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Healing Me Sharply

Controversial and often misunderstood—and currently not allowed in New York state—dry needling probes into muscles to find “trigger points” and relieve pain

by Matthew Schniper on August 7, 2013 · 2 comments

 

Put it this way: If acupuncture is snorkeling, then trigger-point dry needling is deep-sea diving.

As a regular recipient of both alternative therapies in recent months, I’m more than clear on the difference between a needle that settles just under the skin’s surface, and one that probes deep into the belly of a muscle in search of a “dysfunctional neuromuscular junction,” or trigger point.

And beyond the sensory contrasts, the practices’ back stories couldn’t be more different. Acupuncture, which focuses on “meridians” in the body through which chi is believed to flow, enjoys a lengthy history based in Eastern medicine. Dry needling, by contrast, is firmly rooted in Western principles, with initial studies having been published only some 30 years ago.

So I was surprised when my physical therapist and dry needle practitioner, Jeremy Snyder of Rocky Mountain Rehabilitation, told me of how carefully he has to navigate a certain tension present in some circles of the needle community.

“I go out of my way to tell people I’m not doing acupuncture, because I’m not trained in that,” Snyder says. “But physical therapists have the background to learn this technique very easily. . . . We already have a history of knowing anatomy and biomechanics.

“I’ll actually refer to acupuncturists for [when there's] more nerve pain or more pain response. There are times where I think acupuncture does a better job. [Dry needling] is great for musculoskeletal issues.”

Which is what brought me to Snyder in the first place.

Last summer, I broke my leg in a motorcycle accident. I had a tibial plateau fracture, to be nerdy and precise about it.

That’s where the shinbone meets the knee joint, which makes for a relatively traumatic snap spot. Mine required five screws and a surgical steel plate to heal the fracture over a course of several non-weight-bearing months. After that, as I slowly healed, I dealt with a number of pains beyond the primary ache at my fracture site, mainly because my body was compensating for the weak area and working around the metal. My hips would get out of balance, my lower back would ache, and muscles all along the leg that suffered the injury would tighten uncomfortably, hindering my range of motion and mobility.

I sought treatments from a chiropractor, an acupuncturist, a deep-tissue massage therapist and Snyder, who as a PT, literally taught me to walk again. But his dry needling—which he learned four years ago and has since taught to and consulted on with several NFL teams’ training staffs—became a rescue buoy when my joint and greater leg would feel locked down from tight muscles and imbalance.

Before my usual 30-minute treatment, I’d feel a painfully tight muscle band. But after needles went into my muscle—aided by a 9-volt-powered device that sends a tiny electrical current through the needle for the purpose of achieving a contraction—my muscle fibers would go soft and buttery to the touch.

Snyder calls dry needling a “reset,” likening it to “rebooting your computer” and then “running software to reinforce it.” In this analogy, that software comes in the form of therapeutic exercises and the like.

“This is the reset, but really the treatment is your exercise,” he says, adding, “I use the idea of training a movement versus training a muscle.”

About now, you may be wondering just how painful this all is, being stabbed deeply and repeatedly with a 4-cm needle, your bone used as a protective backstop. And I won’t tell you it doesn’t hurt at all, especially when Snyder targets a good trigger point. But honestly, assuming one isn’t needle-shy in the first place, it’s not so bad. If you’ve had serious dental work or gotten a tattoo, you’ll find it a walk in the park. And there are far more uncomfortable things Western medicine subjects folks to in the name of prevention, or so I’m told by my colonoscopy-getting elders.

“We have most of our sensory organs on the skin. Once you get through the skin, it’s not that uncomfortable,” says Snyder. “What people feel is a crampy sensation when you hit a good spot. It feels like a deep muscular cramp.”

For some, the residual, post-needling ache may last a while, but for me it never passed 24 hours and my relief always outweighed that short ache. The “reset,” though, is patient-specific and ailment-dependent.

“In acute injuries, a lot of times it doesn’t need that many sessions to re-create that normal pattern. They bounce back really quickly,” says Snyder. “People that tend to take longer are people with chronic pain or people that have had significant changes to their joints or that have had pathways that have been dysfunctional for a long period. They tend to respond well, but for shorter durations. It tends to last a day to a week.”

For those interested in the real nitty-gritty as to how it all works, Snyder has some disappointing news: The PTs don’t fully understand it.

“Something happens and there’s higher EMG [electrical muscular activity] . . . that changes the chemical makeup of those spots. We know with needling, it decreases the EMG activity and it changes those chemical concentrations in those areas. More importantly, it relaxes the muscle and gets it to fire more.”

Dry needle practitioners draw some data from acetylcholine, the chemical that makes your muscles fire, or contract. And chemical readings done at trigger-point sites with a micropipette (another fun, stabby tool) before and after treatment showed a decrease in acetylcholine and other chemicals post-treatment.

“So one of the theories is with all the contractions [produced via the electrical current sent through the needle, or by repeated manual probing], we’re using up the extra acetylcholine,” explains Snyder, adding that dry needling is argued to produce not only chemical change, but biomechanical and neurological as well.

“Just as in clinical practice,” he says, “if I needle someone’s right hamstring, sometimes their left hamstring’s length improves. And to me, the only way to explain that is there has got to be something happening, either at the spinal segmental level or at the brain level.”

He says it’s not uncommon in orthopedics to find that the site of pain isn’t always the source site of ailment, that muscular referral remains a somewhat elusive phenomenon. Tennis elbow, for example, can be rooted in muscles in the neck.

Yep, it’s all pretty heady stuff. And maybe it’s not for you, even if your insurance covers such treatments. (Medicare, for one, does not.) But again, more and more people are turning to the therapy for relief.

When Snyder began practicing, he says, only seven states allowed PTs to employ the technique; today, only six states (including New York) don’t allow it. Meanwhile, the company he teaches for, KinetaCore, used to offer a single class on the technique every three months; today, three per week are typically scheduled. Shared research on PubMed (ncbi.nlm.nih.gov/pubmed) also abounds, should you care to learn more.

Matthew Schniper is an arts editor at the Colorado Springs (Colo.) Independent, where this story first appeared.

 

 

{ 2 comments }

Dr. Steven Schram August 8, 2013 at 6:24 pm

This is a horribly inaccurate article.

First off, there have been numerous legal rulings, even here in NY (Fernandez from the Department of Education 1992) that have determined that dry needling is simply acupuncture by another name. The purpose of renaming it is to skirt the very stringent regulatory and license requirement necessary for patient safety.

Many acupuncturists are well trained in the techniques referred to as dry-needling, and there is even an entire school whose focus is on these techniques. It is sometimes called ahshi or trigger point needling.

Describing an ancient technique in modern scientific terms does not recast it into the realm of physical therapy, no matter how loudly the PT community may argue that it does. And the use of an acupuncture needle by an inadequately trained practitioner brings more risk to the public. A search of adverse events (besides infections) from the use of acupuncture needles almost always involves under-trained practitioners.

If a patient is looking to get treated for musculo-skeletal pain, and wants to be needled, they should seek out a qualified acupuncturist. Not some practitioner who has taken a weekend course and feels empowered to stick needles into a person because they have also studied anatomy and biomechanics.

Oscar Moreno OMD August 14, 2013 at 8:01 pm

Misleading article in the sense that it shuns acupuncture. Basically it makes this ancient and highly complex practice sound as inferior to dry needling when it comes to muscular problems, and makes dry needling sound as an innovative modern and miraculous practice. The truth is that “dry needling”, or what we called in TCM treating ah’shi points has been done for thousands of years. Don’t you think that a practice that has existed for millennia wouldn’t have already thought and applied this type of techniques? There are many ways of using acupuncture as it can involve deep needling with strong stimulation or shallow needling with light stimulation, just to mention some combinations.

In my opinion dry needling is a deceptive practice in the sense that it wants to look independent from acupuncture, in both roots and methods. If PT’s want to properly use acupuncture, they should study the proper acupuncture degree and apply the practice properly. We don’t go around calling ourselfs eastern physios, we do have professional integrity.

Finally, currently the most alarming issue in regards to dry needling is the lack of proper training. In Australia you only need to train for two days, that’s right, two days! and then you can go and insert needles in people, placing the public at risk. We have to train for at least 3000 hrs to be able to practice acupuncture. Furthermore, the PT board in Australia has allowed the title “Western Acupuncture” to be used by their practitioners so they can jump the TCM degree and use the acupuncture title. What a travesty and strong lack of personal integrity from such individuals.