Transcription:
Dry Needling at Aspirus Riverview Therapies

Melanie Cole (Host):  Dry needling is a technique used by physical therapists to treat myofascial pain. Here to tell us more about dry needling is my guest today, Dr. Matt Ironside. He's a Doctor of Physical Therapy and a Certified Myofascial Trigger Point Therapist at Aspirus Riverview Therapies. Welcome to the show, Dr. Ironside. Tell us, what is dry needling?

Dr. Matt Ironside (Guest):  Dry needling is the technique that is used to treat myofascial trigger points. So, to start we probably need to define what a myofascial trigger point actually is. A trigger point is a hypercontracted group of muscle fibers within an individual muscle. Muscles are made out of many, many muscle fibers, so if we take that down to the fiber level, they've contracted and they've got stuck. Now, the reason that they're stuck is that they're running out of oxygen. As they contract they burn through oxygen stores and the lack of oxygen limits their ability to contract or relax further. As they do that, there's a chemical process that goes on that winds up making that local trigger point more acidic and that acidic environment brings in chemicals that cause pain. The dry needling is the technique that's used to go in to that muscle on that trigger point, that tight band, and loosened that up. It uses an acupuncture needle and it is invasive. It penetrates into the muscle and causes what's called “the twitch response” as it probes that muscle where the muscle contracts. That allows that muscle to reset and start to contract and relax better with the rest of the muscle fibers.

Melanie:  You mentioned acupuncture. Are they similar?

Dr. Ironside:  It uses an acupuncture needle but the theories are very different, so practices are very different in terms of the education and the background with acupuncture. I'm not an acupuncturist, so it's difficult for me to directly speak to a specific technique of acupuncture but it's going to go into the tissues and use what's called the “needle effect” to achieve some analgesia and they would often insert these needle into what are called the “chi points” which is an Eastern medicine term for specific point on the body. In dry needling, we're looking at trigger points and trying to place that needle directly into the trigger point so the trigger point is helpful at the surface. I can get a hold of it, I can feel it, it's going to be different in one patient to the next as to where that location of that trigger point is, and the that needle penetrates that trigger point specifically to that patient. So, that's where the difference is greatest between dry needling and acupuncture. Now there certainly are overlap and similarities to some different forms of dry needling to acupuncture and some forms of acupuncture to dry needling but they are different techniques.

Melanie:  What type of problems can be treated with dry needling?

Dr. Ironside:  A wide, wide variety of problems can be treated with dry needling but it has to come back to the fact that the dysfunction or the pain is being caused by an actual trigger point or it's from within the muscle. For instance, I will use dry needling to help patients with headaches, with low back pain, with sciatica, foot pain, shoulder pain, and, again, it can really be any joint that has a muscle surrounding as long as a trigger point that's causing the pain itself. From these trigger points, you can get local and referred pain, so a lot of times we can treat some poorly defined pains or pain but haven't responded to other more traditional treatments. We can go back to the drawing board and say, “What else could be causing this arm pain? It's not a cervical radiculopathy; it's not a nerve trapped up in the neck, for instance. Let's look at the shoulder and see if some of these shoulder muscles are contributing to a referred pain down the arm that mimics a cervical radiculopathy which may not have responded to unloading of cervical spine and more traditional treatments to cervical spine.”

Melanie:  Dr. Ironside, is the procedure painful? What will people feel?

Dr. Ironside:  It's difficult to describe to an individual what they'll feel. To me, it feels a little bit of an electrical sense when we get the local twitch response or we get the muscle to twitch. It's not what I would describe as comfortable. It's nothing I wake up and say, “I want to have done to me right now for that sensation,” but it's definitely tolerable for the relief that you can get from it. It's uncomfortable but it's tolerable.

Melanie:  Are the dry needles sterile?

Dr. Ironside:  They are sterile. They're single use needles and certainly they're disposable needles and that’s sterile although the procedure is not what you would define as a sterile procedure. It's not enough surgical or anesthetic. It can be done right in the clinic here.

Melanie:  How long does it take for a patient to see results? Will they feel a difference or do they have to keep coming back?

Dr. Ironside:  A typical treatment I will give to patients is about four visits to say we are making some difference with this technique. A visit can be anywhere from 30-45 minutes not solely doing dry needling. So, that's not the only technique that we're going to do within a session but will be included into that session and combine it along with some exercise, some home program, or some home exercise program, some other manual techniques such as manipulation or some soft tissue massage. Then, that whole treatment group together, I would expect my patients to be able to say, "Yes, there's a change within these first three or four visits." or "You know what? That's not changing my pain at all. This is very similar to everything I've been feeling." Then, it's time to go back to that drawing board again and say, “What's our next step? How else can we effect this pain?” Now, that being said, with my headache patient, some of my headache patient can come in with a headache and walk out without one; or, they'll come in with a hip pain and walk out with more of a light switch type of an effect. It happens but it's not what we're looking. It's not a high expectation.

Melanie:  Is there certain training that goes on with learning how to do dry needling? Do many doctors do it? Is this relatively new?

Dr. Ironside:  It is relatively new. There's definitely some additional training that goes on with it. It's a portion of continuing education. It's not an entry level skill but once you graduate with your Doctor Physical Therapy or take your board examination and start to practice, then there's continuing education to maintain your license that a lot of therapists are starting to go into to be able to better address the muscle pain that are in the patients that we see. The training that I went through was a series of five long weekend courses, so, extended weekend for about four days for about four of them and then the fifth was a whole week of practice and certification testing. There was some significant additional education involved with it, yes.

Melanie:  Where does that fit into this whole rehabilitation program that you might give for somebody that has musculoskeletal injuries or pain that's maybe even not clearly defined. When would you be using needling?

Dr. Ironside:  We would be using it if we can identify a trigger point, a primary pain generator or a contributor to their dysfunction or pain. It will tend to be utilized early on within the therapy program and then transitions away for more hands on physical therapy where I'm directing a lot of the treatment; I'm applying a lot of the treatment to the patient. We'll transition that more to exercise base and health trigger point release technique so that the patient doesn't feel like they need to continue to come in to have it done. They have better control of their own pain and symptoms; they can manage their symptoms on their own outside of clinic. They would need to occasionally come back in and have a little bit of treatment applied to them or therapy; some more of the manual techniques applied to them. They tend to fly backwards as they get out further and further away from therapy but usually, the home exercise program should be able to maintain them as well as continue to improve things outside of the clinic.

Melanie:  Wrap it up for us, Dr. Ironside, what type of problems that people can look to and ask you about dry needling for? Give us a good wrap up of it.

Dr. Ironside:  The type of problems that patients should be looking for in them often comes down to have I tried other options or more traditional therapies for it and it didn't work. Does it feel like an aching or cramping? Does it feel referred from one location to the next? Does it poorly localize? Those are often descriptions that I hear that “I just can't really describe my pain” or when I ask a patient to where is your pain? They start at one spot but then you see their hand open up from a fingertip pointing to a single spot to “It's here completely underneath my hand and then it travels out here or it travels down there. It moves a little bit, it changes, its worse when I contract this muscle.” Those are really common things that I hear with patients that are coming in that may be they are appropriate for this treatment. As well as “I've tried other therapies, my imaging is clear and no one really seems to understand exactly where my pain is coming from.” That can sometimes, too, be an indicator to that we just haven't screened out the muscle tissue quite well enough.

Melanie:  Thank you so much for being with us today. It's such an interesting topic. Thank you for being with us, Dr. Ironside. You're listening to Aspirus Health Talk. For more information, you can go to www.aspirus.org. That's www.aspirus.org. This is Melanie Cole. Thanks so much for listening.