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Dry Needling

tentingDry needling has been around since the 1970’s and is an effective treatment modality for pain.  In fact, its has been documented that dry needling used alongside spinal manipulative therapy is an effective treatment for the following conditions.  Remind you this list is by no means exhaustive.

  • Migraines and other headache types
  • Fibromyalgia
  • Myofascial trigger points (all types of muscular aches and pains)
  • Adhesive capsulitis (the ominous frozen shoulder)
  • Non-specific chronic low back and neck pain
  • Knee osteoarthritis
  • Elbow and calf pain (medial, lateral, achilles tendinosis)

The research on dry-needling is growing rapidly and is used at Camp4 primarily as a way of releasing muscle tension and reducing pain.  We strive to stay up-to-date with what the literature tells us about the best way to apply our dry needling therapies and Dr. Laney Nelson has had many speaking engagements teaching these therapies to other health care professionals about acupuncture Taylorsville UT. To learn more about how our dry needling therapies can help you continue reading, or call to schedule your appointment today. 

Acupuncture-History

This section will discuss the current literature’s theories behind how dry-needling works.  Lets first start with the interaction of the needle with the soft tissues of the body.  The primary soft tissues responsible for the mechanical force coupling interaction are the skin, connective tissue, and muscles.  The subjective sensation of the practitioner to an acupuncture needle’s placement is classically termed ‘De Qi’, or in western terms ‘needle grasp’.  This essentially is the sensation felt by the practitioner when the soft tissues hold on to the needle and require a subsequent increase in tissue-pull-out-force. Remind you these needles are generally teflon coated and between 0.12 mm to 0.35 mm in diameter.  

 

Two current theories as to how pull out force is increased with dry-needling.

1. By needles eliciting muscle contraction’s. This requires deep needle insertion and is not well supported.

2. Connective tissue winding around the needle as the result of needle manipulation (twisting).  Winding has been demonstrated in both superficial and deep tissues and is well supported. The remainder of the discussion will be in reference to unidirectional needle manipulation, or clockwise needle rotation as is done to promote tissue winding.

qmark Now the needle is in, which is generally regarded as the equivalent of a mosquito bite, so how does it provide a physiological response? 

The first thing to be aware of is the interconnectedness of your bodies soft tissues, bones, and nervous system.  That seems obvious I know, however the importance of the physical continuity of these structures has only gained wide attention in the last couple decades and gives us much insight into the effects of acupuncture.  

 

sblAs an example I will use an image taken from Anatomy Trains by author Tom Meyers.   This image demonstrates one example of the soft tissue continuity from the bottom of your toes to the top of your head, en route connecting and holding in place your organs, and also your bones.  It seems counterintuitive to think that the soft tissues are actually responsible for holding your bones in place however the concept of biotensegrity explains this all the way down to the cellular level.  Tensegrity is an architectural term which describes how isolated compressive components (bones) are held in place by a continuous net of tension (soft tissues) and under normal circumstances do not touch.anterior head carriage 

The next thing we need to discuss is the cause of non-traumatic muscle aches and pain.  The ominous trigger point, as studied by Travel and Simons which you have heard so much about is the bodies response to tensile asymmetry in your body.  The metaphor commonly employed is that of guy wires which are designed to hold a structure in symmetric tension in order to not only keep it upright, but also for it to provide optimal function.  You can see where this is going so lets use a quick example.

When the weight of our head moves in front of our shoulders as is common with repetitive postures, it increases the force necessary to hold up our head from 25N to 100N.  This puts huge stress on the muscles in the back of your neck, creating trigger points due to those muscles having to contract all day so your head doesn’t fall to the floor.  

Now that you have some trigger point groundwork, lets get into what the literature says about treatment and how acupuncture dry-needling can help you. There are theorized to be two types of trigger points.  These can be anywhere along those connective tissue “lines”, but are generally in separate parts of the same muscle.

1. Active MTrP These are painful with motion and present as a dull ache most of the day. This is the classic muscle ache.

2. Passive MTrP – These are those tender spots your family and friends find when they press on your shoulders and neck.

Since our bodies develop asymmetry over time, certain muscles become overworked and others underworked. We call this postural decompensation and will be discussed further here. The whole time those muscles are contracting they are leaving leftover chemicals (Ach) required for contraction which create hyperirritable spots in the tissue which increases overall pain detection, this is called hyperalgesia.  Another known response is a decrease in blood flow (hypoxia) due to your muscles being overworked which pushes the blood away from your muscles.  Over time this constant perception of pain leads to something called peripheral and central sensitization. Once we have reached this stage you can get pain from any tissue, even if its not the involved tissue and this is called allodynia.

Types-Of-PainThis topic will be discussed more on the manipulative therapy page and is the primary mechanism responsible for many chronic pain syndromes. Disuse and/or injury of your soft tissues and joints causes firing of small diameter pain fibers, also known as c-fibers which carry vague pain sensations to your brain. Without having to get into a neuroanatomy lesson, normalized movement and tension of your soft tissues and joints allows a greater neurologic input of larger sensory fibers that block the transmission of c-fibers.  An easy way to remember this is A/c as developed by Melzack. 

qmark

So, how does a needle effect these tender spots in my soft tissues to normalize function and decrease my pain? 

ico_attentionBefore we can go on, you need to realize that simply because you have trigger points in predictible areas does not mean that they all need to go away. As mentioned above they are your bodies natural protective mechanism to keep you upright  all day. That is when we utilize exercise rehabilitation in order to re-train your nervous system to coordinate proper        muscle firing patterns. That is the only plausible way to get rid of trigger points for the long term.  

Dry-needling has been demonstrated to be as effective as medication in the long term in patients with migraine headaches in regards to onset and frequency. Dry-needling as an adjunct to spinal manipulative therapy has been demonstrated to be better than acupuncture or spinal manipulation alone.

Now that you have a brief understanding of pain, lets list the benefits that are currently cited in the literature regarding dry-needling. 

ico-style1 Needle placement in a latent MTrP at the endplate region causes local and distant muscle twitch responses (micro-contractions).  This is believed to release excessive Ach which depletes the endplate of its storage.  A decrease in overall Ach means a decrease in overall muscle contraction frequency and thus pain. This mechanism is believed to elongate tense connective tissues bands while stimulating A fibers to inhibit pain!

ico-style1 Needle manipulation causes connective tissue winding which elicits a powerful mechanical signal across the cell membrane through focal adhesion complexes. Remember the biotensegrity that connects every structure in three dimensions, cells and all

ico-style1 The mechanical force couple above has been shown to alter cellular gene expression through (fibroblast) shape changes as the result of dry-needle manipulation. The cells actually change shape to a more columnar shape.  The effects this has on the body is very profound but at the forefront of current research interests with regard to soft tissue therapies.

ico-style1 Needle manipulation increases systemic blood flow and oxygenation to the tissues by releasing vasoactive substances such as Calcium Gene Related Peptide, Substance P, and Nitric Oxide. This has the potential to wash away any excess Ach or excessive inflammatory substances.  

ico-style1 Needle stimulation has been shown to release endogenous (created within) opiates which descend from your brain and block pain before it ascends the spinal cord to be perceived.

ico-style1 Needle stimulated tissues activate your autonomic (sub-conscious) nervous system reflexes providing a more broad systemic effect on end organ function. The effect on organ function is not well researched in the United States and is also currently under much investigation.

ico-style1 Needling has demonstrated changes in very specific brain areas as seen with functional MRI. This entertains the idea that dry-needle stimulation effects the way we think about and perceive pain structurally.

For any additional information regarding dry needling Taylorsville UT offered at Camp4 simply ask a question and we will respond to your email as quickly as possible or call now to see how we can better serve your needs.

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Page Citations

1 – Helene M. Langevin*, David L. Churchill*, Junru WuÜ, Gary J. Badgerß, Jason A. Yandow*, James R. Foxá, and Martin H. Kragá

Evidence of Connective Tissue Involvement in AcupunctureThe FASEB Journal express article 10.1096/fj.01-0925fje. Published online April 10, 2002. 

2 – Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain (Review)

The Cochrane library collaboration 2011, issue 2. Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM

3 – Cagnie & Vincent Dewitte & Tom Barbe & Frank Timmermans & Nicolas Delrue & Mira Meeus. Physiologic Effects of Dry NeedlingCurr Pain Headache Rep (2013) 17:348 

4 – Konofagou, Elisa E., Langevin, Helene M. Using Ultrasound to Understand Acupuncture. Engineering In Medicine and Biology Magazine. March/April 2005

5 – Megan Lam, BA, MSc,*† Rose Galvin, BSc, Dip, PhD, MISCP,† and Philip Curry, BSc, PhD,* Effectiveness of Acupuncture for Nonspecific Chronic Low Back Pain.  A Systematic Review and Meta-analysis. SPINE Volume 38, Number 24, pp 2124-2138 ©2013, Lippincott Williams & Wilkins 

 

 

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