Dry Needling

Autumn Paul, PT, DPT

You may have heard about dry needling from one of your friends or family members and now you are thinking, “What is dry needling? Could I benefit from it?”

Dry needling is where the practitioner uses a solid filiform needle or hollow-core hypodermic needle (similar to an acupuncture needle) and places it through the skin and enters the muscle. The practitioner’s goal is to place the needle specifically into a myofascial trigger point (hyperactive muscle fibers).

These trigger points can be located in a tense band of muscle. For example, many people have tightness/soreness located in their shoulders/neck from the tension that they carry throughout the day.

These hyperactive muscle fibers (tense bands of muscle) can send signals to other parts of your body which are considered “referred pain”.

The goal of dry needling is to pierce these trigger points in order to allow these muscle fibers to relax, which can help reduce your pain levels.

“So what conditions may dry needling help with?”

● Headaches

● Shoulder/neck pain/tightness

● Lower back pain

● Tennis and golfer’s elbow

● Shin splints

● TMJ/jaw pain

● Plantar fasciitis

● Hip Pain

“Can any physical therapist perform dry needling?”

In order to be able to perform dry needling, the physical therapist is required to go through extensive training. This training includes studying human anatomy and hands-on practice. These training sessions are often a weekend course or even several weekend courses.

“Awesome, I want to see a physical therapist who can assess and see if I could potentially benefit from dry needling. How do I make an appointment?”

First, look online to see what location is closest to you. Then, you can request to schedule an appointment with a physical therapist who is certified to perform dry needling.

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References:

Firth C, Meon J, Price M, Taylor J, Grace S. Dry Needling: A literature Review. Journal of the Australian Traditional-Medicine Society . 2020;26(1):22-28. Accessed January 14, 2021.

http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143040461&site=eds-live

http://www.kinfolkwellness.com.au/dry-needling-adelaide

Best Way To Get Rid Of Back And Neck Pain… Physical Therapy!

Dennis Kaster, PT

Unfortunately, one of the best-kept secrets around, is that Physical Therapy is one of the most effective and cheapest ways to get rid of back and neck pain.  Most back and neck pain is due to muscle weakness, tightness, poor posture, or work stations that are set up poorly and put extra stress on your body.  A Physical Therapist will assess which of these issues is causing the pain and help you to get rid of it by doing things such as specific stretches, strengthening, improving posture, performing treatment to decrease pain or swelling, using better lifting mechanics, or helping you to set up your work or home workstations to put less stress on your body. 

The typical process in the past has been that when someone injures their back, they go to a medical doctor.  The doctor would decide what to do next, which many times included rest, medications, or expensive imaging.  Several years ago a large medical organization, Virginia Mason, broke down the process of medical care for back injuries, looking for the quickest, most effective, and cheapest way to treat low back pain.  In the end, they found that people who saw a Physical Therapist first for low back pain recovered much quicker, returned to work sooner and the overall cost of care was much less.   This is because Physical Therapists specialize much more in the anatomy and mechanics of how the back works and how to stop and prevent pain.  Physical therapists also do not prescribe opioid pain medications.  Many times medical doctors prescribe opioid prescriptions, advise patients to rest until the pain goes away, or order expensive medical imaging, which many times is not necessary.  Many other research studies have found the same results.

As a result of the findings of multiple research studies, many insurance companies no longer require a physician referral to cover physical therapy, as they realize that people with mechanical low back pain respond much quicker and better if they see a Physical Therapist first.  Most people are not aware of this.  Several studies have shown that as little as 7% of people with low back pain see a Physical Therapist.  This is crazy…..when Physical Therapy is one of the most effective ways to treat low back pain.  Also, Physical Therapists have the expertise to recognize more serious medical issues that would require a referral to a medical doctor.  So if you see a Physical Therapist first and your pain is due to a medical issue, you can rest assured that the Physical Therapist will recognize it and direct you to the appropriate care.  PLEASE HELP US TO GET THE WORD OUT!!  IF YOU HAVE BACK OR NECK PAIN, SEE A PHYSICAL THERAPIST FIRST.  IF YOU OR SOMEONE YOU KNOW HAS BACK OR ANY MUSCLE OR JOINT ISSUE, LET THEM KNOW THAT PHYSICAL THERAPY MAY BE THE BEST FORM OF TREATMENT FOR IT.  If you have questions, please give us a call and we can answer them for you or check with your insurance to make sure our treatment is covered.

References

• Furhmans V. Withdrawal Treatment: a novel plan helps hospital wean itself off of pricey tests.  The Wall Street Journal. January 12, 2007

• Pendergast J, Kliethermes S, et al, A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Research and Educational Trust DOI:10:1111/j.1475-6773.01324.x, Oct. 2011

• Mitchell JM, de Lissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997;77: 10-18

• Moore JH, McMillian DJ, et al. Risk determination for patients with direct access to physical therapy in military health care facilities. J Orthop Sports Phys Ther. 2005;35:674-678

• Leemrijse CJ, Swinkles I, Veenoff C. Direct access to physical therapy in the Netherlands: Results from the first year in community based physical Therapy. Phys Ther 88;8:936-946

• Kenney. Transforming Healthcare, Virginial Mason Medical Center’s Pursuit of the Perfect Experience.  CRC Press, 2011
  
  

Back Pain during Pregnancy and Postpartum

Amanda Uting, PT, DPT

Back pain is common during pregnancy, with the prevalence of low back pain during pregnancy estimated to be between 50-75%. Back pain during pregnancy increases the risk of pain after delivery; more than one-third of women that have back pain during pregnancy still having back pain at 18 months postpartum. Back pain can decrease your ability to do normal activities at work and around the house, limit your exercise, and impair your sleep.

What may contribute to increase pain during pregnancy?

· Weight gain and postural changes: Women with a normal BMI are encouraged to gain 25-35 lbs during pregnancy. This weight gain, along with postural changes related to a growing uterus and baby, puts more stress on your joints.

· Joint laxity

· Fluid retention: results in increased pressure on soft tissues

How can physical therapy help you during pregnancy and after delivery?

As musculoskeletal experts, physical therapist have an important role in decreasing pain and improving function during pregnancy and during the postpartum period. Working with a physical therapist may include the following:

• Patient education

○ Exercise and safe return to exercise postpartum

○ Posture and breastfeeding positioning

○ Healthy bladder habits

○ Scar mobilization for Cesarean deliveries

• Safe manual therapy techniques.

• Home exercises.

Below are some exercises that may be beneficial for you to relieve back pain and increase strength for the physical demands of motherhood.  During pregnancy, please check with your healthcare provider before starting any home exercises.

○ Shoulder blade squeezes: Squeeze your shoulder blades down and back and hold for 2-3 seconds. Perform 10-20 reps. This is a great exercise during or after feeding your baby to counteract a forward shoulders posture.

○ Chest stretch: Stand in an open doorway and rest your palms on the doorframe with your elbows at shoulder height. Lean forward to feel a gentle stretch in the front of your shoulder and chest. Hold 30 seconds and repeat 1-2 times.

○ Cat/cow: On your hands and knees, gently relax your stomach towards the floor and then arch your back up towards the ceiling. Perform 10-20 reps in each direction.                                    

○ Bird dog: From a hands and knees position, attempt to push your abdominals towards the floor, and look forward; then contract your abdominals and arch your back, as if you are trying to hug baby in with your ab muscles. Keep your back flat as you extend one arm. If this feels easy, extend one arm with the opposite leg. Hold for 1 second. Perform 10-20 reps on each side.

○ Child’s pose: From a hands and knees position, bring your big toes to touch and sit your hips back. Let your stomach relax between your knees and feel a stretch in your back as your arms stay extended forward.

In addition, pelvic health physical therapists with specialized training can help patients that experience:

· pelvic pain

· urinary frequency or incontinence

· disastasis recti (abdominal separation)

If you are interested in the benefits of physical therapy during pregnancy or after giving birth, please contact Advanced Physical Therapy & Sports Medicine at (920) 991-2561.

 

References:

Katonis P, A Kampouroglou, A Aggelopoulos, K Kakavelakis, S Lykoudis, A Makrigiannakis, K Alpantaki Pregnancy-related low back pain. Hippokratia. 2011 Jul-Sep; 15(3): 205–210.

Kanakaris Nikolas, Roberts Craig S, Giannoudis Peter V. Pregnancy-related pelvic girdle pain: an update  BMC Medicine 2011. 9(15)

Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008;1(2):137–141.

Ostgaard H, et al. Back pain in relation to pregnancy: A 6 year follow-up. Spine. 1997; 22:2945-50.

Larsen EC, et al. Symptom-giving pelvic girdle relaxation in pregnancy. Prevalence and risk factors. Acta Obstet Gynecol Scand. 1999; 78: 105-110.

Kesikburun, S., Güzelküçük, Ü., Fidan, U., Demir, Y., Ergün, A., & Tan, A. K. (2018). Musculoskeletal pain and symptoms in pregnancy: a descriptive study. Therapeutic advances in musculoskeletal disease, 10(12), 229–234. doi:10.1177/1759720X18812449

“Exercise during Pregnancy” https://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy

“Exercise during Pregnancy” http://americanpregnancy.org/pregnancy-health/exercise-during-pregnancy/

“ACOG Committee Opinion” https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care

“Pregnancy and Low Back Pain: Physical Therapy Can Reduce Back and Pelvic Pain During and After Pregnancy”J Orthop Sports Phys Ther 2014;44(7):474. doi:10.2519/jospt.2014.0505