What is Dry Needling?

IS DRY NEEDLING THE NEW WEAPON AGAINST CHRONIC PAIN? 

The ancient art of acupuncture and the modern treatment called dry needling have one thing in common. They both use tiny filament needles to promote healing. shoulder pain

Acupuncture aims to restore a person’s well-being and balance by placing the needles into specific points in the body to open up the body’s Chi, or energy flow.

With dry needling, on the other hand, the target is pain caused by severe muscle spasm, inflammation or injury.  It is a medicine-based treatment that uses needles to stimulate blood flow and promote natural healing to an area of the body that is affected by pain.  The needling therapy leads to a series of intricate chemical reactions in the brain, such as the release of a neurotransmitter called adenosine, which blocks pain. In addition, the chemical response increases natural opiates that leads to an overall decrease in inflammation.

According to Tanya Kalyuzhny, DPT, director of physical therapy at the Greenwich, CT office of ONS, dry needling can be an effective treatment to disrupt neuro-musculoskeletal pain patterns, release muscular limitations and provide relief from other painful orthopedic and spine conditions.

“Dry needling is a useful technique to remedy a range of painful conditions from stubborn muscle tightness to back pain, temporomandibular joint dysfunction (TMJ) and tendinitis,” Kalyuzhny said. Dry needling has been shown to be one of the most effective procedures to release trigger points. For this reason, therapists also use dry needling with patients suffering from fibromyalgia, a condition that can be difficult to treat manually because the points of pain are deep into the muscle.

During the treatment, a physical therapist who is trained and licensed to perform the procedure will insert a needle directly into a point of spasm in the muscle band, known as a trigger point, or around the region of pain or injury. The therapist will gently maneuver the needle until the targeted muscle twitches in response.  The needle is then wound inside the tissue by turning it in a clockwise or counter-clockwise direction. Turning the tissue allows the collagen fibers to wrap around the needle and release toxins from within the muscle. The needle remains inserted into the trigger point for 10 to 30 minutes, during which time patients may experience momentary muscle cramping or a dull ache at the site. The needle is then unwound back to its starting position, which leaves the wrapped fibers in a relaxed state.

“The release of toxins can result in soreness and bruising for a day or two following the treatment,” said Kalyuzhny. Some people experience pain relief shortly after the procedure. However, additional treatments may be required depending on the nature of the chronic pain and other factors.  It can take as many as three treatments to start noticing a change.

While the treatment is relatively new to the general public, dry needling in use with high performance athletes who need to get back into the game as soon as possible.  “Professional athletes often rely on dry needling to loosen tight muscles and relieve pain caused by tendinitis and other sports injuries,” Kalyuzhny said

In most cases, dry needling is part of a larger therapeutic program that includes retraining and strengthening exercises to restore normal function and control of the affected musculature.  ONS has a number of physical therapists who are trained and licensed in dry needling. You can schedule a consultation to find out if dry needling is a pain management option for you.

Biceps and Shoulder Pain

People with shoulder pain often assume they’ve injured their rotator cuff, but sometimes that is not the only culprit. Shoulder specialist and orthopedic surgeon Dr. Marc Kowalsky of ONS notes that an injury to the tendon of the biceps, the prominent muscle in the upper arm that made Popeye and spinach famous, can cause shoulder pain and other uncomfortable symptoms such as clicking or popping.

“The biceps tendon is an often-misunderstood structure of the shoulder and arm,” said Dr. Kowalsky. “We now know that damage to that tendon is often the primary cause of shoulder pain in active people.”

Anatomically, the biceps muscle has two tendons, called heads, that attach it from the elbow to the shoulder. The tendon of the short head attaches to a bone on the shoulder blade outside of the joint. The long head, usually the source of the pain, takes a circuitous path into the shoulder joint. It then attaches to the top of the socket and the glenoid labrum.

As with any other tendon in the shoulder, the biceps can develop tendonitis and tears. It can be a result of repetitive, strenuous overhead activities. Pain from biceps tendonitis or partial tearing typically occurs over the front of the shoulder. It radiates toward the biceps muscle. If the biceps tendon fully tears or ruptures, patients may notice bruising and a cosmetic deformity as the muscle descends and becomes more prominent, in what is known as a “Popeye sign”. Lastly, you can affect the biceps tendon by instability, particularly in certain overhead athletes including swimmers. Biceps instability can also occur in association with a particular tear of the rotator cuff tendon in the front of the shoulder. When this happens, pain is caused because the biceps has slipped from its bony groove of the upper humerus (head of the arm bone).

Moreover, most patients with tendonitis, a partial, or complete rupture of the long head of biceps can be treated conservatively. You can use a combination of ice, anti-inflammatory medication, physical therapy, and corticosteroid injection, said Dr. Kowalsky. Although the cosmetic deformity from a complete rupture will persist, once the pain from the acute rupture improves, strength and overall function of the shoulder should return to normal. If conservative measures fail to relieve symptoms from biceps problems, surgery may be recommended.  If you experience shoulder pain, consult with a fellowship-trained shoulder  specialist at ONS.