The Single Most Successful Treatment For Back Pain
by onsite, September 6, 2016
Trigger Point Dry Needling is a relatively new treatment option for patients suffering with various types of pain. This treatment has gained a lot of popularity over the past five years, and research is beginning to support its effectiveness. Over the past five years I’ve seen first hand how well it can work with patients, especially those suffering from back or neck pain. In fact, I think the area in which dry needling is the most successful is treating patients with low back pain, sciatica, or muscle spasms throughout the spine. In this article, my goal is to explain how the treatment works, why we think it’s so effective, and the manner in which I utilize it with other treatments.
How Does Putting A Needle Into A Muscle Help My Back Pain?
There are three major mechanisms explaining why putting a small monofilament needle into a muscle helps it function better. Depending on what the goal of the treatment is based on a thorough movement assessment, we can use dry needling to decrease muscle tightness, improve how strong a muscle contracts, and stimulate our body’s healing process to work better.
- Releasing Trigger Points or “Knots” In The Muscle
Trigger points are tight bands of muscle fibers that can be very irritable (tender to compression or stretch). We also know that these trigger points can refer pain into various areas diffusely away from where the actual trigger point is present. For example, one muscle that commonly refers pain down the leg is the deep gluteus minimus. Patient’s often come to me with a diagnosis of sciatica or degenerative disc disease. After my evaluation I usually find deficiencies and tightness in the gluteus minimus muscle. When treating this muscle with dry needling, the patient will typically get a reproduction of their pain down the leg. When this occurs, the treatment is very effective because it’s confirming that the knot of muscle fibers in that specific muscle was the main contributor to pain down the leg.
When the small myofilament needle is inserted into a hyperirritable bunching of muscle fibers, there is a significant response from your body called a “Muscle Twitch Response.” Eliciting a muscle twitch response is very important, as this is the stimulus for a change in the physiology of the muscle tissue in this area. Once the trigger point or tight band of muscle tissue is released, the muscle can stretch and contract more effectively. This results in decreased strain at the attachment points of the muscle, and improved activation and strength so the muscle can do its job more effectively. The Muscle Twitch Response is basically a sub-cortical reflex (meaning that the nerve impulse travels to the spine and back out to the muscle rather than going up to the brain) similar to the phenomena that occurs during a patellar tendon reflex test at the Doctor’s office. The result is a decrease in Muscle Hypertonicity or what patient’s refer to as a “muscle spasm.” The dry needling allows the large superficial “ropey” muscles in the back to relax by stimulating this spinal cord reflex.
- Stimulates A Better, Stronger Muscle Contraction
One of the major things that research has taught us about back pain is how specific muscles begin to turn off the longer someone has pain. There’s a group of muscles deep that sit on the back of the spine called the “Multifidi.” These muscles are extremely important for stabilizing the joints in the spine on one another. The multifidi are postural muscles, so they function to hold body position statically for an extended period of time. Research has shown that when someone begins having pain or injury to a joint/disc in the spine, the associated multifidi muscles at that level get weak and often times shut off. Basically, the nerve signal to those muscles becomes deficient, and “fatty infiltrate” works its way into the muscle fibers making them largely ineffective.
HERE IS WHERE THE DRY NEEDLING CAN DO SOMETHING THAT NO OTHER TREATMENT CAN DO…
Because these muscles are deep below several superficial layers of tissue, the only way to have a direct effect on them is with a small needle. There would otherwise be no way that we could target these muscle with massage or any other hands-on technique. There is some research showing that a lumbar manipulation or adjustment can improve the functionality of these muscles, however I have not seen this to be nearly as effective as using trigger point dry needling. So, by inserting the small needle into the deep multifidi muscles, and then stimulating the dry needles with a muscle activation device like the MARC PRO, we can have a huge direct effect on those muscles. Basically, this is like turning the switch of power back on to these muscles. Because of the disuse, pain, and poor positioning the individual stops using these muscles. As a result, the nerve signal to them becomes very weak, like a short circuit. By utilizing dry needling in conjunction with muscle stimulation, we reset the fuse box and get the nerve to begin sending signal to these muscles once again.
3. Jump Starting Our Bodies Healing Process
We know that when someone has pain or an injury, symptoms often linger even long after the actual tissues have healed or recovered. Thus, a patient continues to have some level of pain or discomfort, even months or years after a surgery or injury. Our body’s healing process has run its course, the surgical repair has held, so why are we still having pain? What we have found in recent years is that our body basically runs out of resources to fully fix or heal tissues in our body. An individual’s body attempts to heal a tissue that has been injured, but because they don’t fully correct or normalize their movement/postural limitations, the injured tissue continues to be damaged at some level. Over time, the body runs out of resources to continually heal these repetitively injured tissues, and the healing mechanisms eventually stop responding when the area needs fixed.
One of the most crucial things we can do for patients having difficulty healing from an injury is help bring new blood flow directly to an area where tissues are injured or dysfunctional. There are various techniques that attempt to employ this phenomena, but none have quite the effect that trigger point dry needling can provide. By actually getting into the muscle, we can facilitate increased blood flow to a specific tissue or muscle. Research on trigger point dry needling has shown a significant increase in blood flow and associated cellular healing related mediators after treatments with the needles. Thus, by using dry needling we can direct an increased healing response specifically within the area that needs it the most.
These three physiological changes that come with trigger point dry needling are why it’s such an impactful treatment. Although trigger point dry needling is not “magic,” it CAN do very positive things to your body that NO OTHER TREATMENT can provide. Trigger point dry needling performed appropriately to the correct tissues puts our bodies in the best possible position or state to be successful. By facilitating muscles to “turn back on,” restoring normal muscle flexibility, and re-initiating a good healing response, dry needling is a treatment I recommend for all my back or neck pain patients, especially those with chronic issues. So considering all these things, if I had to choose only one treatment or exercise to use with a back pain patient, trigger point dry needling would be the winner!
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