By Michaela Gibson Morris
Muscles have their own logic.
Where it hurts may not be the source of the problem.
Pain in the arm could come from the chest. Headache or chest pain could be originating in the trapezius muscle that stretches across the upper back. These trigger points inside the muscles can become sensitized, turning into hard knots that keep the pain coming.
Tupelo physical therapist Joe Elmer is using dry needling as an effective tool in treating trigger points. He’s one of 15 Mississippi physical therapists who are certified to use the technique.
“It’s been around for a while,” Elmer said. “It’s proving to be a very effective treatment.”
Dry needling developed separately from traditional Chinese acupuncture, although both modalities use solid needles. The dry needling technique, which is also called intramuscular stimulation, is based on trigger points first described in the 1940s by cardiologist Dr. Janet Travell, who started researching the phenomenon of referred pain from heart attacks that radiates into the arm. Acupuncture developed over centuries in China and is based on concepts of meridians and energy flow through the body.
Trigger points in muscles in and around joints can produce pain that mimics common, painful conditions, Elmer said. A portion of the muscle becomes sensitized from an injury. The injury heals, but a hard knot persists in the muscle. A chemical builds up along with the knot, creating a persistent loop of pain.
Elmer pinpoints the knotted trigger point and uses a thin, solid needle to stimulate the knot. He watches for a twitch response in the muscle and listens to his patients, who will tell him when he’s hit the source of the trouble.
“The needle itself releases the chemical,” Elmer said. “It seems to release like lactic acid.”
The dry needling technique allows Elmer to go much deeper than manual massage.
“This is one tool,” Elmer said. “We usually do it in combination with a lot of other things,” such as range of motion and strengthening work.
In conjunction with other forms of therapy, Elmer finds dry needling can be an effective treatment for a number of chronic pain conditions, including headaches, neck and shoulder pain, carpal tunnel syndrome, tennis elbow, low back pain, Achilles tendonitis, plantar fasciitis and myofascial pain syndrome.
The needles themselves don’t hurt, Elmer said. Manipulating the trigger points is usually uncomfortable for patients, but not as painful as the condition they are seeking relief from. Patients typically report being sore for 30 minutes to 24 hours after a treatment.
For most of Elmer’s patients, dry needling is done as a course of six to eight sessions to treat an acute problem or three to four months for chronic issues.
Dry needling isn’t a technique to use on acute injuries that are still healing, Elmer said. If muscles are still swollen, it’s too soon to use the technique. Although the needles are sterile and Elmer uses a clean technique, he would also avoid using dry needling during the post-surgical healing period.
Dry needling would not be indicated for people with active infections and those with bleeding disorders. Its use would be limited to specific areas in people who are taking blood thinners.
Dry needling has been an important tool for Wendy Martin’s fight against chronic pain. Martin has been through multiple car wrecks during her life and had two cervical spine fusions. Over the past few years, the pain had gotten so bad, she had started slipping into severe depression. Her doctor referred her for physical therapy, and during her treatment, the therapists suggested dry needling to treat multiple trigger points.
After her first visit, she was extremely sore, but the second night, she was able to sleep through the night – a significant improvement for her.
Martin’s ongoing problems are so severe, she gets dry needle treatments each week. It has allowed her to continue working and get back to the things she enjoys, including gardening, jewelry making and archery.
“I’m less medicated than I’ve been in 10 years,” Martin said.