Take Two Needles and Call Me in the Morning
This week’s blog, in case you haven’t guessed, is about acupuncture. More specifically, a specialized form of acupuncture called “dry needling”.
Dry needling is the use of solid filiform needles for myofascial and other types of pain as well as for sports injuries and sports performance enhancement.
It is called dry needling, because unlike hypodermic needles used to inject substances, these needles are solid and their effect is not based on the injected substance.
The needles used in dry needling are the same as acupuncture needles, but their use is based on neuro anatomical concepts rather than Traditional Chinese Medicine.
Does it hurt?
A healthy muscle feels very little discomfort with insertion of these needles. However, if the muscle is sensitive and shortened or has active trigger points within it, you will feel a sensation like a muscle cramp -‘the twitch response’. You also may feel a reproduction of your pain which is a helpful diagnostic indicator of cause of your symptoms.
Patients often learn to recognize and even welcome this sensation as it results in deactivating the trigger point, pain reduction and the restoration of normal length and function to the involved muscles and nerves.
How Does It Work?
The primary effect of Dry Needling is that it produces a local twitch response. This results in muscle relaxation due to the release of shortened bands of muscle fibers.
There are currently several hypotheses regarding the exact mechanism of pain relief:
- The needling procedure itself leads to muscle relaxation due to stimulation of the spinal reflex arc.
- Needling leads to an increase in range of motion. This results in optimal length tension relationships in myofascial tissue, normal joint function and optimal movement coordination by the nervous system.
- Needling to the paraspinal muscles results in normalization of nerve flow and circulation to those areas affected by the spinal segment area, e.g. needling to the C5-C6 paraspinals can affect the shoulder, elbow and wrist
- The needle injury releases histamine and platelet derived growth factors that causes local irritation and relaxation of the muscle. In addition these biochemicals initiate the healing process, ultimately reducing inflammation and stimulating repair and remodeling of new and healthier connective tissue.
- Dry Needling mechanically breaks up the nodularity of the tissue.
- Studies show that that soon after a local twitch response is obtained, normalization of the pH and of several biochemicals and neurotransmitters occur in the environment surrounding the trigger point. These chemicals are involved in regulation of pain. Therefore, normalization of these levels will decrease the pain.
Dry Needling may cause an increase in pain which can last from a couple of hours to several days, followed by an expected improvement in the overall pain state. This increase in pain is mainly caused by the “twitching” of the muscles. It is also related to over activity of the shortened muscle bands that have not been released. Sometimes there is a temporarily increased spasm of the treated muscles.
After the Treatment
Modalities to decrease muscle pain such as hydrotherapy (alternating hot and cold), gentle stretching, taking extra vitamin C and Bromelain as well as following an anti-inflammatory diet, can be helpful in accelerating the healing process and reducing post-treatment discomfort.
As the pain decreases and range of motion increases, corrective exercises such as self myofascial release, static stretching, isolated intramuscular activation and integrated movement exercises are prescribed for long term pain relief and prevention.