An Overuse Injury from Playing Too Much Pickle Ball!
Here is a 53 year old man who came in to have his Biceps Tendonitis treated by Dry Needling. He is relatively de-conditioned from his desk job, slightly obese, and a recent convert to pickle ball. Unfortunately, as with many good things, he was having so much fun that he over did it! And while pickle ball injuries have become very common, they are easily treated with dry needling.
Pain and Immobility due to Active Trigger Points
He comes in with pain and immobility of the right shoulder. The orthopedic tests and physical exam suggest activated Trigger points, in the long head of his Biceps brachii, and in the anterior deltoid. These are the primary cause of his pain.
The anterior deltoid is the primary mover for raising your arm over your head, which he cannot do. He feels pain in both those muscles when he tries to throw the pickle ball.
Unlocking the Motor Points to Release Tight Fascia and Muscles
The secondary cause of his pain are the stiff tight muscles that prevent him from throwing the ball or elevating his shoulder. This tightness is associated with active trigger points.
What causes immobility, stiffness and tightness in sore muscles and fascia? What we describe as tightness in a sore muscle is literally the muscle and fascia shortened. Muscles work by shortening. With overuse, especially if unconditioned, they become shorter to the point of stiffness, tightness and pain. This is the source of “myofascial pain.”
The most effective way to treat this shortening is if we release the active trigger points, but also if we stimulate the “motor points.”
Resetting Communication Between the Motor Nerves and the Muscles and Fascia
I always want to “unlock” tight, shortened muscles and fascia by stimulating the motor nerve entry point of the related muscle. The motor nerve entry point is commonly called the “motor point.”
The motor point, to use an analogy, is where the “Chinese speaking” motor nerve (the nerve that tell each voluntary muscle what to do,) is translated into “English” for the muscles and fascia who do not understand Chinese.
The Muscle Twitch Response
When you needle motor points, just like trigger points, you can get a very strong “fasciculation.” That is when the muscle and fascia jumps, involuntarily. This fasciculation is also called the “muscle twitch response.”
Why Releasing the Muscles and Fascia Relieves Tendonitis
Releasing the muscles and fascia by stimulating the motor points is very effective for healing sports injuries and relieving pain.
This is because your inflamed tendon, (itis means inflammation) is the victim of shortened, tight muscles and fascia. Tight muscles are literally shortened. This places stress on the tendon. Release the tightness so that the muscle can return to its normal length. Now the pressure is off of your tendon and it can heal!
Needling Directly into the Tendon Attachment w/E-Stim
In the above video you can see that I have needled the insertion of the biceps tendon into the humerus. I do this when there is extraordinary tenderness and pain over the tendon. This often give an immediate relief from your pain. This is because the needle has a physical anti-inflammatory effect on inflamed tissues.
You will notice I am using electrical stimulation with my dry needles. Electrical stim increases the effect of the needles. I only use it in patients that are ready for the next level treatment…Not everyone wants it or likes, so i like to wait for the second visit, except when the patient is very gung ho!
