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What is Dry Needling and How Can it Help Me? / Chronic Pain
Katie Ruebush discusses dry needling and how it can be beneficial as well as chronic pain and possible ways to treat it.
Featured Speaker:
Katie Ruebush, PT, DPT
Katie Ruebush, PT, DPT, a Bushnell, IL native, received her B.S. double majoring in Exercise Science and Human Performance and Fitness with a minor in Biology from St. Ambrose University. She went on to earn a Doctor of Physical Therapy degree from Washington University in St. Louis, completing clinical rotations at Rush Hospital in Chicago, IL and The Rehabilitation Institute of St. Louis. After completing a women's health clinical at Rush Hospital and participating in a women's health focus study under a women's health board certified physical therapist and professor at Washington University, Katie began to specialize in pelvic floor therapy in 2013. Katie has since expanded her knowledge and experience in this area but also treats patients with various orthopedic and neurological conditions. Katie is a member of the American Physical Therapy Association (APTA) and the Academy of Pelvic Health Physical Therapy. Transcription:
What is Dry Needling and How Can it Help Me? / Chronic Pain
Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.
Melanie ole (Host): Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us as we discuss dry needling and how it can help you. Joining me is Katie Ruebush. She's a Women's Health Physical Therapist with Memorial Hospital. Katie, thank you so much for being back with us today. So, you've recently become certified in this practice of dry needling. Before we talk about what it is, can you tell us a little bit about yourself and your background and the additional training that you need to become certified to do dry needling?
Katie Ruebush, PT, DPT (Guest): Sure, thanks for having me today. This is a topic I'm really excited to talk about. I'm a physical therapist. I've been a PT for over eight years and I've treated a lot of different types of patients. And I currently am treating a lot of women, in pelvic floor dysfunction. But I also have this interest in orthopedics and neurology and treating patients with chronic pain. So, I recently was certified in a technique called dry needling, and it requires some additional training on top of your physical therapy license and degree. So I did two different courses, level one and level two that were fairly intensive to be able to offer this new service called dry needling, which is a very beneficial treatment, for treating patients with any type of pain or restriction in a joint, people who are lacking flexibility or experiencing any pain.
Host: So tell us what it is. You just gave us nice little kind of working definition of what it helps, but what exactly is it?
Katie: Sure. It's, it's based on the theory of myofascial pain. Myofascial pain is the theory that's bands of taught muscle tissue can reproduce pain or restrict movement. And using a very small sterile needle, you can insert that needle into muscle or connective tissue to release those myofascial trigger points and improve function, improve muscle contractility, decrease pain and increase range of motion. Like I said, I've been really pleased with the results. People are responding really well. It's decreasing their pain and people are able to say that they're getting through the day without pain, they're sleeping better and just feeling a lot of relief from it. I would compare it a little bit to what you feel in a deep tissue massage. People who respond really well to that deep tissue massage, tend to respond very well to dry needling.
Host: Well, people hear the word needle, Katie, and they wonder what the difference is between acupuncture and dry needling and really the science behind this technique versus acupuncture. Why one works, one doesn't or how they work. What's the difference between them?
Katie: Really the only similarity between acupuncture and dry needling is the diameter of the needle being used. The theory is very different between the two. So, an acupuncture treatment is very superficial with the needles and it's based on the theory of different meridians in the body, which are like invisible energy pathways. Dry needling, again is based on that myofascial pain model. And the needle is inserted intramuscularly. Meaning, that we're releasing those tissues that maybe aren't receiving enough blood supply or oxygenation, and those muscles become dysfunctional when they aren't getting enough blood supply. So, the science behind it, there's several reasons why dry needling is helping.
And there is some research to back this. But it's helping people because of a few things. One is that we're increasing the blood flow and we're changing the chemicals in that tissue by creating this pro-inflammatory response. So, we get this extra blood flow to the tissue that's really bathing muscle and connective tissue and nerve, and it instigates this cascade of good chemicals to that area.
And essentially it's using your body to heal itself. Some other reasons why dry needling is helping is because when muscles are really taught and tight and you get those myofascial trigger points, there's this extra neural input to that tissue. So, there's extra noise at the motor end plate. And so by releasing that muscle, we can kind of reset the neurological system and improve in a normal, and normalize that input from the nervous system.
It also is thought to increase some feel good hormones like endorphins and serotonin, and maybe even oxytocin. And I would say also, just thinking about chronic pain and pain science, we're interrupting the pain pathways, which can lead to a remapping of the brain and helping to desensitize some signals that might be hypersensitive.
So, there's really several reasons why it's helping, but those are the big ones that research is supporting the use of dry needling.
Host: Well, thank you for that. And before we discuss really patient selection, who can do this, tell the listeners what trigger points really are and why those are what you're using.
Katie: Trigger points or bands of really taught parts of muscle. And sometimes you press on those knots or those trigger points, and you might even feel a referred pain. For example, in your, some of your neck muscles. There are trigger points that refer to the head and create headaches. So, releasing some muscles in the neck tend to help with, with different headache, pain, depending on where that headache is located. But again, it's, it's improving the blood flow to the tissue that has this myofascial trigger point.
Host: So, now tell us who it is that can benefit from dry needling. My son's a gymnast and he went in for dry needling around his shoulder and he really loved it. He thought it helped tremendously. So, tell us, really, who who can benefit from this?
Katie: Really anyone with any type of pain or joint restriction. If you have stiffness, if you've had, like you said, a sports injury, or maybe it's a more chronic condition or a chronic pain, but anybody that's had a, a lot of headaches or neck pain, back pain, I've seen even some jaw. What's called TMJ dysfunction. Sciatica is a big one. Anything restrictive, like a frozen shoulder could benefit from it. Plantar fasciitis, sports injuries like shin splints tend to do pretty well. Even people that have had numbness in their hand or arm have been telling me that they've got some relief from those symptoms as well.
There's even a little bit of research on some vestibular dysfunction improving, so, dizziness and even the ringing in the ear might benefit from some dry needling.
Host: So, where does it fit into a rehabilitation plan Katie? Because people think they're going to go see a physical therapist for, as you said, whether it's vestibular or pelvic floor, or injury or any of these things you've mentioned, where does it fit into that rehab plan, when you're looking at helping them with whatever injury or malady that they've got going?
Katie: Well, I think people get the most lasting results when dry needling is accompanied with other therapy techniques. It does matter what posture you're using all day long and how you're moving, using proper body mechanics. So, people get more relief and more longer lasting relief, if you do some stretching and some really specific exercises, and just allowing me, a movement specialist to analyze how you're moving and how you're sitting at work, talking about even like modifying your workstation so that you're in an optimal alignment and posture all day long. So, it it's really beneficial and it really jump-starts the rehab process, but you really need a few other things in your plan of care to, to fix your problem and maintain that relief.
Host: I think a big question that you probably get, and I've heard this question a lot too. Is, does it hurt? Are there any complications, soreness? I mean, we get a shot and maybe our arm is sore for a few days, but this is not quite the same, is it? Tell us a little bit about any complications or really if the needles hurt.
Katie: The needle is so small, actually, most people don't even feel the needle go in, but once that needle hits a trigger point, you're going to feel a deeper ache. And afterwards you might have a little soreness. Some people do, some people don't. Usually people have a little bit of muscle soreness. It feels kind of like you've worked out or had a deep tissue massage.
But the, the discomfort is pretty minimal and it only lasts about 24 hours. As far as risks, they're pretty low. Because you are inserting a needle into the skin, there is a small risk for infection, but it's a low risk and we use sterile needles and we clean the skin. I use gloves and sanitizer, but, patients who are significantly immunocompromised would not be a good candidate, but other than that, you know, the risks are pretty low and the results are pretty significant.
Host: That's excellent to hear. If someone has dry needling and they're thrilled with the results, tell us a little bit how often they need to come back to maintain those results. And what's involved in an appointment with you?
Katie: It depends on the patient. And it depends on what the patient Is doing outside of the dry needling. You know, if they're doing the stretching and some specific exercises that I'm having them do and really modifying how they're moving, you know, some people need one or two sessions. If you've had dysfunction for a really long time, you might need more like three or four visits.
It really just depends. But I usually see patients about once a week. And some people get, get relief for a few weeks. Some people get relief for a few months. So, it's very, just dependent on the patient. How long you've had it. What other lifestyle changes are you making? When you come in for an appointment, I'll do an assessment and I'll take some measurements.
We'll do some baseline testing and then we'll do some dry needling and then talk about posture, positioning, some exercises and other techniques that might help you and develop a plan of care, that's focused around what your goals are and what activities you want to get back to and, and what you want to achieve during your time in physical therapy.
Host: Is this something that people need a referral for?
Katie: Not necessarily. Illinois makes that answer a little bit more complex, but if you don't have a doctor's referral, you can give me a call and get in to schedule an appointment with me and I can help you go through the appropriate channels that you need to continue to see me.
Host: What an interesting topic and I've done a lot of shows about chronic pain and heard from so many different people in the pain management field, this is a huge field now, pain management. So, tell us a little bit about pain as you see it as a physical therapist, the difference between chronic pain and acute pain and since pain, what we're talking about, is somewhat subjective, how do you measure it?
Katie: Well, it depends on the source that you're reading, how we categorize chronic pain and acute pain. We used to think of it as pain that lasts over six months, but recently they've changed that definition. It's really pain that persist over three months or in a response to the healing process that is not typical.
So, if you've, you know, injured your lower leg, and typically it heals in a few weeks and yours is persisting with pain for six or eight weeks, you know, that could be considered a chronic pain as well. Acute pain would be pain that lasts less than three months. So, it depends on what source you're looking at, but somewhere in that three to six months is the cutoff for chronic versus acute pain.
Host: So, how does somebody decide or know when it is time to see a physical therapist for that pain, whatever, the reason for the pain and before they would see you, do they have to go see an orthopod for their pain or their primary care provider to not only get a referral to physical therapy, but to decide that, yes, this is something that can help you with your pain?
Katie: Sure. Anytime someone wants to come see me for their pain, I think is fine. I like to tell people if you've had pain for two weeks or more, it is really beneficial to come in and get an evaluation by a physical therapist so that we can address the issue before it becomes more severe and before it becomes chronic. We know that once that pain becomes chronic, it's a little more complex to treat, and we really want to stop that pain cycle before it becomes chronic. Chronic pain is a vicious cycle, but it is also really fascinating because it changes the neural pathways and how your brain is mapped. But also regarding seeing the physician first. Ideally, if you can see your physician and get a referral, that would be the ideal way to go, because we know there are multiple things that can cause pain, and we want to make sure that they've ruled out organs and other more serious conditions.
Host: So, then tell us what you do. How do you work with a patient that's suffering from chronic pain? Tell us a little bit about this multifaceted approach to painful disorders and what are some of the first things that you would do with someone when they come to you.
Katie: Well, chronic pain is treated a little bit differently than acute pain. And that's because our brain, when you've had pain for a long time, it starts to interpret painful signals differently. And sometimes, those neural pathways are more sensitive. So, I would compare it to, if you felt a feather brush along your skin, someone with chronic pain might feel a much more intense, painful sensation than just that feather.
So, there's kind of a misinterpretation of signals sometimes, and there's a lot that goes into that theory behind chronic pain. But the main gist is that our central nervous system is having some altered sensory processing and patients are having a little bit less of a like a decreased pain threshold. But in physical therapy, we treat chronic pain a little bit differently because we know that sometimes movements that are painful, are not harmful. And so the best treatment for chronic pain is movement and actually not avoiding movement. Sometimes that chronic pain cycle continues because people are avoiding movement.
And really what we need more of is, is activity. So, just education for patients that doing some aerobic exercise, even if it's just 10 minutes at a time, walking, biking, you know, stationary bikes, swimming, things that are a lower intensity, but for a longer period of time is really helpful. Another key factor is how you're moving. As a PT, I'm a movement specialist, and I can help you learn to move in an optimal way so that your joints are loaded in an optimal position and you aren't damaging tissues. We don't drive our car when it's out of alignment, you know, you wear out the parts of that car and the human body is no different. We really want to move in an optimal alignment to protect our joints. So, some of what we're doing is just teaching you how to move in a safe and pain-free way.
Host: One of the things I, one of the things that I've heard over the years as an exercise physiologist is whether I use, people ask me all the time and I know they ask you too; ice, heat, bracing. When someone's suffering from knee pain or back pain, which so many people or neck pain, shoulder pain, whatever it is. Are you somebody who likes heat or ice or a combination of these modalities? What do you tell people to do on their off time when they're not working with you?
Katie: Again, I think it depends on the patient. You know, how recent was your injury? If your injury occurred within the first two weeks, ice is probably better. And then when it becomes chronic, you know, it depends on what feels best for the patient. So, sometimes it's ice, sometimes it's heat. And I usually just tell the patient whatever feels better to you once you're out of that acute phase of the injury.
And as far as bracing goes again, I think it depends on the patient and really what the activity is that they need to do. And what we can do to make it feel better. And there are times where a brace can help. And there's times where I don't really want that patient to wear a brace because I don't want to restrict their movement.
But again, when it comes to chronic pain, it's really about just moving and not being afraid to move. And you go back to the basics that we need to live a healthy lifestyle at a healthy weight and stay active. We need to get adequate sleep. We need to manage our stress and really just reach out to the health care team to, to help you manage your pain.
Host: One of the things I've found most interesting about this burgeoning field of pain management, Katie, is that while we're trying to move away from opioids and I'm sure you've had plenty of people that have come to you, that have been on pain medication, but now it seems that many in the field, physical therapists, athletic trainers, chiropractors, acupuncturists, massage therapists, everyone's kind of running along the same track now. Have you seen this in your practice that some people come to you and say, I don't want to be on opioids anymore, or I've seen a chiropractor and that's helped, but not completely. What have you seen as far as this multidisciplinary approach to the field of pain management?
Katie: Well, I think as a physical therapist, it is really exciting because we do have the ability to have an effect on this opioid crisis that's happening in our country. My whole job is about how to help people either decrease their pain meds or avoid pain medication or avoid surgery. So, we really do play a huge role in, in that opioid crisis. And as far as the interdisciplinary team, we have to have a team approach. Here at Memorial, we have primary care providers who are fantastic at helping patients with several options to manage their pain. If the patient that has chronic pain is having a lot of stress that's contributing to the pain; seeing our mental health team here at Memorial might be part of your treatment plan. Weight management is huge when it comes to decreasing pain and the loads our joints are taking. And so it might mean talking with our dietician, Ashlyn Houseright. So yes, having a team approach is crucial.
Host: It definitely is in, and before we get ready to wrap up, I'd like you to offer your best advice for us about seeing a physical therapist, if we are someone who's suffering, whether it's acute or then becomes chronic pain and give us a little ergonomic lesson, if you want to. Tell us, cause you mentioned before, ,sometimes it's about lifestyle and behaviors and we've all, you know, people, a lot of people have started working from home or they do a very physical job. What do you want us to know about ergonomics, sitting at a computer? You know, using our hands, our kids are all texting. They're going to get that text thumb or text neck. What do you want us to know? Give us your best advice.
Katie: My best advice is get up and move, take lots of breaks. And our body is made to move and be active. And so just keeping moving is the best advice I can give you. Don't be afraid to move. If you're having an ache or a pain, it's better to move, than it is to avoid or have fear for movement. And just specifics on sitting at a desk, having a good backrest, making sure your chair has some armrests, that your computer screen is at eye level, that you're not reaching for that keyboard or reaching for the mouse, having your knees at a 90 degree angle and your hips at a 90 degree angle.
Some specifics for the computer are things about just proper mechanics and posture during the day. And like I said, get up and take breaks. Don't sit there for hours on end. Get up and move.
Host: And you could help people with those mechanics and suggestions, can't you? I mean, I personally had elbow pain and from sitting behind this microphone and on a computer and I got one of those penguin mouses that turns my, you know, it rotates my arm and the pain went away almost immediately from the position that I was in where I was pronating my hands.
So, you know, there are a lot of suggestions and you could help people with those suggestions, can't you?
Katie: Exactly and it's, it's all, it's different based on the patient. So, sometimes it's helpful if you can even take a picture of your workstation or take a picture of you sitting at your workstation, because everyone's going to have a different setup and different things they can, or can't modify. Some people use two screens, which has becomes an issue.
So it really just depends on the patient and maybe your job isn't sitting at a desk. Maybe it's something more labor intensive where I can teach you how to bend and how to lift and how to do whatever task it is that you're doing all day in a better way. And in a, in a less painful way.
Host: What great information we have given today. Katie, you're just a wealth of information and knowledge. And thank you so much for joining us today. To schedule an appointment with Katie, please call 217-357-6560. You can always visit our website at mhtlc.org for more information. There's lots of information on the website and that.
And that concludes this episode of Say Yes to Good Health with Memorial Hospital. We'd like to thank our audience and invite you to download, subscribe, rate, and review this podcast on Apple podcasts, Spotify, and Google podcast. And if you found it informative, please share with your friends and family on your social channels. We're learning from the experts at Memorial Hospital together. I'm Melanie Cole. Thanks so much for joining us today.
Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.
What is Dry Needling and How Can it Help Me? / Chronic Pain
Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.
Melanie ole (Host): Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us as we discuss dry needling and how it can help you. Joining me is Katie Ruebush. She's a Women's Health Physical Therapist with Memorial Hospital. Katie, thank you so much for being back with us today. So, you've recently become certified in this practice of dry needling. Before we talk about what it is, can you tell us a little bit about yourself and your background and the additional training that you need to become certified to do dry needling?
Katie Ruebush, PT, DPT (Guest): Sure, thanks for having me today. This is a topic I'm really excited to talk about. I'm a physical therapist. I've been a PT for over eight years and I've treated a lot of different types of patients. And I currently am treating a lot of women, in pelvic floor dysfunction. But I also have this interest in orthopedics and neurology and treating patients with chronic pain. So, I recently was certified in a technique called dry needling, and it requires some additional training on top of your physical therapy license and degree. So I did two different courses, level one and level two that were fairly intensive to be able to offer this new service called dry needling, which is a very beneficial treatment, for treating patients with any type of pain or restriction in a joint, people who are lacking flexibility or experiencing any pain.
Host: So tell us what it is. You just gave us nice little kind of working definition of what it helps, but what exactly is it?
Katie: Sure. It's, it's based on the theory of myofascial pain. Myofascial pain is the theory that's bands of taught muscle tissue can reproduce pain or restrict movement. And using a very small sterile needle, you can insert that needle into muscle or connective tissue to release those myofascial trigger points and improve function, improve muscle contractility, decrease pain and increase range of motion. Like I said, I've been really pleased with the results. People are responding really well. It's decreasing their pain and people are able to say that they're getting through the day without pain, they're sleeping better and just feeling a lot of relief from it. I would compare it a little bit to what you feel in a deep tissue massage. People who respond really well to that deep tissue massage, tend to respond very well to dry needling.
Host: Well, people hear the word needle, Katie, and they wonder what the difference is between acupuncture and dry needling and really the science behind this technique versus acupuncture. Why one works, one doesn't or how they work. What's the difference between them?
Katie: Really the only similarity between acupuncture and dry needling is the diameter of the needle being used. The theory is very different between the two. So, an acupuncture treatment is very superficial with the needles and it's based on the theory of different meridians in the body, which are like invisible energy pathways. Dry needling, again is based on that myofascial pain model. And the needle is inserted intramuscularly. Meaning, that we're releasing those tissues that maybe aren't receiving enough blood supply or oxygenation, and those muscles become dysfunctional when they aren't getting enough blood supply. So, the science behind it, there's several reasons why dry needling is helping.
And there is some research to back this. But it's helping people because of a few things. One is that we're increasing the blood flow and we're changing the chemicals in that tissue by creating this pro-inflammatory response. So, we get this extra blood flow to the tissue that's really bathing muscle and connective tissue and nerve, and it instigates this cascade of good chemicals to that area.
And essentially it's using your body to heal itself. Some other reasons why dry needling is helping is because when muscles are really taught and tight and you get those myofascial trigger points, there's this extra neural input to that tissue. So, there's extra noise at the motor end plate. And so by releasing that muscle, we can kind of reset the neurological system and improve in a normal, and normalize that input from the nervous system.
It also is thought to increase some feel good hormones like endorphins and serotonin, and maybe even oxytocin. And I would say also, just thinking about chronic pain and pain science, we're interrupting the pain pathways, which can lead to a remapping of the brain and helping to desensitize some signals that might be hypersensitive.
So, there's really several reasons why it's helping, but those are the big ones that research is supporting the use of dry needling.
Host: Well, thank you for that. And before we discuss really patient selection, who can do this, tell the listeners what trigger points really are and why those are what you're using.
Katie: Trigger points or bands of really taught parts of muscle. And sometimes you press on those knots or those trigger points, and you might even feel a referred pain. For example, in your, some of your neck muscles. There are trigger points that refer to the head and create headaches. So, releasing some muscles in the neck tend to help with, with different headache, pain, depending on where that headache is located. But again, it's, it's improving the blood flow to the tissue that has this myofascial trigger point.
Host: So, now tell us who it is that can benefit from dry needling. My son's a gymnast and he went in for dry needling around his shoulder and he really loved it. He thought it helped tremendously. So, tell us, really, who who can benefit from this?
Katie: Really anyone with any type of pain or joint restriction. If you have stiffness, if you've had, like you said, a sports injury, or maybe it's a more chronic condition or a chronic pain, but anybody that's had a, a lot of headaches or neck pain, back pain, I've seen even some jaw. What's called TMJ dysfunction. Sciatica is a big one. Anything restrictive, like a frozen shoulder could benefit from it. Plantar fasciitis, sports injuries like shin splints tend to do pretty well. Even people that have had numbness in their hand or arm have been telling me that they've got some relief from those symptoms as well.
There's even a little bit of research on some vestibular dysfunction improving, so, dizziness and even the ringing in the ear might benefit from some dry needling.
Host: So, where does it fit into a rehabilitation plan Katie? Because people think they're going to go see a physical therapist for, as you said, whether it's vestibular or pelvic floor, or injury or any of these things you've mentioned, where does it fit into that rehab plan, when you're looking at helping them with whatever injury or malady that they've got going?
Katie: Well, I think people get the most lasting results when dry needling is accompanied with other therapy techniques. It does matter what posture you're using all day long and how you're moving, using proper body mechanics. So, people get more relief and more longer lasting relief, if you do some stretching and some really specific exercises, and just allowing me, a movement specialist to analyze how you're moving and how you're sitting at work, talking about even like modifying your workstation so that you're in an optimal alignment and posture all day long. So, it it's really beneficial and it really jump-starts the rehab process, but you really need a few other things in your plan of care to, to fix your problem and maintain that relief.
Host: I think a big question that you probably get, and I've heard this question a lot too. Is, does it hurt? Are there any complications, soreness? I mean, we get a shot and maybe our arm is sore for a few days, but this is not quite the same, is it? Tell us a little bit about any complications or really if the needles hurt.
Katie: The needle is so small, actually, most people don't even feel the needle go in, but once that needle hits a trigger point, you're going to feel a deeper ache. And afterwards you might have a little soreness. Some people do, some people don't. Usually people have a little bit of muscle soreness. It feels kind of like you've worked out or had a deep tissue massage.
But the, the discomfort is pretty minimal and it only lasts about 24 hours. As far as risks, they're pretty low. Because you are inserting a needle into the skin, there is a small risk for infection, but it's a low risk and we use sterile needles and we clean the skin. I use gloves and sanitizer, but, patients who are significantly immunocompromised would not be a good candidate, but other than that, you know, the risks are pretty low and the results are pretty significant.
Host: That's excellent to hear. If someone has dry needling and they're thrilled with the results, tell us a little bit how often they need to come back to maintain those results. And what's involved in an appointment with you?
Katie: It depends on the patient. And it depends on what the patient Is doing outside of the dry needling. You know, if they're doing the stretching and some specific exercises that I'm having them do and really modifying how they're moving, you know, some people need one or two sessions. If you've had dysfunction for a really long time, you might need more like three or four visits.
It really just depends. But I usually see patients about once a week. And some people get, get relief for a few weeks. Some people get relief for a few months. So, it's very, just dependent on the patient. How long you've had it. What other lifestyle changes are you making? When you come in for an appointment, I'll do an assessment and I'll take some measurements.
We'll do some baseline testing and then we'll do some dry needling and then talk about posture, positioning, some exercises and other techniques that might help you and develop a plan of care, that's focused around what your goals are and what activities you want to get back to and, and what you want to achieve during your time in physical therapy.
Host: Is this something that people need a referral for?
Katie: Not necessarily. Illinois makes that answer a little bit more complex, but if you don't have a doctor's referral, you can give me a call and get in to schedule an appointment with me and I can help you go through the appropriate channels that you need to continue to see me.
Host: What an interesting topic and I've done a lot of shows about chronic pain and heard from so many different people in the pain management field, this is a huge field now, pain management. So, tell us a little bit about pain as you see it as a physical therapist, the difference between chronic pain and acute pain and since pain, what we're talking about, is somewhat subjective, how do you measure it?
Katie: Well, it depends on the source that you're reading, how we categorize chronic pain and acute pain. We used to think of it as pain that lasts over six months, but recently they've changed that definition. It's really pain that persist over three months or in a response to the healing process that is not typical.
So, if you've, you know, injured your lower leg, and typically it heals in a few weeks and yours is persisting with pain for six or eight weeks, you know, that could be considered a chronic pain as well. Acute pain would be pain that lasts less than three months. So, it depends on what source you're looking at, but somewhere in that three to six months is the cutoff for chronic versus acute pain.
Host: So, how does somebody decide or know when it is time to see a physical therapist for that pain, whatever, the reason for the pain and before they would see you, do they have to go see an orthopod for their pain or their primary care provider to not only get a referral to physical therapy, but to decide that, yes, this is something that can help you with your pain?
Katie: Sure. Anytime someone wants to come see me for their pain, I think is fine. I like to tell people if you've had pain for two weeks or more, it is really beneficial to come in and get an evaluation by a physical therapist so that we can address the issue before it becomes more severe and before it becomes chronic. We know that once that pain becomes chronic, it's a little more complex to treat, and we really want to stop that pain cycle before it becomes chronic. Chronic pain is a vicious cycle, but it is also really fascinating because it changes the neural pathways and how your brain is mapped. But also regarding seeing the physician first. Ideally, if you can see your physician and get a referral, that would be the ideal way to go, because we know there are multiple things that can cause pain, and we want to make sure that they've ruled out organs and other more serious conditions.
Host: So, then tell us what you do. How do you work with a patient that's suffering from chronic pain? Tell us a little bit about this multifaceted approach to painful disorders and what are some of the first things that you would do with someone when they come to you.
Katie: Well, chronic pain is treated a little bit differently than acute pain. And that's because our brain, when you've had pain for a long time, it starts to interpret painful signals differently. And sometimes, those neural pathways are more sensitive. So, I would compare it to, if you felt a feather brush along your skin, someone with chronic pain might feel a much more intense, painful sensation than just that feather.
So, there's kind of a misinterpretation of signals sometimes, and there's a lot that goes into that theory behind chronic pain. But the main gist is that our central nervous system is having some altered sensory processing and patients are having a little bit less of a like a decreased pain threshold. But in physical therapy, we treat chronic pain a little bit differently because we know that sometimes movements that are painful, are not harmful. And so the best treatment for chronic pain is movement and actually not avoiding movement. Sometimes that chronic pain cycle continues because people are avoiding movement.
And really what we need more of is, is activity. So, just education for patients that doing some aerobic exercise, even if it's just 10 minutes at a time, walking, biking, you know, stationary bikes, swimming, things that are a lower intensity, but for a longer period of time is really helpful. Another key factor is how you're moving. As a PT, I'm a movement specialist, and I can help you learn to move in an optimal way so that your joints are loaded in an optimal position and you aren't damaging tissues. We don't drive our car when it's out of alignment, you know, you wear out the parts of that car and the human body is no different. We really want to move in an optimal alignment to protect our joints. So, some of what we're doing is just teaching you how to move in a safe and pain-free way.
Host: One of the things I, one of the things that I've heard over the years as an exercise physiologist is whether I use, people ask me all the time and I know they ask you too; ice, heat, bracing. When someone's suffering from knee pain or back pain, which so many people or neck pain, shoulder pain, whatever it is. Are you somebody who likes heat or ice or a combination of these modalities? What do you tell people to do on their off time when they're not working with you?
Katie: Again, I think it depends on the patient. You know, how recent was your injury? If your injury occurred within the first two weeks, ice is probably better. And then when it becomes chronic, you know, it depends on what feels best for the patient. So, sometimes it's ice, sometimes it's heat. And I usually just tell the patient whatever feels better to you once you're out of that acute phase of the injury.
And as far as bracing goes again, I think it depends on the patient and really what the activity is that they need to do. And what we can do to make it feel better. And there are times where a brace can help. And there's times where I don't really want that patient to wear a brace because I don't want to restrict their movement.
But again, when it comes to chronic pain, it's really about just moving and not being afraid to move. And you go back to the basics that we need to live a healthy lifestyle at a healthy weight and stay active. We need to get adequate sleep. We need to manage our stress and really just reach out to the health care team to, to help you manage your pain.
Host: One of the things I've found most interesting about this burgeoning field of pain management, Katie, is that while we're trying to move away from opioids and I'm sure you've had plenty of people that have come to you, that have been on pain medication, but now it seems that many in the field, physical therapists, athletic trainers, chiropractors, acupuncturists, massage therapists, everyone's kind of running along the same track now. Have you seen this in your practice that some people come to you and say, I don't want to be on opioids anymore, or I've seen a chiropractor and that's helped, but not completely. What have you seen as far as this multidisciplinary approach to the field of pain management?
Katie: Well, I think as a physical therapist, it is really exciting because we do have the ability to have an effect on this opioid crisis that's happening in our country. My whole job is about how to help people either decrease their pain meds or avoid pain medication or avoid surgery. So, we really do play a huge role in, in that opioid crisis. And as far as the interdisciplinary team, we have to have a team approach. Here at Memorial, we have primary care providers who are fantastic at helping patients with several options to manage their pain. If the patient that has chronic pain is having a lot of stress that's contributing to the pain; seeing our mental health team here at Memorial might be part of your treatment plan. Weight management is huge when it comes to decreasing pain and the loads our joints are taking. And so it might mean talking with our dietician, Ashlyn Houseright. So yes, having a team approach is crucial.
Host: It definitely is in, and before we get ready to wrap up, I'd like you to offer your best advice for us about seeing a physical therapist, if we are someone who's suffering, whether it's acute or then becomes chronic pain and give us a little ergonomic lesson, if you want to. Tell us, cause you mentioned before, ,sometimes it's about lifestyle and behaviors and we've all, you know, people, a lot of people have started working from home or they do a very physical job. What do you want us to know about ergonomics, sitting at a computer? You know, using our hands, our kids are all texting. They're going to get that text thumb or text neck. What do you want us to know? Give us your best advice.
Katie: My best advice is get up and move, take lots of breaks. And our body is made to move and be active. And so just keeping moving is the best advice I can give you. Don't be afraid to move. If you're having an ache or a pain, it's better to move, than it is to avoid or have fear for movement. And just specifics on sitting at a desk, having a good backrest, making sure your chair has some armrests, that your computer screen is at eye level, that you're not reaching for that keyboard or reaching for the mouse, having your knees at a 90 degree angle and your hips at a 90 degree angle.
Some specifics for the computer are things about just proper mechanics and posture during the day. And like I said, get up and take breaks. Don't sit there for hours on end. Get up and move.
Host: And you could help people with those mechanics and suggestions, can't you? I mean, I personally had elbow pain and from sitting behind this microphone and on a computer and I got one of those penguin mouses that turns my, you know, it rotates my arm and the pain went away almost immediately from the position that I was in where I was pronating my hands.
So, you know, there are a lot of suggestions and you could help people with those suggestions, can't you?
Katie: Exactly and it's, it's all, it's different based on the patient. So, sometimes it's helpful if you can even take a picture of your workstation or take a picture of you sitting at your workstation, because everyone's going to have a different setup and different things they can, or can't modify. Some people use two screens, which has becomes an issue.
So it really just depends on the patient and maybe your job isn't sitting at a desk. Maybe it's something more labor intensive where I can teach you how to bend and how to lift and how to do whatever task it is that you're doing all day in a better way. And in a, in a less painful way.
Host: What great information we have given today. Katie, you're just a wealth of information and knowledge. And thank you so much for joining us today. To schedule an appointment with Katie, please call 217-357-6560. You can always visit our website at mhtlc.org for more information. There's lots of information on the website and that.
And that concludes this episode of Say Yes to Good Health with Memorial Hospital. We'd like to thank our audience and invite you to download, subscribe, rate, and review this podcast on Apple podcasts, Spotify, and Google podcast. And if you found it informative, please share with your friends and family on your social channels. We're learning from the experts at Memorial Hospital together. I'm Melanie Cole. Thanks so much for joining us today.
Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.