At one point during the Bike and Brew festival, a lovely announcer featured our clinic. I was happy about that until I heard her say:
"At ALTA Physical Therapy, they do needling, which is the single most painful experience I have ever had." Just. Great.
This was not exactly what we wanted to convey about Trigger Point Dry Needling (TDN). Nor is it true for most people. But, that might be the word on the street.
So it's time to describe TDN, how it works and why experiences vary so much between patients.
The American Academy of Orthopedic Manual Therapists says this about TDN: Dry Needling is a neurophysiological evidence-based treatment that decreases pain, reduces
muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.
What they meant was this: you could get better faster. Here's why:
Muscles get tight for several possible reasons
- You pull or strain a muscle and it tightens as a result (protective response).
- A series of micro traumas create small tears that, over time, cause muscles to lose flexibility.
- A tight muscle pulls on the tendon, compresses the bursa and perpetuates the problem.
- You are "tension head" and that tension goes right to your upper traps or lower back or some other muscle.
Effects of Tight Muscles on Soft Tissue
Being tense influences both the central nervous system (brain) and the peripheral nerves that go to the body. Those hyperactive nerves tighten muscles and compress joints. Muscle tightness further compresses the joint and you have a vicious cycle of tightness, joint pain and nerve irritation.
Effects of Tight Muscles on
Joints and Nerves
So why can a little - and I mean little - needle make such a big change?
- Increased blood flow-studies show immediate increases in blood flow to the muscles.
- Tight muscles are surrounded by connective tissue. TDN relaxes the taut band around the muscle, allowing muscle cells to return to normal length.
- Spontaneous electrical activity (SEA)-it happens where a hyperactive nerve meets muscle. SEA is associated with tissues that are very sensitive to pressure. The electrical activity diminishes with introduction of the needle, though no one knows why.
- Biochemical changes: Following TDN, changes to the local tissue chemistry are profound. Elevated levels of chemicals that cause pain normalize. With repeat sessions, chemical changes lead to increased blood flow that helps tissues recover faster.
- These biochemical changes are seen in local tissue, but effects are far reaching. Endorphin levels rise in muscle, but also in blood, causing a systemic effect. Substance P (for pain) decreases locally and at nerve roots as well.
But not all needling experiences are alike? Why?
TDN is not for everyone. Some folks are needle phobic and
the anxiety and dread causes a heightened pain resp
onse to the needle. So....if the picture on the right makes you queasy, we'll try something else.
We have lots of options!
Some people have experiences where they come out of treatment feeling like they had an encounter with a porcupine. An overzealous PT can make TDN feel awful, but that's not how we do it. Therapists at ALTA have the experience and discernment to minimize discomfort while maximizing results. It's where less is more and where experience is priceless (and almost painless). If resolution of one or two trigger points, well chosen, causes a cascade of relaxation in surrounding tissues, then they leave well enough alone.
IS TDN right for you?
With prolonged muscle tightness, your central nervous system is already getting altered input. This causes what is called central sensitization. Your pain threshold is lower than normal and your body is on high alert. So being judicious about when and how much trigger point work you get is something your therapist always considers before doing TDN. The right therapist makes all the difference.