Small Needle Knife Therapy and Common Diseases
I. Introduction
The small needle knife is a treatment tool made of metal material that resembles a needle and a knife in shape. It is the product of organic combination with the theory of dynamic balance of force and soft tissue release, and has a history of more than 30 years. Its indications are mainly soft tissue injury lesions and bone and joint lesions.
The advantages of small needle knife therapy: it is a green therapy, except for local anesthetics without any drugs, is a minimally invasive or closed soft tissue release, treatment incision is small, no sutures, damage to human tissue is also small, and is not easy to cause infection, no adverse reactions, no need to rest after surgery, short treatment time, short course of treatment, easy for patients to accept.
Second, the basic content
1.Needle tool
Small needle knife is generally about 10-15 cm, the diameter of 0.4-1.2 mm ranging. Divided into hand-held handle, needle body, needle knife three parts. Needle knife width is generally equal to the diameter of the needle body, sharp edge.
2.Operating method
(1) the choice of body position to the doctor’s convenience when operating, the patient is treated when the self-feeling position for the principle of comfort. Such as in the neck treatment, mostly using the sitting position; head can be selected according to the position of the disease supine position or low head position.
(2) into the needle knife four-step protocol: a: fixed point b: orientation c: pressure separation d: stabbing.
(3) Commonly used stripping methods are
a, along the muscle fibers, or tendon distribution direction to do shovel stripping – that is, the tip of the needle knife immediately adjacent to the tissue to be stripped to do in and out of the propulsion action (not up and down lifting and inserting), so that the lateral adhesions of the tissue fibers break off and loosen.
b. Do horizontal or fan-shaped oscillating action of the tip of the needle knife, so that the longitudinal adhesion of tissue fibers break off and loosen.
c.Do oblique or non-directional needle knife tip paddling action, so that no certain pattern of adhesion of tissue fibers to break loose.
(4) cutting and peeling 2-5 times can be out of the needle, general treatment 1-3 times, the time between two depending on the situation 5-7 days ranging.
(5) Indications for the application of small needle knife.
a. The patient feels painful symptoms at a certain place.
b.The doctor can touch the sensitive pressure pain at the lesion.
c, palpation can be felt under the skin there are strips or pieces or ball-shaped hard, nodules.
III. Clinical application
1.Cervical spondylosis
The etiology and pathology of cervical spondylosis are very complex, and although different types of cervical spondylosis have their own unique pathogenic factors, they still have their commonality. Cervical spondylosis starts slowly and is predominant in middle-aged and elderly people, especially in long-term accounting, sewing, computer operation, desk-bound workers and drivers. According to some statistics, the incidence of cervical spondylosis in different populations can range from 1.7% to 17.6%n, and the incidence increases with age, with 40-60 years old as the high incidence age; the current incidence of cervical spondylosis has increased, and there is a trend of youth. Pathological changes are as follows.
1.Disorders of force balance;
2, change of intervertebral disc;
3, changes in the cervical joints;
4, changes in the spinal canal, intervertebral canal and its filling;
5, the change of vertebral artery;
6, changes in the spinal cord and nerves.
Point: The painful point is the treatment point. It is often in the upper and lower occipital collar line, C2 spinous process, C3-7 paravertebral process, transverse process, C7 spinous process, internal superior scapular angle, and oblique muscle belly.
Method: Use the straight stab method. Gently peel longitudinally 1-2 times can be done, which can be combined with local massage to enhance the therapeutic effect.
2.Extra-articular humeral ankylitis (tennis elbow)
Most of them are caused by accumulative strain injury, resulting in mild internal tearing and slight local bleeding and mechanization of the tendons of the extensor carpi radialis, extensor digitorum profundus and extensor digitorum posterior attachment point of the humerus, and scarring and adhesion in the process of self-repair, which squeezes the neurovascular bundle there and causes pain. It is mostly seen in tennis players, farmers, workers, housewives, typists, etc.
It is a common and frequent clinical disease. The mechanism of small needle knife therapy for the treatment of this disease is that small needle knife can strip and unblock various adhesions between tendons and ligaments, so that microcirculation can be restored and tendons and ligaments can be repaired, which can act directly on the lesion site, and the painful point can be effectively released by loosening and stripping the adhesions, while blocking the conduction of the nerve endings, thus releasing the vascular nerve compression, loosening the muscle tension, relieving the pain, unblocking the qi and blood, unblocking the meridians, and making the symptoms Eliminate the symptoms.
Take the point: find the most obvious place of pressure and pain.
Method: Make the small needle knife incision line and the direction of the extensor carpi radialis muscle parallel stab into the subcutaneous humeral epicondyle, first use the longitudinal sparing and peeling method, then use the incision and peeling method, feel the sharp edge has been scraped flat, then use the transverse scraping and peeling method, then sparing the extensor carpi radialis muscle, extensor digitorum profundus muscle, rotator digitorum posterior muscle tendon, out of the needle knife, bandage. Then flex the elbow joint 2-4 times, generally 1 or 2 times can be healed, each interval of 5 days.
3.Frozen shoulder
When a person reaches old age, the synovial membrane atrophies and thins, and the metabolic function decreases, so that the muscles and tendons around the shoulder are not moistened by synovial fluid, and inflammatory exudation of the muscles and tendons around the shoulder joint and joint capsule occurs, and fibrous tissue proliferates and the joint capsule thickens, while the soft tissues around the shoulder become widely adherent and develop. Regardless of the pathological changes, the prominent manifestation of patients in the consultation is pain and dysfunction, so eliminating pain and relieving dysfunction is the key to treating frozen shoulder.
Among the etiologies of frozen shoulder, subacromial bursitis, subdeltoid bursitis, rostro-humeral ligament injury, triceps longus tendinitis, supraspinatus infraspinatus injury, and lateral triceps head injury play an important role in the development of frozen shoulder. These pathological changes initially manifest as pain, with mild symptoms in the early stages, and the trunk forms a reduction in certain movements in order to avoid discomfort, gradually leading to a state of tissue adhesion contracture and mechanization. The use of small acupuncture therapy opens up a new pathway for the treatment of frozen shoulder, which relieves the cause of the formation of frozen shoulder, namely the problem of extensive adhesions of the soft tissues around the shoulder, and belongs to the treatment for the cause.
Point of extraction: local painful point.
Method: Longitudinal sparing and transverse stripping method is used.
4.Flexor tendon stenosis tenosynovitis (popping finger)
Tendonitis refers to the tendon sheath due to mechanical friction caused by chronic sterile inflammatory changes, people in daily life and work, are inseparable from the finger flexion and extension activities, due to frequent activities, excessive friction, coupled with some parts of the bony bulge or tendon direction of travel to change the formation of the angle, increased mechanical friction, tendon sheath in the early occurrence of congestion, edema, exudation and other sterile inflammatory reaction.
After repeated trauma or prolonged period of time, chronic fibrous connective tissue hyperplasia, thickening, adhesion and other changes occur, and the tendon becomes locally thickened, the wall of the canal thickens, the lumen of the canal is narrowed, and the tendon passing through the canal is compressed, and clinical symptoms occur. The thickened tendon sheath is mostly located in the metacarpal bone slide area, and the inner layer of the thickened tendon sheath forms a band-like narrowing of the fibrocartilage ring, and the tendon in this area forms a bulbous enlargement due to abrasion and thickening.
Because of the narrowing of the tendon sheath and the thickening of the distal tendon, when the tendon passes through the narrow tendon sheath, it encounters a temporary obstruction, and if it is forced through, it produces a popping sound.
Point: The distal transverse palmar line of the metacarpophalangeal joint is painful.
Method: The incision line is parallel to the tendon’s direction, stabbing vertically to reach the bone surface, and performing longitudinal incision to unblock and transverse stripping.
5. Pear-shaped muscle syndrome
The main cause of pear-shaped muscle changes is acute injury and chronic strain. Due to some kind of intense or uncoordinated exercise. To the muscle spasm, bleeding, edema and other aseptic inflammation occurs. After acute injury or chronic strain, the pear-shaped muscle gradually degenerates, resulting in thickening and hardening of the muscle bundle or adhesions, which stimulates or compresses the adjacent sciatic nerve and blood vessels, resulting in sciatica as an important symptom of the syndrome.
Small acupuncture treatment can release local adhesions, restore mechanical equilibrium, and reduce the compression on the nerve. At the same time, it can enhance blood circulation and improve blood supply to the lesioned tissue. At the same time, it can enhance the blood circulation of the lesion and improve the blood supply, thus promoting the recovery of the lesioned tissue. Further eliminate inflammatory congestion, edema and metaplasia, nerve nutrition to promote the recovery of nerve function.
Point: the pressure point of the sciatic nerve under the pear-shaped muscle, that is, the projection point of the inferior foramen of the pear-shaped muscle (the midpoint of the posterior superior iliac spine, the midpoint of the caudal line and the inner 1/3 point of the line of the tip of the greater trochanter)
Method: The incision line is parallel to the sciatic nerve, and the body of the needle knife is stabbed vertically into the skin with the skin surface, passing through the gluteus maximus muscle layer by layer, and there is obvious soreness and swelling when it reaches the pear-shaped muscle, avoiding the string of numbness along the sciatic nerve inferior transmission. Line longitudinal sparing peeling method.
6.Heel pain (heel spur)
In recent years, from a biomechanical point of view, the majority of scholars believe that heel spurs (osteophytes in front of the lower part of the heel node) are due to abnormal pulling of the metatarsal tendon membrane. Patients tend to have a combination of flat feet of varying degrees of severity. Specifically, the causes of heel spurs and heel pain are as follows:
First, abnormally high stress on the metatarsal tendon membrane. The fibers of the metatarsal tendon membrane resting in the metatarsal pad are tightly connected to the base of the first phalanx of the metatarsal and reach the periosteum. Therefore, the metatarsal pad and the metatarsal tendon membrane are essentially one continuous whole. Thus, when walking normally, the body weight is forward, the toes are dorsally extended, the 1st toe joint is tightened to the metatarsal key membrane, and the arch of the foot is lifted up, resulting in a great pulling force on the metatarsal tendon membrane. If the patient stands for a long time, walks for a long time, gains weight or reduces foot strength, chronic injury may occur at the attachment of the plantar tendon membrane to the heel nodes, forming chronic inflammation of the fibrous tissue, resulting in “bone spurs” due to stress imbalance, causing synovitis and heel pain. If the plantar or/and lateral ankle muscles are weak, the tension on the plantar key membrane is even greater. If the arch of the foot is sunken and the long and short ligaments of the foot are relaxed, the burden on the metatarsal tendon membrane is increased. In addition to the downward pressure of the weight, so many factors converge to make the broken tendon membrane suffer from long-term, continuous tensile stress, it will appear at the heel stop of the metatarsal membrane stress changes – osteophytes, commonly known as heel spurs.
Second, the bunion muscle also starts at the heel tuberosity, on its medial side. It is an important structure for maintaining the medial arch of the foot. Based on the same stress changes, it can also produce heel spurs, except that the osteophytes are on the medial side of the heel tuberosity. In addition, the heel branch of the posterior tibial nerve travels beneath the bunion muscle and can be compressed when the bunion is tense, causing pain. This explains why there is not one but two pressure points on the heel spur, one near the center and one on the medial side.
Third, each tendon attached to the heel node has a tendon surrounding structure, i.e., peritendinous loose connective tissue, synovial bursa, fat pad, etc. These tissues do exist between the heel nodes and the Achilles tendon, and MRI images are available to demonstrate pathologic changes such as bursitis and fat pad inflammation. If osteophytes are already present and aseptic inflammation of the tendon peripheral structures is present, the pain is very intense; whereas, although heel spurs are present, there are no lesions of the leg peripheral structures and therefore no painful symptoms, so they are called painless or asymptomatic heel spurs. The causes of heel spurs are multiple, so the treatment of heel spurs should take into account many factors and design a treatment plan for the pathological changes. Only in this way can the treatment be tailored to achieve good results.
Point: The tip of the bone spur (where the pressure pain is most obvious).
Method: The patient lies supine on the treatment bed, place the foot steadily, find out the most obvious pressure pain point, after routine disinfection, the needle knife mouth line and vertical axis, the needle body and the heel at an angle of 60 °, the depth is straight to the tip of the bone spur, for transverse incision and peel and shovel peel, 3-4 times can be out of the needle knife, if 1 time is not healed, after 5-7 days can do a second time.
7.Transverse process syndrome of the third lumbar vertebra
The transverse process of the third lumbar vertebra is particularly long and extends horizontally. There are vascular nerve bundles crossing near the end of the transverse process, and there are more myofascial attachments, such as sacrospinous muscle, internal and external oblique abdominal muscle and lumbar square muscle. The third lumbar vertebra is located at the apex of the physiological anterior convexity arc of the lumbar vertebra, which is an important part of the mechanical transmission. In labor, when one side of the paravertebral muscles contract, the opposite side of the transverse process is leveraged up to pry, the activity is large, usually must rely on the surrounding muscles to maintain its functional balance. Otherwise, it is easy to cause tears in the muscles attached to the area, friction, compression and irritation of the vascular nerve bundle due to injury, and back-lumbar hip symptoms. The syndrome has anatomical and biomechanical correlates that are susceptible to external forces.
In fact, the transverse process is anatomically formed at the so-called “intersection of muscle, nerve and bone attachments”, i.e., the “lumbar square and sacrospinous muscles, the lumbar nerve branch and the third transverse process”, and the existence of this anatomical pattern undoubtedly increases the symptoms of injury The posterior lateral branches of the L1, L2, and L3 spinal nerves branch out from the intervertebral foramen, then penetrate the fibrous foramen of the intertransverse ligament, travel downward and outward on the dorsal side of the transverse process, cross the spinous muscle and lumbar dorsal fascia to the subcutaneous level, and descend across the skeletal crest into the buttocks to form the superior gluteal cutaneous nerve, with the posterior lateral branch of the L1 reaching the lateral underside of the skeletal crest, and the L2 The posterior lateral branch of L3 goes through the buttock to the posterior femur, and L1 may go to the top of the N fossa. Therefore, inflammatory stimulation of the transverse process or spastic muscles (muscle fibers attached to the tip of the transverse process like a tightly drawn bowstring), thickened and tense fascia or scarred dense tissue squeeze the posterior lateral branches of L1 , L2, and L3 spinal nerves, and gluteal leg symptoms may occur. When the posterior branch of the L1 , L2, and L3 spinal nerves is stimulated, it can reflexly cause tension in the innervated innominate muscles of the foramen ovale. When the posterior lateral branch of L1, L2, L3 spinal nerve is stimulated, it can reflexly cause tension in the innominate muscles of the foramen ovale, and the vascular bundle accompanying the posterior lateral branch of L1, L2, L3 spinal nerve can be blocked by compression of venous return, and the pathophysiological changes such as bleeding, exudation and secondary scar adhesions in the transverse process of the 3rd lumbar vertebra can cause the disease to develop without obvious trauma or with only mild injury. Point: The pressure pain is obvious. Method: The needle is inserted parallel to the longitudinal axis of the human body, and when the incision touches the bone surface, the needle is removed by the transverse stripping method and the feeling of loosening between the muscle and the bone surface. Generally 1 time that is healed, not healed after 5 days for a second time. 8.Lumbar disc herniation The main symptom of lumbar disc herniation ((LmH) is lumbar and leg pain and numbness. The cause is mainly due to long-term bending work, acute and chronic injuries, etc., so that changes in the biomechanics of the spine caused by local soft tissue contracture or relaxation, resulting in insufficient blood supply, hypoxia, lack of energy and accumulation of metabolic products, resulting in ischemic myalgia and lack of energy muscle softness, when the balance of soft tissue mechanics is disrupted, on the one hand, will cause the lumbar vertebrae unbalanced force and change in the relationship between the position, this and the degeneration of the intervertebral disc On the other hand, the damage to the soft tissues themselves can also directly cause compression and stimulation to the nerves that travel through them; all of these pathological changes can release a large amount of inflammatory mediators, stimulating the free nerve endings and causing pain. Take the point: intervertebral space pressure pain point (at the intervertebral joint), the midpoint of the calf numbness area. Method: the waist in the center of the pain point into the needle knife, the needle knife tip to reach the intervertebral small joint ligament around the tissue for sparing stripping 3-4 times, out of the needle knife; calf parts with a straight stab longitudinal stripping method can be. IV. Precautions 1, the doctor must be familiar with the deep anatomical knowledge of the treatment point, in order to improve the accuracy of the operation and improve the efficacy. 2, the selection point must be accurate, to find the center of the pain point into the needle, into the needle to maintain vertical (non-pain point can be flexible choice of needle approach), such as oblique into the needle easy in the deep wrong lesion site, easy to damage non-lesion tissue. 3, pay attention to aseptic operation, especially when doing deep treatment, important joints such as knees, hips, elbows, necks and other parts of the joint deep cutting especially when attention. 4, small needle knife into the needle method should be fast and quick, so as to reduce the pain caused by the needle. In the deeper part of the shovel stripping, horizontal stripping, longitudinal stripping and other methods of peeling operation, the technique should be light, otherwise it will aggravate the pain, or even damage the surrounding tissue. When doing longitudinal stripping at the joint, be careful not to damage or cut ligaments and tendons. 5.Postoperative local massage can be done for some treatment points with less trauma to promote blood circulation and prevent postoperative bleeding adhesions. 6.For some cases, the short-term effect is very good, but after 1-2 months or longer, the pain recurs and the original disease state is restored, especially in the parts with greater load, such as knee, shoulder and elbow joints, lumbar region, etc. The following factors should be noted The following factors should be noted: the patient’s habitual life, walking posture, work posture, etc. caused by recurrence; surgery to release the local adhesions, but the postoperative trauma due to the lack of local exercise caused by adhesions; local again suffered from wind, cold, dampness invasion. Therefore, special attention should be paid to life and living.