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THE OFFICIAL BLOG OF BEXAR ATHLETIC TRAINING

A WORD WITH
DOCTOR SPRAGGINS

Injury treatment and prevention guidance with Bexar Athletic Training owner, Dr. Spraggins.

What is Dry Needling

And Why Should I Let Someone Stab Me?


I want to take a second and lay out what dry needling is and isn’t. Clear some air about it and lay out how I use it at Bexar Athletic Training.


Performing needling on a runners distal hamstrings

As an Athletic Trainer (AT) I am always looking for the most effective tools to assist my patients in alleviating pain and increasing or restoring mechanical function. I tell patients constantly, "I really want to get you to the point that they don’t need me, I don’t want to see you for 60 visits". Over the past 8 years I have used many different tools such as Graston or instrument assisted soft tissue massage (IASTM), decompression using cupping, taping, and joint mobilizations, all to great effect. However, DN is by far my most efficacious tool to generate change in a patient’s condition.



 

What the heck is dry needling?

On a basic level Dry Needling is a using a very thin needle (0.12 – 0.35mm commonly) into a patient’s problem tissue to target a very specific response. Some practitioners might say they are looking for trigger points, and that is true to a degree, but that is only a small portion of DNs usage. DN is meant to stimulate a response in the target tissue. It can be used to tease out an active trigger point, increase blood flow and nutrient flow to a joint space, release tension in a muscle that’s hypertonic. It can also be utilized to stimulate blood flow to a nerve to increase activation of that signal, this is extremely helpful in scenarios for people in that “fight or flight” loop. It is referred to as dry needling, simply because there is not a medicine or serum being injected. In-fact most dry needles can fit inside some of those used to deliver medications.


Most DN practitioners, at least most ATs like me and Physical Therapist (PT) are relying on their knowledge of anatomy and their understanding of the inflammation cascade to enact change on a target tissue. Think of it this way, for an active trigger point or tense and restrictive muscle; the needle becomes a stimulus. Same as a thorn, a very, very small thorn, my most common size used is 0.25mm x 30mm. That stimulus elicits an inflammatory response that delivers blood flow to the area. This blood flow isn’t just more of the same blood but is full of chemical mediators to respond to the stimuli. These mediators or responsible for a surplus of actions. Everything from clotting to stop bleeding to pain regulation and nutrient delivery. I could go deeper into inflammatory cascade, but that’s boring and not the point of this post.


Essentially the needle in basic terms causes the body to clean up or restore a tissue to its original or intended state. This often allows the AT or PT to better work with the patient in rehabilitative exercises allowing the patient to complete movements not previously capable. Getting the combination of stimulation and inflammation correct can truly allow movement patterns to be improved, function to be restored and the body to be returned to its corrected state. These things are the basic goal of any rehabilitative therapist, hence why I refer to DN as my most efficacious tool. Nothing else gets me the response DN does with one session.


What Dry Needling is NOT

Often I hear; “Oh its Acupuncture.” Well, yes and no, but mostly no. Am I an acupuncturist, absolutely not. For starters getting certified might as well be like getting another bachelors degree all together. Acupuncture is in simple form, a complex eastern medicine technique some regard as pseudoscience (I disagree but, that’s another podcast). There is some contention between acupuncture and DN practitioners, given the time given to be proficient seems very different. Acupuncture can take several hundred hours of training to even begin. DN introductory courses are typically completed in a weekend. That sounds concerning until you realize you must first be a practicing AT, PT, Chiropractor or other medical and or rehabilitative professional holding a degree and proper certification before you can take the DN course. This is also state dependent, as not every state agrees on which licensed medical professionals can use DN in their practices. DN differs from acupuncture in that it relies heavily on the practitioners already acquired knowledge and understanding of human anatomy and its systems. However, I do use acupuncture needles, that I get from the same source as all acupuncturist. Also much of our current understanding of the these systems, stems from learning derived over the vastly longer lifespan that acupuncture has been in practice and observed versus the few decades DN has been in use.


Dry needle for cervical tension, head and neck tension.

Should I get stabbed?

That is a complex question indeed. I have been told that perhaps I shouldn’t use the wording “stabbed”. For injuries that have not healed or corrected themselves naturally or with other remedies, I start to consider DN. Post-surgery, with physician approval, I look toward DN to help restore function faster, decrease scar tissue faster and genuinely promote safe and rapid healing. If someone is very sensitive to the idea or concept of being stabbed, hates needles, or has a honest fear of them. I often will start with as few as 2-4 needles in an area, just to help assist and push past the fear. Believe it or not, there is even a DN technique to help with the anxiety, its one that is very helpful and not painful at all.


More commonly I will use DN to restore range of motion and relieve tension in muscle areas. My most favorite use is for neck tension and its related problems. I enjoy working on neck since it is the only thing that provides relief for my own neck issues (C5,6 disc issues), but mainly its just instantaneous relief for most patients. The muscles that hold your head up and provide small movements as you track the screen in front of you hardly get stretched or released. DN allows me to elicit direct change on even the smallest of muscles in the head and neck.


Taking a deeper dive you can find DN being used for things such as tinnitus, temporomandibular disorders (TMD/TMJ), carpal tunnel, vagus nerve stimulation, autonomic nervous system stimulation and regulation, chronic pain mitigation, post surgery scar management and manipulation. I am sure I am leaving out a plethora of uses and methods DN is being utilized for, some of my colleagues will correct me I'm sure.


Dry needling (DN) or integrative dry needling (IDN) is a very powerful clinical tool for me to both alleviate pain as well as improve function. There are piles upon piles of evidence-based research indicating both the safety and effectiveness of DN in the rehabilitative clinical space. I am hard pressed to find a better tool, but that being said, not everything needs stabbed, and I don’t always needle on the first date.

If you have an injury you would like to consider for DN or another treatment, let me know.


Most runners and some luchadors can benefit from DN on glutes and piriformis

If you want to dive deeper down the rabbit hole of DN, look no further that Jasons Blog https://intricateartseminars.com/tag/blog/. Intricate Arts is where I got my start into DN and Jason has a great blog about almost every condition that can be needled. I get no kickbacks from them, I just really think it’s a great source of information. Thank you for reading, let me know how I can serve you!


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