Dry Needling to Treat Pain
What is Dry Needling?
Dry needling (DN) is a treatment technique for acute and chronic pain that contributes to movement impairments. During a treatment, the physical therapist will locate trigger points, or “muscle knots” that are painful when touched on the patient. Then, the therapist will insert thin filiform “dry” needles 5-10mm into these myofascial trigger points to “release” the pain.
Benefits of Dry Needling.
DN provides many possible benefits:
- reduce pain
- help release toxins
- promote healing (faster recovery)
- normalize dysfunctions
- reduce muscle tension of the motor endplates (nerve impulses at transmitted to muscles at these sites)
Other Names for Dry Needling.
Physical therapists also commonly refer to the procedure as:
Orthopedic Institute Physical Therapist Performing Dry Needling on a Patient
Is Dry Needling Effective at Treating Pain?
Yes. A meta-analysis published in the Journal of Orthopedic and Sports Physical Therapy concluded that DN may decrease pain and increase pressure pain threshold (PPT) compared to control treatments. PPT is a test that measures deep muscular tissue sensitivity, which is the amount of pressure needed to go from a non-painful pressure sensation to a painful pressure sensation.
Orthopedic Institute Physical Therapist Discussing Dry Needling with a Patient and showing a Spine Model
Who May Benefit From This Treatment?
People of all ages, athletes, and non-athletes with musculoskeletal acute or chronic injuries may benefit from a session of treatments. DN is commonly used in the treatment of many injuries including:
- trigger points
- neck and back pain
- muscle strains
- headaches
- hip and knee pain
- hip and shoulder impingement
- bursitis
- plantar fasciitis
- fibromyalgia
- sports injuries
In addition, DN may effectively treat overuse injuries, including but not limited to tendinitis and golfer and tennis elbow.
However, there are some contraindications for this treatment method. A discussion of the current problem and past medical history should occur with a physical therapist to determine if dry needling is an appropriate and safe treatment option for you.
Why Might This Treatment Work When Other Treatments Don’t?
When massage therapy, chiropractic treatment, or traditional physical therapy techniques provide only temporary relief, it may be that the problem resides deeper in muscles that rest along the skeletal bone. DN can be a more effective and long-lasting treatment option if this is the case, as it allows the physical therapist to target muscles at all levels within the musculoskeletal system.
Orthopedic Institute Physical Therapist Demonstrating Dry Needling Location on a Spine Model
Does This Treatment Work for Everyone?
Most people benefit in the short term from DN treatments. In fact, the research suggests that not only does DN provide a statistically significant effect on functional outcomes, but at 6 to 12 months, patients also favored DN for decreasing pain. However, the same meta-study concluded that that evidence of the long-term benefit of DN is currently lacking.
How is Dry Needling Different from Acupuncture?
DN is sometimes confused with acupuncture. While acupuncture and dry needling both involve inserting tiny monofilament needles as part of the treatment, this is the only similarity between the two methods. Acupuncture has its roots in ancient Chinese medicine and attempts to restore the proper flow of energy throughout the body. With acupuncture, the physician inserts needles into points of the body along meridian lines. Acupuncture is most often used to treat chronic pain, internal ailments, digestive problems, insomnia, and stress. Sometimes these needles are left in place for 15 to 30 minutes.
DN, developed in the early 1980s, is based on modern Western medicine principles and is used to treat localized trigger points to reduce pain, improve joint mobility, improve strength, and normalize movement function. Treatment time is usually 10 to 15 minutes.
What is a Trigger Point?
An active trigger point is a taut band of skeletal muscle or “knot” that is usually hyperirritable to direct pressure. These active trigger points often “refer” pain to other body areas that the physical therapist can map into specific patterns. Active trigger points may contribute to muscle weakness and restricted range of motion. A physical therapist uses their expert knowledge of these common referral patterns and anatomy to identify specific trigger points to establish appropriateness for dry needling as an effective treatment.
What Happens During a Treatment?
Upon identifying the trigger points, the physical therapist will treat the exposed skin to establish a sterile field, to reduce the risk of complications from inserting the needles. The physical therapist will then insert a thin filiform “dry” (unmedicated) needle through the skin, directly into the identified trigger point.
Orthopedic Institute physical therapist performing dry needling on a patient.
Is the Treatment Painful?
When the needle hits the trigger point, the patient often feels a sensation of deep pressure or localized twitch response from the muscle, followed by a feeling of release or decrease in tension. To avoid any unnecessary discomfort, the physical therapist continually communicates with the patient during the treatment process to monitor for any abnormal response to treatment that may indicate the need to relocate the needle within the target area or modify the treatment depth.
The physical therapist may elect to use a pistoning technique or electric stimulation in conjunction with dry needling to elicit the desired twitch response within the muscle to provide pain relief.
How Deep do the Needles go into your Skin?
In the early 1980s, at the age of 60, Peter Baldry, an English physician, practiced and promoted acupuncture and trigger point dry needling before it was common in Western medicine, training other doctors to use the techniques and writing several textbooks. Baldry recommended inserting needles to a 5-10mm depth over myofascial trigger points (MTrP) for 30 secs. Many physical therapists use this approach to this day.
Orthopedic Institute Physical Therapist with Dry Needling Needles
How long does a Treatment take?
The total treatment time may take 10 to 15 minutes.
What do you do after a Treatment?
Dry needling is rarely a treatment given to a patient in isolation. Physical therapists will provide an exercise prescription recommendation in the form of stretching or correct movement exercises following dry needling treatment to maximize the effectiveness and longevity of the treatment benefits.
How Often Should you get a Treatment?
A typical treatment plan will call for once-a-week sessions over 2 to 3 weeks, mixed with regular physical therapy. In rare cases, patients may choose up to 6 sessions depending upon their results.
Orthopedic Institute Physical Therapist Discussing Dry Needling with a Patient
Who can Perform a Treatment in South Dakota?
DN is an approved treatment for specially trained physical therapists in South Dakota to perform. When performing the treatment, physical therapists wear gloves and appropriate personal protective equipment (PPE).
Call Orthopedic Institute for questions or to schedule a session at 605-977-6845.
James T. Brunz, MD
Specialties – Areas Of Focus
PAIN MANAGEMENT
• Non-Opioid, Non-Surgical Acute and Chronic Pain Treatments
• Non-Surgical Back and Neck Pain Management
• Spinal Cord Stimulator Implants
• DRG Stimulation
• Epidural Injections
• Interventional Spine Injections
• Radiofrequency Ablation (Rhizotomy)
• Neuropathy
• Chronic Pain
• Nerve Root Block
• Trigger Point Injection
• Kyphoplasty
• Vertebrogenic Chronic Low Back Pain (Intracept Procedure)
About
Dr. Brunz is a fellowship-trained pain medicine physician who provides non-surgical musculoskeletal care to patients for whom surgery is not the best option or has failed to relieve symptoms adequately. He works closely with the surgeons at OI to provide comprehensive musculoskeletal care. He specializes in treating neuropathy, joint, neck, and back-related pain, and spinal cord and DRG stimulator implants. In addition, his practice provides interventional pain services for diagnostic and therapeutic purposes.
Dr. Brunz has been selected as a Key Opinion Leader for St. Jude Medical in the field of neuromodulation. This is a select group of physicians who are chosen because of their expertise in the field of neuromodulation.
Outside of the office, Dr. Brunz enjoys hunting, fishing, snowboarding, watersports, and spending time at the lake with his family. He is an avid collegiate wrestling and Husker football fan. Over the years, he has been involved in coaching youth athletics, including wrestling and baseball and supporting local charities such as the American Cancer Society and the Boys and Girls Club.
Get to know Dr. Brunz
Testimonials
K. C. Chang, MD
Specialties – Areas Of Focus
PHYSICAL MEDICINE (PHYSIATRY)
• Non-Opioid, Non-Surgical Acute and Chronic Pain Treatments
• Non-Surgical Back and Neck Pain Management
• Electroacupuncture
• EMG – Electromyography (electrodiagnostic studies)
• Interventional Spine Injections
• Epidural Injections
About
Dr. Chang is a board certified physical medicine and rehabilitation (PM&R) specialist and has been treating patients non-surgically for pain management of their neuro-musculoskeletal problems and disabling conditions, using treatments such as acupuncture, epidural, trigger point injections, physical therapy, and medications. He also subspecializes in electrodiagnostic medicine. Electrodiagnostic medicine is a method of medical diagnosis that obtains information about diseases by recording the electrical activity of body parts or by measuring the responses to external electrical stimuli.
He is named one of America’s Top Physicians in the specialty of Physical Medicine and Rehabilitation by Consumer’s Research Council of America. He has over 30 years of experience treating patients with neck and back pain. Orthopedic Institute and Dr. Chang have received Exemplary Status Laboratory Accreditation from the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM).
On a personal level, Dr. Chang also enjoys playing tennis and reading and is active in his church.
Get to know Dr. Chang
Testimonials for Dr. Chang
10 Facts About Microdisectomy for Leg Pain & Weakness
A microdisectomy is a relatively common procedure used to alleviate leg pain, weakness and, occasionally, pain in the lower back. For some patients, back surgery can be a frightening concept—so we’ve put together a list of facts that you should know about the use of microdisectomies to correct back pain and weakness.
Read on for 10 facts about microdisectomies for leg pain and weakness.
1. The Procedure Can Be Minimally Invasive
While there are different surgical methods for microdisectomies, they are generally minimally invasive—often utilizing a surgical microscope and performed through a small one inch incision in the lower back.
2. It Removes the Herniated Portion the Disc
After making the incision in the spine, the surgeon removes the membrane over the nerve root and carefully retracts the nerves from the herniated disc in order to remove the source of pressure on the nerve root.
3. It Usually Offers Immediate Relief from Leg Pain
The purpose of a microdisectomy is to remove a small portion of the herniated disc in your spine that is placing pressure on the nerve root. Removing pressure on the nerve root will often completely remove the source of the pain and patients generally feel pain relief immediately following the procedure.
4. Recovery May Take Months for Neurological Symptoms
When the nerve root is damaged by the herniated disc, it may lead to numbness, weakness or other neurological symptoms in the leg or foot. Following the surgery, it may take months for the nerve root to fully heal and for these symptoms to subside.
5. You Should Try NSAIDs and Physical Therapy First
Patients should generally only consider surgical intervention when alternative treatment options, such as oral steroids, NSAIDs and physical therapy have failed to address their pain.
6. The Procedure Is Up to 95% Effective for Sciatica Pain
According to the Spine Institute of San Diego, the success rate of micodisectomies approaches 95% for appropriately chosen patients. This translates to high rate of success and pain relief for those experiencing pain, weakness or numbness in their legs.
7. Most People Leave the Hospital Within 24 Hours
Because the procedure is minimally invasive, many patients who undergo a microdisectomy are able to go home within 24 hours of their procedure—often on the same day.
8. It is Sometimes Referred to as “Microdecompression”
Some people refer to a microdisecotomy as a microdecompression due to the procedure’s decompression of the nerve root.
9. A Microdisectomy is Different Than a Disectomy
While disectomies and microdisectomies are both surgeries involving the partial or complete surgical removal of an intervertebral disc, they are two separate procedures. The “micro” in microdisctomy refers to the use of microscopic magnification, which allows for smaller incisions and a less-invasive surgery overall.
10. Roughly 5% of Patients Develop a Recurrent Herniation
While microdisectomies have an incredibly high rate of success at alleviating leg pain in patients, one of the most common complications is a recurrent disc herniation—which may require another procedure to correct.
If you suspect that you may be in need of a microdisectomy to alleviate pain, weakness or numbness in your legs, make an appointment today to meet with one of the members of the comprehensive spine team at the Orthopedic Institute.
Ice vs Heat: What’s Better for Pain Relief?
Slight to moderate pain doesn’t always require a trip to the doctor’s office. In certain situations, using a cold pack or heating pad at home can help you feel better, faster. The trick is finding the right treatment for your needs—and knowing how to use that treatment without causing yourself further pain or injury.
Ready for some cool tips and hot advice? Read on for the basic on using ice and heat for pain relief.
If you’re treating pain at home, simply remember this quick rule of thumb: Ice is for numbing the inflammation associated with fresh injuries (like if you fall and hurt your knee or ankle) – and heat is for soothing stiff, aching muscles and joints.
Let’s take a quick look at when to use both:
When to use cold therapy:
- If you have had a recent injury (within the last 48 hours) where swelling is a problem.
- Apply an ice pack, frozen gel pack or even a bag of frozen vegetables wrapped in a towel to the affected area. You should never apply a frozen item directly to the skin, as it can cause damage to the skin and tissues.
- Apply cold treatment as soon as possible after an injury.
- Use cold therapy for short periods of time, several times a day. Ten to 15 minutes is fine, and no more than 20 minutes of cold therapy should be used at a time to prevent nerve, tissue, and skin damage.
- Elevate the affected area for best results.
When to use heat therapy:
- If you are experiencing joint or muscle pain or stiffness.
- Minor stiffness or tension can often be relieved with only 15 to 20 minutes of heat therapy.
- Moderate to severe pain can benefit from longer sessions of heat therapy like warm bath, lasting between 30 minutes and two hours.
- Local therapy is best for small areas of pain, like one stiff muscle. You could use small heated gel packs or a hot water bottle if you only want to treat an injury locally.
- Regional treatment is best for more widespread pain or stiffness, and could be achieved with a steamed towel, large heating pad, or heat wraps.
- Full body treatment would include options like saunas or a hot bath.
When NOT to use cold or heat packs:
- If you have areas of skin with open wounds or rashes.
- If you have areas of skin with poor sensation to heat or cold.
- If you have areas of the body with known poor circulation.
- If you have diabetes.
- If you have an infection under your skin.
If the treatment hasn’t helped much with regular use, or makes your pain worse, see your doctor to discuss other treatment options. It’s also important to call your doctor if you develop any bruising or skin changes while using cold or heat therapy.
When Should You See a Doctor for Neck Pain?
Your spine is important and, when you’re experiencing chronic neck pain, it can be scary. How do you know when neck pain crosses the line from being “a pain in the neck” to something more serious?
Check out this quick reference guide for common causes of neck pain and when it’s time to see a doctor.
Common Neck Pain Causes
The tricky thing about neck pain is that it can have a number of causes. Most of the time it’s temporary and could go away with something as simple as a good night’s sleep or a dose of over-the-counter pain medication. Common causes include:
- Tension headaches: Tension headaches are an incredibly common brand of headache and they are often associated with pain and tenderness in the neck.
- Sleep position: Sleeping in a position where your head lacks support and your neck is strained can often cause neck pain. To avoid neck pain from sleep, try sleeping on your back. You might also need a new mattress or pillow for additional support.
- Looking up and down: People tend to hold their cellphones too low and situate their televisions too high. This can lead to looking up or down for extended periods of time, which can cause neck pain.
- Using the phone: While pinching your phone between your ear and your might be a convenient way to hold a conversation while keeping your hands free, this practice can put strain on your neck.
- Dehydration: The discs in your spine that separate your vertebrae need hydration. If your body is dehydrated, these spongy discs become less spongy, which can lead to neck pain.
- Carrying heavy objects: Carrying too much weight in one hand, such as in a briefcase or purse, can put undue strain on your shoulders, back and neck.
- Posture: Sitting in a slouched position with your head in front of your shoulders can put a greater strain on your neck.
Serious Neck Pain Causes
While neck pain often results from less-serious conditions such as slouching or dehydration, there are a number of serious medical conditions that can cause neck pain as well. If you’re experiencing serious neck pain, you may want to consider seeing a spine specialist at the Orthopedic Institute.
- Worn joints: Just like other joints in your body, the padding between your vertebrae can wear down with age. This can cause bone spurs which can affect your joint motion and cause pain.
- Injuries: Rear-end auto collisions can result in whiplash injury, which occurs when the head is jerked backward and then forward, straining the soft tissues of the neck. Strains or sprains to the neck after an auto accident may not be immediately evident. Symptoms may start or intensify in the days after the accident but generally are short lived and treated with simple conservative measures such as ice, heat, over the counter anti-inflammatories, muscle stimulation or a exercise/therapy program.
- Disease: Certain diseases such as rheumatoid arthritis, cancer or other inflammatory conditions can cause pain and stiffness in the neck. If you have persistent symptoms and family history of auto-immune diseases you may want to contact your physician.
- Nerve compression: The disks in your spine that separate your vertebrae are soft on the inside with a tough exterior on the outside. A herniated disk occurs when the softer inside ruptures through the tougher exterior. A herniated disk in your neck may also cause pain in your shoulder or arm. Herniated disks, along with bone spurs in the vertebrae of your neck, can press on the spinal nerves or the spinal cord, resulting in pain, weakness or numbness and tingling
If you have severe, lasting pain, and signs that may indicate one of the more serious causes of neck pain mentioned above, it’s time to Stand Up For Your Spine. Learn more about our experienced neck and back team.
5 Signs You May Need a Hip Replacement
Many people managing rheumatoid arthritis, osteoarthritis, osteonecrosis and other general joint health issues struggle with whether or not they should seek hip replacement surgery. They have pain, but it can be hard to decide if the pain is significant enough to warrant a hip replacement.
Check out our list of 5 signs that it’s time to consider a hip replacement.
1. Hip Pain
The first, and perhaps most obvious, sign that you should consider a hip replacement is hip pain. Do you walk with a limp or depend upon a cane because of your hip pain? Hip pain shouldn’t interfere with your ability to live your life. If your pain affects your daily life, disrupts your sleeping habits or both, the damage may be serious enough to consider a hip replacement.
2. Limited Mobility
Simple tasks such as standing up, walking or taking the stairs can be incredibly difficult and painful for someone in need of hip replacement. Some people remain unaffected by their limited mobility, but if your hip pain limits your mobility to the point of interfering with your daily life, consider speaking with a physician about your options.
3. Stiffness
Does your hip stiffen up while sitting? Stiffness in a hip joint is a telltale sign that a hip may need to be replaced. Many patients in need of hip replacements will also experience stiffness when attempting to simple tasks, such as putting on shoes or gardening.
4. Grating or Rubbing
A grating or rubbing feeling in your hip joint, especially in combination with the other issues listed here, is another indicator that you may want to look into hip replacement. The hip joint is lined with smooth cartilage that prevents your thigh bone from rubbing against your hip bone. When you experience grating or rubbing, these bones are rubbing together, which can be painful and may be a sign that your hip joint should be replaced.
5. Nothing Else Works
Hip replacement surgery is never the first option. Before looking into a hip replacement, try other pain treatment options such as medication, injections, stretching and exercise. If these more moderate pain management approaches do not work, then a hip replacement may be your best solution.
If your hip pain doesn’t limit you from doing normal activities or you get relief from less invasive treatments, you may not need a hip replacement. If you are still unsure whether or not you should look into a hip replacement, come in to the Orthopedic Institute and speak with one of our hip specialists about your options.
Hip replacement can return you to a higher quality of life. Check out these Orthopedic Institute hip replacement success stories!
10 Causes of Leg Cramps
Leg cramps are a pain, literally! It may not always obvious what causes them, but the pain associated with leg cramps makes them nearly impossible to ignore. The Orthopedic Institute team has compiled a list of 10 common causes of leg cramps to help you understand and avoid this pesky problem.
1. Dehydration
Have you been drinking enough water? Dehydration is one of the most common causes of leg cramps. A cramp is an involuntary contraction of a muscle. The fluids in your body allow your muscles to relax, but—when those muscles are dehydrated—they get irritable and prone to cramping. Staying hydrated, especially during physical activity, is an excellent way to avoid leg cramps.
2. Overuse
In addition to dehydration, leg muscles can also cramp from overuse. When doing particularly intense physical activity, the nerves in your spine can become overexcited and fire involuntarily, contracting your muscles and causing a cramp. Those with more sedentary lifestyles may experience muscle overuse from more mild activities such as walking, hiking, gardening. Resting your legs and stretching often will help you avoid cramps from overuse.
3. Fatigue
Your muscles need time to recover. If you use them for extended periods of time without proper rest, the potential for leg cramps is greatly increased. As the muscles in your leg become tired, they become less efficient and require more nutrients than they would if they were rested. Avoid muscle cramps from fatigue by giving your muscles proper rest and conditioning them for any prolonged use.
4. Excessive Sitting or Standing
Bodies are meant to move, so staying in one position, regardless of whether you’re sitting or standing, puts you at greater risk for muscle cramps. Standing for too long can cause your muscles to fatigue, which will increase the likelihood of a cramp. Sitting can leave muscles in the same position for an extended period of time, which can lead them to spasm and cramp. If you sit or stand all day for work, try to alternate between sitting and standing so your body is not in one position for too long.
5. Medications
Certain medications prescribed to treat Alzheimer’s, high cholesterol, asthma, Parkinson’s and osteoporosis have a tendency to cause muscle cramps. If you’re experiencing leg cramps due to medication, talk to your doctor about your pain and possible medication alternatives.
6. Potassium Deficiency
Potassium in the cells of your leg muscles helps the brain tell the muscles when to start and stop contracting. When you have a potassium deficiency, these signals are not relayed properly, and muscle contractions may be prolonged, causing a cramp. Bananas are high in potassium, so adding them to your diet will help maintain proper potassium levels and avoid cramps.
7. Poor Circulation
Poor circulation in your legs can prevent your leg muscles from getting all the oxygen they need to function. This can lead to leg pain, muscle spasms and cramps. Walking, stretching, and wearing compression stockings can all help manage poor circulation in your legs and prevent cramping.
8. Excessive Alcohol Use
The nerves in your leg can be damaged by alcohol abuse. Excessive drinking can alter the levels of thiamine, folate and vitamins B6, B12, and E, which are all needed for your nerves to function properly. This is called alcoholic Neuropathy and can be the cause of leg cramps. Avoiding alcohol can restore the nutritional health of your muscles and stop your legs from cramping.
9. Pregnancy
Women in the third trimester of pregnancy often experience leg cramps, especially in the evening hours. In this case, cramps can be caused by the additional weight of the baby, changes in circulation, and pressure from the baby placed on the nerves in your legs. Regular exercise, leg and or foot massages, and stretching are all ways to prevent leg cramps.
10. Multiple Sclerosis
One of the symptoms of multiple sclerosis is spasticity, a condition which causes certain muscles to be continuously contracted. Multiple sclerosis causes damage to the central nervous system, which can cause spasticity and lead to cramping in the legs. You can manage leg cramping caused by multiple sclerosis through maintaining a healthy diet, stretching and massaging your legs and treating them with hot and cold therapy.
