Dry Needling involves the insertion of acupuncture-type needles into muscles in order to relieve pain and restricted range of motion. A myofascial trigger point is a tender “knot” in the muscle tissue. Most of us have these tender areas in various places in our bodies. You might feel a tight band of tissue for example in the upper trapezius muscle of your upper shoulder. In the middle of that tight band, you might feel a small hard nodule. That’s a trigger point. The nodule will be painful when pressed and may also cause pain to radiate out to other areas. A tight upper trapezius trigger point can cause headaches for example. Often, the trigger point that causes symptoms might be quite distant from the painful area. For instance, the gluteus minimus muscle in the hip can cause pain all the way down the leg.
Myofascial trigger points usually form when there is some kind of stress on the muscle. This may be from a sudden overload in a traumatic injury like a fall, a car accident or lifting something improperly. Or, it may happen over a long period of time for example from chronic postural stresses such as sitting at a computer. Most of us have movement patterns, which are not as efficient as they could be. We tend to overuse certain muscles, and underuse others. Also, trigger points can be caused by a problem with the nerves that supply the muscle. This often happens near the spine where the nerves exit from the spinal column. There may be a degenerated or herniated disc, or some arthritis in the joints of the spine. If the spinal nerves become compressed or irritated, the muscles that the nerves supply, become more irritable and are likely to develop trigger points.
This leads to a “vicious cycle” of pain and dysfunction. If you have pain in your shoulder, elbow or hand there may also be a problem in your neck. If you have hip, knee or foot pain you will usually benefit from treatment to your low back.
The fancy technical details....
There is ongoing research about what’s actually happening physiologically at a trigger point. We know that there is a continued release of certain neurotransmitters at the junction where the nerve and muscle meet. This causes a self-sustaining contraction in part of the muscle It holds on, and doesn’t usually let go until it is treated. Also, there is a low level of spontaneous electrical activity at the trigger point site. Because of the muscle tension, there may be some pressure and irritation on the nerve fibers and blood vessels in the area. This causes pain and tenderness in the area, and the decreased circulation causes an “energy crisis” at the trigger point.
Trigger point dry needling is an advanced therapeutic technique that involves placing a small needle into a muscle in order to cause a quick contraction that releases the trigger point. This release improves flexibility and circulation in the muscle and can lead to a decrease in pain and other symptoms. Dry Needling can significantly improve range of motion in post surgical knees and shoulders, and is an effective treatment of low back pain and chronic conditions.
Dry Needling is not acupuncture. Acupuncture is based on restoring flow of energy (“chi”) along meridians in the body. Dry Needling is based on modern Western scientific principles and our knowledge of anatomy and physiology. We needle muscles that harbor trigger points.
During each painless treatment, laser energy increases circulation, drawing water, oxygen, and nutrients to the damaged area. This creates an optimal healing environment that reduces inflammation, swelling, muscle spasms, stiffness, and pain. As the injured area returns to normal, function is restored and pain is relieved.
We are not here to fix you independently of your help. You will be required to be an active participant. We are here to educate you on why you are in pain and how to fix it. We will guide you with treatments, education and exercise into making the necessary changes to achieve long lasting results that you are able to reproduce at home. We have seen a direct correlation between length of treatment and those who are doing work at home and those who aren't.
During you initial evaluation, an extensive history will be taken to rule out red flags and other issues that may affect successful outcomes. You will then be put through a movement screen to look at global movement. From there we will further break down the movement deficits that are related to your pain and dysfunction. As we do this, we are looking at movement habits that you may or may not be aware of which are affecting you pain and function.
As this is done, we test movements to see which improves your symptoms and which increases discomfort. The movements/exercises showing improvement are the same exercises you will receive for home completion. You will NOT be burdened with a large exercise program, typically you are asked to do 2-4 exercises. The exercises you are asked to do are custom to YOUR needs. We do not give cookie-cutter exercises to every patient with the same area of pain.
You are taught how to complete these exercises correctly and efficiently. To help keep your movements consistent when you work at home, we will either take video of you performing them here in the office on your personal cell or email links to videos through a patient portal. Therapy in the office will not be at its most successful, leading to a waste of your time and money, if follow-up work is not done at home. Doing your 'homework' is how you will continue to progress each week with new exercises.
There are a lot of different ways we can address soft tissue injuries and soft tissue dysfunction. Here we use our fingers and massage tools. Sometimes we take a different approach to communicate with the muscles. While dry needling is very effective, breaking the skin barrier is not always necessary. The use of an instrument to assist in soft tissue work is incredibly helpful and accelerates the healing process. Not only does the speed of recovery improve, but the quality of recovery also improves. By using an instrument, we communicate different messages to the brain and the body lays down a higher quality collagen; and this is particularly helpful when the scraping is combined with movement because we talk to the movement receptors in the joint too.
We perform specific soft tissue techniques that address tension patterns across muscle groups. Imagine your individual muscle fibers are like the teeth on a Ziploc bag, if they don’t line up, the bag doesn’t work. This technique lines the muscle fibers back up, much like the teeth on the Ziploc bag, and keeps the power in to be expressed appropriately in muscle contractions.
Another tool we have here are air cups; these can be powerful tools in the healing and recovery process. When we use a scraping tool and cups it is a minor “insult” to the body, stimulating blood flow, lymphatic drainage, and an entire cascade of the healing process without breaking the skin. These leave characteristic bruises while the healing process takes place, and we like to joke about octopus attacks in our office.
Chiropractic translates to “done by hand” and is associated with manual impulses delivered to joints in the skeleton to restore movement and assist in the process of restoring communication between the brain and body via the nervous system. Chiropractic has been around since 1895 when David D Palmer founded it with a notorious adjustment delivered to the janitor of his facility with a book. The early Chiropractors had a difficult path finding out where they fit within the medical profession. They were misunderstood and were accused of providing medical care without being licensed, this happened up until the 1960’s! The profession is continuously evolving, and Chiropractors are growing too.
As a newer profession, we take it seriously to use evidence informed care with a patient centered approach to address the WHOLE human and gather measurable information. We have found that Chiropractic adjustment may be our most powerful tool; but is most sustainable when used in conjunction with functional movement assessments, soft tissue work and neuromuscular re-education in the form of rehabilitative exercise.
Chiropractic has been proven to be extremely effective in treating back pain, neck pain and headaches and has been shown to be received best with education on the body and the WHY behind the pain. We are here to empower you with that information throughout the whole process. And guess what? Here at Evolution, we deal with so much more than the spine and we do it well.
With Chiropractic visits, you can expect to start with one of the most thorough and detailed histories with your clinician. From there, applicable neurological, orthopedic, and other movement screens will inform the individualized path for your care. When your clinician has cleared you of any red flags or indicators that an adjustment may cause further harm, your treatment will begin. The frequency and duration will be personalized to what is going on with your body; no blanket care plans here.
The adjustments delivered will be specific to you and where your body needs mobility restored. The adjustment is what we associate with the “crack”; but we do not require an audible sound for it to be effective. By using a specific hands-on technique, we can communicate to the brain through the nervous system that the area needs attention. The adjustment also releases those “feel-good” endorphins, those don’t suck either. If you have never been adjusted before or if it is your first time back in a while, it is normal for you to feel some soreness in the area and the areas around the areas adjusted.
With chronic pain and chronic injuries, the quality of food we put into our bodies and the amount of inflammation in our organs can affect how we experience pain. The symptoms we have are little clues and happen in clusters. By taking this holistic nutritional questionnaire, we can identify what organ systems are getting overloaded and how we can support that to improve your experience of pain and inflammation in your whole body. The questionnaire allows us to take a “history in motion” and gives us easy biomarkers to measure progress objectively.
Dr. Carly uses the NAQ - Nutritional Assessment Questionnaire to identify potential nutritional deficiencies, imbalances in the body, and which organs or body systems need the most attention from a nutritional perspective. It is a detailed questionnaire that uses over 300 signs and symptoms to evaluate you as a whole.
If you are interested in learning more, please make an appointment with Dr. Carly!