How Dry Needling Addresses Neural Tension: A Case Study in Cervicogenic Headaches & Low Back Pain 🧠

Hi everyone, Dr. David Griswold here! If you’ve ever struggled with stubborn pain cases where nothing seems to work, this approach might be a game-changer. In this Clinical Relevance video, we explore how neurologic dry needling can resolve complex pain patterns by targeting neural tension—an often-overlooked driver of chronic symptoms. Let’s break down the science, a real-world case, and why this approach could transform how you treat stubborn pain.

🔬 The Study: Neural Tension’s Role in Whiplash-Associated Pain

A landmark study compared individuals with symptomatic whiplash to asymptomatic controls. Key findings:

✅ Positive slump tests were more common in symptomatic patients.
✅ Adding tension through the knee (extension) and ankle (dorsiflexion) reproduced neck pain.
✅ Limited knee extension & ankle dorsiflexion mobility correlated with neck dysfunction.

Takeaway: Neural system pathology impacts adjacent tissues, contributing to pain and restricted movement.

🧠 The Neuroanatomy Connection: From Suboccipitals to Thoracic Spine

Neural tension doesn’t exist in isolation. Here’s how it links across regions:

Upper Cervical Spine:

⚡ Irritation at the myodural bridge (C2 nerve) can cause:

• Suboccipital muscle tension
• Dural restrictions
• Cervicogenic headaches

Thoracic Spine:

📍 A critical anchor point for the dural system. Chemical irritation here can reduce mobility and amplify pain signals.

“When the nervous system is irritated, it creates a ripple effect—guarding, tension, and dysfunction follow.”

🏥 The Case: Resolving Multi-Regional Pain with Precision Dry Needling

Patient Profile:

🔹 Cervicogenic headaches (3/10 pain)
🔹 Chronic right-sided low back pain with occasional leg tingling
🔹 Positive straight leg raise (50% limited), restricted lumbar flexion, and right-sided flexion-rotation test

Assessment Clues:

🧐 Neural tension patterns suggested central sensitization, not just local tissue damage.

💉 The Treatment: Neurologic Dry Needling Protocol

We targeted neurochemical irritation without touching the lumbar spine:

1️⃣ Upper Cervical Needling

✔ C2 paravertebrals & greater occipital nerve distribution
✔ Suboccipital region to reduce dural tension & muscular guarding

🎯 Immediate Results:
✅ Headache ↓ to 1/10
✅ Flexion-rotation test normalized
✅ Unexpected bonus: 15° improvement in straight leg raise & lumbar flexion

2️⃣ Mid-Thoracic Needling

✔ Superficial paravertebral & interspinous techniques to calm neurogenic inflammation

🎯 Final Results:
✅ Headache: 0/10
✅ Low back pain: Resolved
✅ Lumbar flexion & straight leg raise: Full, pain-free motion

🔍 Why This Works: The Science of Systemic Change

✅ Reduces Neurochemical Irritation: Dry needling calms sensitized nerves & dura, breaking the pain-inflammation cycle.
✅ Resets Neural Mobility: Addressing tension upstream (cervical/thoracic spine) improves function downstream (lumbar/leg).
✅ Minimally Invasive: No need to needle symptomatic areas—strategic input resets the entire system.

🎯 Key Clinical Takeaways

✔ Assess Globally: Look for neural tension patterns (slump test, ROM restrictions) in patients with multi-regional pain.
✔ Needle Strategically: Target neurogenic hotspots (upper cervical, thoracic spine) to create systemic change.
✔ Trust the Science: Even distant needling can resolve symptoms by addressing the nervous system’s interconnectedness.

📚 Want to Dive Deeper?

This case is part of our Clinical Relevance Series, where we translate cutting-edge research into actionable clinical strategies.

🎥 👉 Watch the full case breakdown now and see how these techniques create real results!

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📌 Neurogenic Inflammation & Chronic Pain
📌 Advanced Dry Needling Techniques for Neural Dysfunction
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