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Dry needling and acupuncture – A physio’s perspective

How many times have I heard this … “Needles?! Not today…. Let’s do it another time when I’ve prepared myself”

In practice, I have discovered that about 20% of patients have some kind of reticence or phobia around the concept of needles. For some, it may be a childhood memory of that dreaded vaccination in the arm or buttocks. For others, it’s the anticipation of ‘that sharp pointy thing stabbing into me!’ There is also little knowledge and some concern around the eastern practice of acupuncture. Whatever the reason, needling is not always the most popular tool in our physio tool kit.

dry needling needles

Fortunately, there are many other tools in the physio’s proverbial tool kit, so needling is by no means an essential. However, it can be a very effective tool when given selectively and skilfully…. and received fearlessly. Let it be stated that if there is any phobia or concern around needles, it is best that they are not used. This is because fear releases chemicals in the brain that are in opposition to healing. When in doubt, rather don’t!

The purpose of this month’s blog is to:

1.) Hopefully dispel any fears and phobia’s around needling.

2.) Demystify the concepts of acupuncture versus dry needling.

3.) Enable understanding of HOW the needles work their magic.

Trigger points … causing tricksies

First of all…. Why is there a need to stick a needle into your muscle in the first place?

Needles are an effective way to treat trigger points in muscles.

Have you ever felt a tender, palpable ball or band in one of your muscles? It sometimes feels like you are pushing on a bruise, but there is no evidence of a bruise or any recent trauma to that area. Sometimes the muscle can ache, or feel hurt or tired when you try to use it. It may even refer pain to other parts of the muscle or body. This is a trigger point. They are very common in the muscles around the neck and shoulder blades (particularly in desk workers) or the thigh muscles and the calves (particularly in runners and cyclists).

dry needling trigger points

Trigger points are primarily caused by constant or repetitive load on a muscle or set of muscles. This can either be from being in one position for long periods (e.g. desk worker or paddler) or repetitively using the same set of muscles, sometimes with little time between episodes to recover (e.g. runner or bowler). Please note that this is very different from a muscle strain, where there is an element of tissue damage and inflammation present.

Muscles are made up of muscle fibers, positioned like rows of spaghetti running alongside one another inside the muscle belly. Inside these strings of spaghetti are even smaller strings of spaghetti called myofibrils. Myofibrils are made up of sections of interlocking filaments called sarcomeres. These sarcomeres glide together and ‘lock’ at any point along their length when a muscle contracts/shortens. They then glide apart when a muscle stretches or lengthens.

When a muscle is in its relaxed resting position, they sit about halfway (i.e. the interlocking filaments are about halfway overlapped). In the case of a trigger point, the muscle will be in a relaxed state, but there will be a section of muscle that is ‘stuck’ in a contracted/ fully overlapping state. This causes increased resting tension in that part of the muscle, causing a trigger point.

You could say that the muscle has ‘gone on strike’ because it is tired of being overused and not adequately rested! I think we are all familiar with this concept. Pain is how your body ‘speaks’ to you, telling you when it needs attention or when it needs to be offloaded!

Dry needling … west is best?

Dry needling is an effective and efficient technique for the treatment of muscular pain and dysfunction. It is particularly good for relaxing overactive muscles, which contain trigger points. In simple terms, the treatment involves inserting a fine, sterile single-use needle into a muscle’s trigger points without injecting any substance. The mechanical action of the needle stimulating and releasing the trigger point is what does the magic.

dry needling needle in calf

Dry needling is based on western anatomical and neurophysiological principles. There are maps of where trigger are likely to sit in most muscles and how they are likely to refer. This is usually fairly consistent from person to person. Inserting a needle into the trigger point helps to ‘deactivate’ it by stimulating the sarcomeres to ‘unlock’ themselves and glide back to their normal resting position. This can also be done through sustained pressure (aka ‘trigger point therapy’) and myofascial release techniques. So rest assured, if you really don’t dig needles, there are other ways to release overworked muscles.

Acupuncture … the beastly easterly!

Dry needling should not to be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture. However, since the same needles are used in both dry needling and acupuncture, the confusion is understandable. From the outset, they practically ‘look’ the same when being administered …. But the underlying philosophy underpinning each is quite different. The points along the body used are also different.

Acupuncture originated in China over 5000 years ago. Some say that acupuncture in India actually predates this, and travelling healers took the practice across to China. It’s based on the belief that health is determined by a balanced flow of ‘chi’, the vital life energy present in all living beings. This is the same as our nerve and blood flow in western medicine, which carries ‘life’ to all the parts of the body. In fact, the chi pathways actually mirror the nerve and blood pathways to a large extent! Across times and traditions, we are actually more the same than we are different.

According to acupuncture theory, chi circulates in the body along twelve major pathways, called meridians, each linked to specific internal organs and organ systems. By inserting needles at specific points along the meridians, the practitioner can redirect and reposition the flow of energy (chi) for the purpose of relieving tension, stress, and pain. The uninterrupted and balanced flow of energy along these meridians contributes to one’s overall health.  However, blockages and imbalances result in pain and illness.

Acupuncture can be used to treat a myriad of different illnesses, but in physiotherapy we are really just interested in the points that treat musculoskeletal pain. There are some acupuncture points that are very effective for treating pain, both on a whole body level for painful conditions … but also for specific joints and areas of the body. For example, the 36th point along the stomach meridian (called ST 36) is really good for treating knee pain.

Putting it all together

This is how both western acupuncture and dry needling taught me to reason through HOW the needling works in your body:

1.) At a local level, the needle causes the little blood vessels around the needle to dilate. You can usually see a red ‘flush’ around where the needle is inserted. This causes an influx of blood to the area. As mentioned earlier, the blood carries ‘life’, bringing more oxygen and nutrients to the area and carrying away waste products and toxins. This facilitates healing.

2.) At a spinal level, the needle causes a ‘throb’ or ‘pulsing’ sensation. You will remember this vividly if you have been needled! This feeling is actually the stimulation of a particular set of nerves that ‘override’ the pain signals going up to the brain, as they travel faster up the spinal cord.  This serves to lessen the brain’s perception of pain. Other physio tools, such as TENS and interferential therapy, do the same thing.

3.) At a higher brain level, the activation of the above-mentioned nerves actually stimulate the brain into releasing a barrage of ‘feel good’ chemicals called endorphins. These chemicals have a natural pain relieving effect. This is also how needling can work for whole-body or wide-spread pain, as experienced by patients with chronic pain conditions.

The effect of dry needling and acupuncture is different for everyone, as we are all individually created and we differ in our responses to most things in life.

In closing, hopefully this has been helpful in dispelling the myths and maladies around needling, as well as providing a better understanding of why we use it and how it works.

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