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Treating Cervical Dystonia With Trigger Point Dry Needling
A person afflicted with cervical dystonia often tries a variety of treatments to alleviate the pain and limiting factors of the illness. In my case, after getting Botox injections for two and a half years, I recently started receiving trigger point dry needling. It has been 90 – 100 % effective in relieving my pain and allowing me to resume daily activities I had been unable to do since acquiring dystonia.
I was first diagnosed with laterocollis dystonia in January of 2007 at the age of 52. However, in early 2005 I had begun seeing a chiropractor for stiff neck and shoulder/arm pain. The spinal x-rays taken for treatment evaluation showed my neck angling to the right even though my head was straight, an indication I may have been dystonic prior to 2007. The discovery of the dystonia was made after I developed acute onset headache in December 2006. I rarely had headaches so when over the counter drugs did not give relief from the constant pain, I went to my general practitioner who prescribed various pain killers and muscle relaxants. Even so I landed in the hospital and received the full battery of tests recommended for a patient with adult sudden onset headache. Life-threatening conditions were subsequently ruled out but I still had no relief from the fuzzy/foggy head, upper shoulder aches, lack of mobility and constant headaches.
On January 2, 2007, I met with a neurologist specializing in head and neck issues. He provided my care for the following two and a half years. In addition, he prescribed physical therapy (PT) with Frank Gargano, PT, DPT, OCS, MCTA, a specialist in headache and neck ailments using manual therapy treatment. It was this working relationship between neurologist and physical therapist that led to quick diagnosis of laterocollis dystonia which was causing the cervicogenic and referred pain headaches.
Prior to the onset of the headaches I had kept busy on our three acres, doing landscaping, vegetable gardening and maple syrup production. I was an active dancer and leader in a weekly English Country dance group and did sailboat racing every weekend with my husband during the summer. In addition I enjoyed making the long car drives required when our children were in college and the frequent road trips to visit my mother down state. I was available to help people at a moment’s notice, traveling near and far to give assistance where and when needed. This lifestyle came to a halt and for the next three years I experienced a new way of living, not always happy with the restrictions I encountered.
I researched movement disorders in my family and discovered there was a history of disorders in both my relatives and myself. My maternal aunt and grandmother both suffered from Parkinson’s disease. For myself, I recalled my head tilted to the right for a brief time when I was eight. I was unable to straighten my head, although there was no pain associated with the tilt and people thought I was just cocking my head. Although brief in time it may be significant since it occurred during pre-pubescence and my current dystonia surfaced during peri-menopause, both times when hormone levels are in flux. In addition I have had Restless Leg Syndrome (RLS) my entire life. My earliest memories of childhood include the agonizing frustration of restless legs, and RLS has continued through the years. I now take Mirapex for relief.
Botox was selected as the treatment for my cervical dystonia and I received my first round of injections in March 2007. I was relieved to have my headaches and stiffness dissipate after three weeks as the toxin became effective. However, within 11 weeks after the injections, the pain and inflexibility returned so I began the regimen of receiving 400 units of Botox every three months. The sites of injection included my right and left trapezius muscles, right and left sternocleidomastoid muscles, right semispinalis capitus, suboccipital, levator scapula and longissimus muscles.
I had follow-up PT sessions with Dr. Gargano for muscle stretching and strengthening and spinal manipulation. A side effect of the Botox was a temporary weakness of the neck muscles producing a “floppy neck” and over time I developed muscle weakness in my arms. I also experienced pain associated with arm abduction that was most pronounced following a Botox treatment. However, I continued with the injections because of the relief I got from the headaches and upper trapezius pain. During these years I adjusted my lifestyle to the chronic pain and immobility of cervical dystonia. I learned to schedule events, activities and travel around Botox injections hoping I would have two months out of three when I would feel decent.
Then in September 2009 my Botox treatment did not work. This was a blessing for it presented the opportunity for Dr. Gargano to use trigger point dry needling (DN) as a treatment for my dystonia. Trigger point dry needling, unlike acupuncture, is based on neuro-anatomy and modern scientific study of the musculoskeletal and neuromuscular systems. Very fine filament needles are inserted through the skin into the muscular trigger points of pain. The effect is to deactivate the trigger point and relax the muscle.
We quickly found that DN paired with manual therapy treatment of the upper spine provided not only the most complete and immediate pain relief I had as yet experienced but also enabled me to resume my active lifestyle. I have been in better health, enjoyed more flexibility and balance from the current regimen than I ever had with Botox injections. Currently, I receive treatments every two weeks with the hope that over time the period between treatments will lengthen.
The culminating success story of DN occurred in January 2010 when I undertook an unplanned trip to my daughter’s home, driving eight hours, assisting her for a week and then driving back home – all with freedom of motion and freedom from pain. The independence I experienced during this adventure was a feeling I had not encountered since I acquired cervical dystonia, and it would not have been possible prior to my receiving trigger point dry needling. I am now beginning to resume my previous active life, once again being available to help others where and when needed.
P.S. I have appreciated the packet I received for joining ST/dystonia. It has useful information and the DVD is an added plus. I also enjoy the added humor that is snuck in at the bottom of the pages and elsewhere. Laughter is good. Thanks.
I just got back from another dry needling session and continue to be amazed at the immediate relief I receive. I last about two weeks between treatments. Thankfully, when the treatment wears off and the pain returns (which is sudden), I am able to schedule an appointment for the next day. I continue to savor the ability to commit to activities in the ufuture and to forget what dystonia feels like. I was acutely reminded about the pain yesterday when the muscles spasmed, my neck and head pulled to the right and I once again moved rigidly about the house, coming to rest in the easy chair to weather out the pain. Then, this morning at 8:00 I scheduled an appointment for 9:00 a.m. and was back home by 10:30 smiling and giddy over the relief from the pain.
I will be curious to see if dry needling will work for other dystonia patients and how my experiment with it plays out.
Thanks for connecting us all,
Resource for Spasmodic Torticollis/ Cervical Dystonia:
ST/Dystonia, Howard Thiel, Executive Director, www.spasmodictorticollis.org
Resource for Trigger Point Dry Needling:
Frank Gargano, owner/director, Rehabilitex, www.rehabilitex.com