Dry Needling in San Diego
Eyton Shalom, M.S., L.Ac specializes in the treatment of Pain with Dry Needling, Acupuncture, Cupping, Moxabustion, Gua Sha, and Electrical Stimulation.
How Dry Needling Relieves Pain and Treats Injuries
Dry Needling is the single most effective method for treating the pain caused by activated trigger points in muscles and fascia. A high percentage of acute and chronic pain is caused by activated trigger points. It involves the insertion of a dry needle directly into the trigger points and motor points of the fascia and muscles, in order to stimulate and “release” them.
What is the Difference between Dry Needling and Acupuncture?
Dry Needling gets its name because it is an alternative to the injection of lidocaine (wet needling) into trigger points with a hypodermic needle, as MDs might do. All dry needles are actually acupuncture needles.
The difference between acupuncture and dry needling is that acupuncture is based on the theory of the flow of Qi through the acupuncture channels mapped in ancient China, and dry needling is based on a knowledge of western anatomy and the location of trigger points and motor points.
What Are Trigger Points?
Trigger points are focused areas of hyper-irritability in muscles and their related fascia. We all have latent trigger points in predictable locations throughout the body. When latent, they are painless. But, through tension and overuse, trigger points become activated.
At this point, and over time, trigger points become inflamed, and a source of pain. Really common areas to notice this are at the top of the shoulders, between the shoulder blades, and in the shoulder blades.
What are Active Trigger Points?
Active Trigger points are present in chronic pain, overuse or repetitive use pain, and in sports injuries. When trigger points become active, they send a message to the muscles, and to the fascial layers that integrate the muscles, to shorten.
Cases of tendonitis and bursitis, for example, develop when overuse activates sore tender trigger points which in turns leads to shortening of the muscles and fascia. The muscles and fascia become “locked short.” The lock is the trigger point.
The key to unlocking active trigger points is Dry Needling. Nothing really works as quickly or as deeply.
How Does Dry Needling Work?
When you needle into the muscle spindle inside the points, it unlocks. There is often a dull achey sensation, and the muscle will twitch. This is called the “muscle twitch response”, and also referred to as “fasiculation.”
When you unlock the muscle spindle with a needle, and “deactivate” trigger points , the muscles and fascia return to their normal length, which alleviates stiffness, achyness, and pain, and gives a chance for the strained tendons, sprained ligaments, and bursa to heal.
How Soon Will I Feel Better with Dry Needling and How Many Visits Will I Need
Most people feel considerable improvement after even a single visit. They get up off of the table, and feel an immediate loose and refreshed feeling. You might also feel sore where the needles were placed, like a post-workout soreness.
Some people, with fresh injuries, can feel all better after even a single visit. But most people need 2-3 visits for a recent injury, and 5-6 for more chronic pain. Its really rare that I see someone more than 6 times, which is considerably fewer treatments than with acupuncture, chiropractic, or physical therapy. I can remember a single person in 31 years who took 10 treatments, for severe, chronic, low back pain.
What Kinds of Injuries and Pain Can I Treat With Dry Needling?
Dry Needling gives fast relief from
- Neck Pain
- Shoulder Pain
- Rotator Cuff Pain
- Back Pain
- Herniated or Bulging Discs
- Piriformis Syndrome
- Trigger Point Pain
- Tight, Shortened Muscles and Fascia
- IT Band Pain
- Sports Injuries
- Tennis Elbow (lateral eicondylitis)
- Golfer’s Elbow (medial epicondylitis)
- Carpal Tunnel Sydrome
- Brachial Plexus Syndrome (Thoracic Outlet Syndrome)
- Achilles Tendinitis
- Heel Spurs
- Morton’s Neuroma
- Foot Pain
- Nerve Entrapment Syndromes
- Facial Pain
- Tension and Migraine Headache
- TMJ, and more.
Do I have Trigger Point Pain ?
Trigger points are specialized tissue bundles. They are present in everyone’s muscles and fascia. Normally they are latent, or inactive. With overuse, chronic tension, or injury, trigger points can become “activated” and painful. This is called “trigger point pain”. You can have trigger point pain with no other injury.
Trigger point pain can be constant or intermittent, mild, moderate, or severe. It can feel like you are being stabbed, it can be burning, it can even keep you up nights. And the good news is, it usually is gone after a single treatment!
How Trigger Point Pain Mimics Nerve Pain
Trigger point pain has predictable referral patterns, and so, can even mimic nerve pain. This is because your active trigger point has a painful core that radiates outward.
This is often the case when people feel they have Sciatic Pain. Trigger points in the buttock and hamstring can cause intense burning pain to radiate down the leg, which feels like sciatic nerve pain, but is not.
It IS also true, that people with actual sciatic pain from nerve entrapment at the piriformis (Piriformis Syndrome) or from disc bulge will also have active trigger points. Its usually part of the mechanism of injury. Chronic shortened muscle and fascia of the spine and back compress the disc space placing pressure on the disc until it budges or herniates.
Tension Headache, Migraines, and Trigger Points
Another example where active trigger points can cause other kinds of pain are tension headache and migraine… Almost everyone with tension headache or migraine have severely activated trigger points in their scalp, neck and shoulders.
And like patients with neck pain, they will also have those pesky trigger points we can get in the rhomboid muscles between our shoulder blades. I find these in 90% of cases. When I press on those points it radiates pain up into the shoulder and neck.
Nerve Entrapment Syndromes and Motor Point Release
Nerve entrapment syndromes are when a nerve is compressed by tight muscles and fascia. This can happen anywhere in the body. Common areas are in the neck, shoulder, forearms, buttocks, and legs.
Our nerves flow sort of like water in a hose. Muscle and fascia that are shortened from overuse, tension, and injury compress the nerve. The nerves often pass between muscles. This is as if someone were standing on the hose. It obstructs the flow of water.
Worse, a single nerve can be compressed in two or three places along its pathway at the same time. This translates into pain. If the entrapment continues over time it develops into numbness, tingling, and eventually weakness.
Motor Points and the Shortening of Normal Muscles
Motor points are specialized tissues in the muscles. They are where the motor nerve (as opposed to sensory nerve) tells the muscle what to do, whether to contract or relax.
Muscles work by shortening. A healthy muscle (and fascia!) shortens when being used, like a biceps curl, and returns to its normal length at rest.
But with mental tension your muscle never rests completely, the motor point keeps signaling to the muscle to shorten. With the fight or flight response, or vigilance, your muscle remains ready to go, ergo, shortened. This is why progressive relaxation or body scanning can be so helpful for chronic pain and anxiety
Overuse, or Repetitive Use, and Shortened, Locked-Tight Muscles and Fascia
Repetitive Injuries, also called overuse injuries happen when your muscles are so shortened by use, that its hard for them to return to normal….The motor point gets locked and is unable to send healthy messages to the muscle. As a result your muscles are left in shortened positions. This is how pain begins.
This can happen, for example, with jobs that involve long hours at the keyboard, or manual labor such as working in construction, landscaping, or in a kitchen. This shortened muscles and fasica is the mechanism of many seemingly acute sports injuries, like tennis elbow, carpal tunnel syndrome, and golfers elbow…
Its also at the root of many sports injuries, like the shoulder injuries I see in baseball players and boxers, or the foot and leg injuries I have treated in dancers.
The Exact Mechanism of Dry Needling Motor Points
The innocent evil genius of this process is the motor point. Each muscle has one. The motor point, or more accurately, the motor nerve entry point is where the nerve that starts in your spine takes the neurochemical messages from the brain to the muscle.
But the nerve “speaks Chinese” and your muscle and fascia “speak French.” The solution is the motor point. Its the translator between the nerve and the muscle/fasica…Its job is to order the muscle around and tell it what to do–contract, relax, contract, relax.
Inside your motor point is a spindle. With tension, overuse, and injury the spindle gets contracted. This contracted spindle tells your muscles and fascia to stay short, and hear short means tight…locked tight. This leads to pain, stiffness, and finally, injury.
Pistoning Technique in Dry Needling
When I stimulate the spindle of the motor point with the dry needle, the motor point twitches, and in response the fascia and muscle relaxes, which means it lengthens. You feel better right away, looser…Now the torque place on your tendons eases, and if there is a nerve entrapment, that also releases. Normal nerve signals resume. Numbness, tingling, and pain go away.
I can increase the effect of the dry needling by using the pistoning technique, as follows. I do this by inserting the needle into the motor point, eliciting the muscle twitch response, and moving the needle gently in an up and down motion. This is called the pistoning technique in Dry Needling and “lift and thrust” in Chinese Medicine.
Changing the Angle of the Needle for Greater Effect
I may change the angle of the needle as I lift and thrust to get different motor point fibers. Sometimes I even use two needles at once. I place one needle perpendicular to the skin, and the other at a 45 degree angle. This way I get different motor fibers at the same time.
Then I let you rest for a few minutes. This is because once the needles are in there is a cascade of healing biochemicals produced by your nervous and endocrine systems. People often become woozy, or fall into a deep sleep.
Needle, Rest, Repeat, Rest Again
The other reason I like to let you rest is because after your body relaxes for a while, then I can stimulate the needle a second time. This is often when I get the most profound release. It gives an even better result. In some cases where the person is very developed, and extremely tight, I left them relax again and stimulate one more time as I remove the needles.
Imagine your healthy muscle is 2 feet long. But when in pain, its shortened to 1.5 feet. Just making these numbers up to be simple. I hit the motor point, the spindle releases to 1.70 feet. You rest for 5-10 minutes. Now I needle you again, and it releases to 1.90 feet…If I were to just place the needle in, get a response, and remove the needle right away, you would not get as great a response, and would have to spend money on more treatments!
Where are Trigger Points Located and How Do I Find Them?
Trigger points are found in the muscles, the fascia, even on blood vessels and on the surface of bones. They have predictable anatomical locations we learn by study and experience.
The trigger points in the muscles and fascia are the cause of most Chronic Pain. They play a huge role in Sports Injuries. They play a major role in all headache pain.
Trigger Points are associated with tight muscles and exquisitely tender focal points. When you press on trigger points they hurt, but it usually “hurts good.” When you dry needle these points, they stop hurting completely. When you release motor points along with trigger points you treat both the cause and the result of short, tight muscles.
Acupuncture Vs. Dry Needling
The most effective treatment for trigger points is Dry Needling. Its a physical method that changes muscle tissue immediately. And it works directly on the muscles and fascia where the pain is. Motor nerves tell the muscles and fascia what to do.
Stimulating the muscle spindle of motor points causes muscles and fascia to lengthen and return to their original anatomical position. This facilitates more effective stretching and strengthening. A shortened muscle can not exert the same force as a healthy one. A healthy muscle rests at its normal anatomical legnth..
Pioneered by Janet Travell, M.D., Dry Needling is based on Western anatomy and physiology, and involves learning the locations of Motor Points and Trigger points in the muscles and fascia, and the correct technique of needling.
Acupuncture, on the other hand, is based on study of how Qi flows thru the Acupuncture Channels, or “Meridians.” There are 365 major acupuncture point locations we learn and needle in our practice.
Acupuncture points are where biological energies from deep inside the body rises to the surface. That is why all our acupuncture points are found on the skin. Acupuncture works by sending signals back to the brain via the sensory nervous system. Indeed, some practitioners of acupuncture, such as the Japanese, prefer very very light superficial needling just below the skin
Dry needling, on the other hand, is a deeper needling that seeks to change the state of muscles and fascia via the muscle spindle in trigger points and motor points. It uses the information carried from the brain to the myofasical anatomy via the the motor nerves. Acupuncture on the other hand works via the sensory nerves that travel back in the other direction, from the skin to the brain.
In fact, its not uncommon for me to combine dry needling with acupuncture…I use the acupuncture to treat underlying conditions of anxiety and mental tension in cases of chronic tight muscles.
Needle Technique in Dry Needling
Dry Needling is “Physical Medicine”, as Physical Therapy, Chiropractic, and Deep Tissue Bodywork therapies are.
While acupuncture technique can range from so light you don’t feel anything, to a dull achey feeling at the needle site, dry needle technique produces a muscle twitch response. We stimulate your trigger point to produce this fasiculation. The more we stimulate it, the more it releases.
This is a physical method, the equivalent of Deep Tissue massage versus light Swedish massage. We place the needle in the trigger point and use it the way a skilled bodyworker uses her fingers.
This muscle twitch response or fasiculation is your trigger point deactivating and the motor point stimulating the muscle to release and lengthen. It feels really good, though sometimes you do have to breath through it. Your whole body relaxes immediately and when done your pain is either gone or much better. Your muscles feel loose.
What is Fascia?
Fascia is a “band or sheet of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates muscles and other internal organs.”
It is a kind of connective tissue, like the skin, tendons and ligaments, that has enormous elastic properties. Fascial tissue works with muscles to move bones, and also reduce the friction that occurs when muscles contract and release. In doing this the fascia serves as a protector for the nerves and blood vessels that lie within the muscles.
These bands of connective tissue called Fascia organize our muscles and help the brain instruct the muscles on contraction and relaxation.
What’s really cool is that there are bands of fascia that organize individual muscles, like the muscles in your thumb, for example, but there are also larger bands of fascia that, for example, begin in the neck, cover and pass through various layers of muscles in your entire arm, from the neck to the shoulder and all the way to the fingertips.
We call these bands “fascial trains.” If you want to understand your fascia, a good place to start is the book Fascial Trains, by Myers.
The Brain, Motor Points, Fascia, Muscle
When you do a biceps curl, here is a summary of what is happeng.
- You first decide consciously (at the gym) or unconsciously (the sudden need to fight off a mountain lion or man) to curl the biceps
- Brain sends signal to the motor point of the biceps, via the motor nerve that enters the biceps at the “myoneural unit”, to contract
- Motor Point contracts and now signals to fascia and muscle to contract. Trigger points activate in the process to aid contraction
- You finish your workout, or fight off the mountain lion, now, your brain, via both the motor nerve and parasympathetic relaxation response, send chemical messengers to motor point, fascia, muscles, trigger point, to unwind and return to normal
Motor Points and Trigger Points
Trigger points are areas of localized inflammation that can be very painful locally, but can also mimic nerve pain and radiate through the body…They are associated with fascial pain and can even be a source of “mysterious” abdominal pain, due to adhesions in the fascia…Dry needling can release these adhesions by deactivating trigger points in the abdominal muscles
Dry Needling is also used to stimulate motor points. Stimulating motor points with dry needling causes tight, shortened muscles and fascia to return to their normal length.
With injury and chronic tension, fascia becomes a source of pain. The fascial sheath that encapsulates your individual groups of muscle fiber within a muscle becomes too stiff, (or too mobile in less common cases), or even develops adhesions and fibrositis.
And example of a fibrositic nodule associated with chronic tension are those lumps people get at the top of their shoulders in the upper trapezius. Dry needling can resolve fibrositic nodules, especially when combined with Electrostimulation, Cupping, and Heat Therapy.
There is a lot more to fascia as well. Fascial tissue, like muscular tissue has a kind of primitive memory. This is why muscles change with poor posture and bad ergonomics.
The fascia helps the muscle remember what to be like, whether to be relaxed (lengthened) or tense (shortened). Chronic shortened fascia plays a role in injuries from ligament sprains in athletes to herniated discs in desk jockeys.
Just send me a text at 858-585-1998, give a call, at 619-296-7591, or email–firstname.lastname@example.org if you want to find out whether dry needling can help your issue, or just to make an appointment. Thank you!
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