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At the mere mention of needles, many people become nervous and apprehensive.  Some go so far as to associate them with pain and discomfort and prefer not to have any form of needling done in their treatment sessions. This is puzzling to me as, often, their reason for visiting a specialist is to deal with the presence of existing pain and discomfort. To the credit of this therapeutic technique, any discomfort felt will be momentary and overshadowed by the long term benefits of Dry Needling in easing muscle pain.

The needle is the most effective instrument available to therapists to stimulate the Peripheral Nervous System through muscle receptors. It is also an effective means through which to release Myofascial trigger points – physio speak referring to a hyperirritable spot normally within a taut band of muscle.

Trigger points may:

• Refer pain
• Alter sensation
• Affect joint and muscle range of movement
• Cause muscle weakness

(See previous articles for more information on trigger points).

Furthermore, many patients confuse Dry needling and Acupuncture. Even though the needles are the same and 71% of Myofascial trigger points overlap with classical acupuncture points (Melzack), the premise of each technique is very different. Unlike Dry Needling, Acupuncture is a branch of Chinese medicine in which the needles are used to target specific points that provide access to the meridians in the body through which Qi (energy) flows. Acupuncture aims to balance the energy.

Dry Needling offers both Superficial and Deep needling:

Superficial Dry needling involves the use of short, narrow needles placed into the tissue directly over the trigger point or painful area. The pin prick stimulates so-called A delta fibers which are faster than the fibers which carry the pain stimulus  (C fibers). The stimulation of the A delta Fibers therefore reaches pain receptors first with the effect of assisting to block out pain (see diagram below). In fact, similar pathways are involved in the way in which rubbing a sore toe that’s been bumped can help to ease that pain.

Deep Dry needling sees a needle placed directly into the trigger point. Thus much longer needles are used to reach the trigger points in the muscles. Insertion of the needle in this way triggers a host of physiological responses which ultimately see the release of the myofascial trigger point. What one could expect to feel during needling is a deep muscle ache, referred pain or a local twitch response when the muscle being needled jumps or twitches as the trigger point is accessed. Patients are often concerned when this happens but specialists will reassure them that this response is a critical element of successful therapy and is in fact encouraged.

After undergoing needling it is very important that one stretches the muscles that have been needled and applying heat can ease any stiffness.

Needling is not to be seen as an isolated treatment. It is one of many techniques available to a physiotherapist in treating a patient holistically and effectively. It is my hope that this information will go some way towards removing the fear associated with the therapeutic tool that is Dry Needling.

Andrew@PhysioPRO

Trigger points are hypersensitive areas within a muscle belly, commonly called “knots” that when stimulated, usually refers pain in areas around and away from the actual trigger point. They MIMIC pain in predictable band(s) away from the trigger point and also cause contractions in muscles that form taut bands… A trigger point is simply a small contraction within a muscle that can be excruciatingly painful.

Common ways in which trigger points mimic other conditions:

Weight-bearing on one leg more than the other (usually when we’ve had an injury to one side, we bear less weight on that side for example), can cause trigger points to develop in the gluteal muscles. Looking at this pain pattern, we could assume this to be sciatica. Sciatica is the description of a pain pattern and not a true diagnosis. (Fig.A below)

Another scary referral pattern is when a patient complains of severe pain in the left side of chest and down into the left arm. After appropriate testing for a possible heart problem is found to be negative, trigger points in the pectoral (chest) muscles are a likely cause for the chest and referred pain down into the arm. This pain referral pattern closely mimics that of a heart attack…and more often then not, they’re just as painful and stressful.

Severe headaches have become all too common. More often than not, after conducting many scans and tests, the muscles in and around the neck and jaw are found to be harbouring trigger points that are causing the headaches. These muscles contract strongly and can compress nerves and blood vessels causing muscle and nerve pain.

Other severe presentations that may involve trigger points as their cause are the 6-pack abdominal muscles mimicking appendicitis and other abdominal pains.

A wide range of sports injuries including: Tennis Elbow, Shin Splints, Biceps Tendonitis and Bursitis, may involve muscles that mimic and these conditions.

There may be various causes that flare-up trigger points, these may include:

Long term or very sudden overuse of muscles, activation by other trigger points usually in neighbouring muscles, disease, psychological distress (via systemic inflammation), post-surgery, direct trauma to the region, when nerves do not function properly along their path (radiculopathy), infections and chronic health issues such as diabetes, arthritis, smoking, etc.

Common treatment modalities we would use at PhysioPRO to treat trigger points could include:

• Proper diagnoses of trigger points and appropriate referral if serious pathology is suspected.
• Myofascial release techniques and ischaemic pressure.
• Dry-needling.
• Muscle energy techniques.
• Posture correction, Strapping and Taping techniques.
• Proper muscle activation, muscle and movement re-education.

For thorough assessment and comprehensive treatment kindly contact us….

Mitesh@PhysioPRO

Recently, I’ve become very conscious of the fact that I need to address the issue of my personal health and wellbeing (Read: “I really have to shed some kilo’s because I feel like an inert morsel, experiencing unexplained discomfort at times” ). Tired of uncomfortable, boring and outdated workout routines and aiming to get new information in order to enjoy working out again, I came across a thought provoking article online…”

Correcting Posture: Myth or Reality? by Anoop Balachandran (originally published at MindandMuscle.net ). Also see: http://www.exercisebiology.com.

Physiotherapists perform a postural assessment as part of their initial assessments. Deviations from an ideal posture, such as an exaggerated anterior pelvic tilt – will definitely lead to low back pain. A forward head or grossly rounded upper back posture will end in shoulder, neck, and upper arm pain. We have all heard of examples where posture is definitely linked to pain.

The belief of posture related pain conditions is quite widespread. Surprisingly though, there is little scientific evidence to show that ‘bad’ posture will cause pain. We see people with ‘bad’ postures with no pain, and many more with ideal posture in a lot of pain, this shows that there is much more to pain than just posture.

Classifying postures and making people believe that certain postures and movements are bad and dangerous, instills fear of these postures, and enhances pain by fear-avoidance patterns. In short, casual conclusions about pain and posture could be doing more harm than good.

As Physiotherapists we are trained to look for common postural problems and then correct these where necessary. We are also focused on attempting to show a person struggling with pain that they are not doomed to a painful future because of their less than ideal posture but rather an aversion to mobility and normal function. So, the key to long-term alleviation of related pain is management by ‘physical therapy’ not just a passive reception of treatment.

In essence we must note that…

– There is no ‘perfect’ posture.

– Pain isn’t always caused by muscle imbalances (tightness or weakness).

– Pain is much more complicated than just stretching and strengthening the right muscles.

– The body doesn’t do well with prolonged periods of immobility.

– To break the immobility-pain cycle – we encourage movement and never restrain it.

– Corrective postural therapy (such as the various physiotherapy pain – relief modalities and ergonomics) can be effective but must always include movement and functional activities (commonly referred to as exercises).

Yours in Health

Mitesh