So, excuse me if I sound like I have just discovered the Mormon Gold plates, or Moses’s stone tablets, but the missing link in orthopedic manual physical therapy has come to me in the form of a bunch of fine filament needles. Known in lay person and Traditional Chinese Medicine parlance as Acupuncture needles, these tiny thin pieces of pointy metal hold the key to transforming my own, and no doubt, the entire physical therapy profession. Dry needling, aka trigger point needling, is simply put, the bomb.
My personal history of interest in these implements goes back to old running injuries, and my quest to avoid surgery on my chronically tendinopathic IlioTibial Band. All along, from the onset of cramping, through the pain and limping, I felt that I needed something stuck into my thigh to energize or release something. I tried orthotics, different sneakers, Acupuncture, prolotherapy, injections of cortisone and painkillers, ART and Graston technique. I resorted to prayer, lighting candles, a Medrol dose pack and Reiki. I blamed the alignment of the stars and Jupiter. Eventually, the MRI showed a tendon essentially glued to the bone, devoid of a bursa, no inflammatory reactivity; deep bone bruises despite being almost non-weight bearing for months. Much research and surgeon-hopping led me 360 degrees back to my orthopedist. I had to resort to getting a scalpel to do the job, and to be fair, Dr. Hubbell did some magic, returning me not just to running, but to a full road cycling career in the Pro-1-2 Women’s field, multiple years racing cyclocross at local and national level, and All-American triathlon success. Continued weekly strength training with Ed’s TRX boot camp has helped me maintain a more global approach to fitness, and a new perspective on tendinopathy.
As a course requirement for my Ph.D. program at Rocky Mountain University of Health Professions, I was required to write a white paper on a clinical aspect of our PT profession: I chose dry needling, since my interest was still piqued, years after surgery. I had my eye down the road on an acupuncture certification, way down the road, since this PhD was now in its 3rd year, (and is still looking like 2 more ahead), but those needles were still fresh in my mind. In the course of my studies, I had been reading a lot about the injection of growth factors, of platelet- rich plasma, of autogenous blood products, used in the quest to heal and regenerate injured tissue. It seemed like those needles needed to get deeper, to irritate the tissue more, in order to provoke healing. My keyboard was on fire, the paper was inspired, and I scored an “A” for the coursework. I submitted it, and was accepted for publication in one of my professional journals, to my delight, and the applause of my Graduate Program Director. One down, many more to come, she told me.
Professional education courses abound in orthopedic manual physical therapy, and over the years I bounced from guru to guru, from the Australians, through the Brits, to the Canadians, achieving my APTA Orthopedic Certified Specialist letters, but still feeling like I was missing a key skill. I brushed up on spinal manipulation, refreshed biomechanical evaluations, learned motion analysis, and helped established cycling and running analysis clinics. I was getting my patients back to sports, quicker, but felt like I could still do better. Was I being too type-A or was there really more that I could offer?
With this years increase in running, preparing for off-road 25k’s in Ireland and PA, I had developed some niggling injuries of my own, as I have experimented with a more minimalist running shoe to match my natural mid-foot strike. My Achilles heel is my Achilles heel, and the increased heel drop of the Inov-8’s combined with increased trail distances has contributed to some cranky ankles. I massaged the knots in my medial Gastrocnemius, knowing the link between such tendinitis and overactive trigger points: I fantasized about jabbing needles deep into the muscle bellies, and “re-setting” the trigger points. I signed up for the Kinetacore course, and set off for a long weekend in Baltimore with a colleague.
The course was light on theory, since the majority of the class was composed of long standing PT’s, some already needling in the armed forces. After an overview of spontaneous electrical activity, abnormal biochemical milieu in trigger points with cytokines, histamines and other vasoconstrictors and irritants, referred pain patterns from trigger points, we went right into the needling, starting on a banana! Practicing SNT (Safe Needling Technique) with cleanliness and safety as a priority. PT’s glove up, even for bananas! Moving onto the forearm, (mine) to practice techniques of insertion and handling of the needles. With a review of surface-anatomy, a drop of the drawers, and Sharpie marking up on the skin, we were off! Vinny and I jabbed everything not overlying the lungs in the next 3 days, working right down to spinal laminae, iliac crest bones, cranial periosteum, the works! We learned quickly, having spent many many years in PT and post-grad school, with 20 years of clinical practice under each of our belts. What struck us very deeply (apart from the 100mm needles hitting the femur, tibia and ilium bones), was the newfound appreciation for the 3-dimentional aspects of muscles and fascia, this new plane of knowledge deepening our understanding of patho-anatomy, kinesiology and movement. Level 2 requires 200 treatment sessions before being able to attend; I am already up to 6, between hitting my staff up for practice, and getting Dennis before he had had his coffee this morning. Practice is limited to “family”, and confined to the restrictions of the curriculum, but already, I am more comfortable with insertion depth, needle selection, use of the electric stimulation machine, and treatment processes.
Self-test: in the ultimate scientific experiment, the N of 1 study, the solitary participant is subjected to different processes and with each variable, the outcome is documented. I can already testify that after 5 needles in my Gastroc, Tibialis Anterior and Peroneals, my Achilles pain is 90% gone, and tolerated a 10 miler in the woods at tempo pace without a single grumble. I can squat deeper without heel-lift, and what I had been thinking was ankle capsular restrictions, have lessened considerable, without touching the ankle. Hmmm. The other leg. To Be Continued.