores
MDN
Patient in prone position
The TrPs should be needled on an oblique angle from lateral to medial
The needles should be directed caudally and towards the lamina groove to avoid the nerve roots

24. Latissimus Dorsi
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

25. Latissimus Dorsi
MDN
The patient is in a supine position with the shoulder in abduction and the hand resting under the head
The upper TrP/taut band is held with a pincer grip between the thumb and fingers
The TrP is needled perpendicularly/obliquely in a posterior direction
For the midfibre TrP, the needle is inserted transversely on a posterior and superior angle and directed towards the rib to avoid pneumothorax

26. Rectus Abdominis
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

27. Rectus Abdominis
MDN
The patient is in a supine position with the hips flexed
The upper TrP is needled with caution transversely towards the xyphoid process
The midfibre TrP is needled transversely from lateral to medial
The lateral abdominal wall may be depressed to aid needling
The lower TrP (pyramidalis) is needled transversely towards the pubis
Transverse insertion is required to avoid needling into the peritoneum

28. External Obliques
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

29. External Obliques
MDN
The patient is in a supine position with the hips flexed
The upper TrPs over the ribs are needled transversely and directed over the rib to avoid pneumothorax
Other TrPs are needled by grasping the portion of the muscle in a pincer grip and directing the needle obliquely into the TrP
Needles must travel transversely to the muscle in order to avoid needling into the peritoneum

30. Bibliography
Travell, J. G., Simons, D. G., & Cummings, B. D. (1983). Myofascial pain and dysfunction : the trigger point manual (Vol. 2). Baltimore: Williams and Wilkins
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999). Travell & Simons' myofascial pain and dysfunction : the trigger point manual (2nd ed. Vol. 1). Baltimore: Williams & Wilkins
Deadman, P., Al-Khafaji, M., & Baker, K. (1998). A manual of acupuncture. Hove, East Sussex: Journal of Chinese Medicine Publications