Dry Needling

What The Cup?

Dynamic cupping and how it fits in to your sports recovery and pain relief.

Outside of a select few who actually had cupping therapy prior to 2012, most of us remember the first time we saw the little bruise circles - Michael Phelps, 2012 Olympics.  Just as Kinesio taping sparked our curiosity during the prior Olympics with Volleyball megastars Kerri Walsh Jennings and Misty May-Treanor, as soon a Michael Phelps stepped on the starting platform for his first races, questions started to pop up on every major news outlet across the world.  

 

So What Is Cupping? 

Cupping therapy is a form of ancient Chinese medical therapy dating back thousands of years. Basically, heat is used to create pressure inside the ‘cups’, now achievable through pressure valves without heat, which draws the superficial soft tissues (skin, fascia, and maybe muscles) up into the cups...all in the name of greater circulation and pain relief.  While this practice has been around the block a few times, as manual therapists progress in knowledge and skill, so do our practices.

 

Enter A New Form Of Cupping Therapy.

Taking a tried and true form of therapy and adding movement, this is what the modern landscape of manual therapy looks like.  With cupping, this is no different….enter DYNAMIC CUPPING.

While cupping therapy has its benefit, clinically we have found that incorporating movement, specifically, a full range of motion and sport-specific movements during cupping can help relieve pain and improve the needed movements to return to play and activity faster.  

At Revive Sport & Spine, Dynamic cupping is utilized in 2 ways.  

One is to place the cups in the desired area of injury.  The practitioner will then glide and move the cups around with the intention of affecting the underlying tissue with improved circulation and adhesion release.
The second option is to affix the cups in the desired location and then have the patient progress through a series of movements and specific sports related actions.

 While data is hard to come by for this practice, partly as it is difficult to study it against a sham treatment, clinically the results have been beneficial when used with other therapies such as active soft tissue release, dry needle therapy, and other chiropractic and physiotherapy modalities.  

 
 

 

Conditions That Respond Well To Dynamic Cupping.

Treatment plans for care and actual therapies used should be case specific.  That being said, dynamic cupping has shown to be beneficial in relieving pain and speeding recovery from low back pain, neck pain, hip pain, shin splints, IT band syndrome, Achilles tendonitis, rotator cuff strains, shoulder pain, as well as many other musculoskeletal complaints.  

 

How Does Cupping Work?

  • Improved circulation.

    Hallmarked by the circular bruise post-treatment, as the tissue is pulled up into the cup, capillary beds begin to swell and break (mildly), leading to an increase in blood flow.  
  • Mild Inflammatory Response

    Anytime tissue is damaged, intentionally or unintentionally, the body begins a cascading response that causes what we call inflammation.  Inflammation carries the cells needed to heal damaged tissue and in this case, we intentionally apply suction to mildly damage capillary beds and move soft tissue, in turn causing a mild inflammatory response with the goal of increased recovery and shortened time.  
  • Tissue Movement & Decompression

    As a manual therapist, most treatment modalities utilize pressure or the pressing in on a tissue.  Cupping is one of the few that is decompressive in nature as it pulls the skin and superficial tissue away from the body.  While the debate is still out, utilizing dynamic cupping can help relieve pain and restricted motion by decompressing the tissues and moving them across each other.  Further studies will hopefully begin looking into this.
  • Clinical Evidence

    As a clinician that utilizes dynamic cupping therapy with runners, CrossFit athletes, and golfers as well as the low back pain, neck pain, and shoulder pain sufferers associated with desk sitting, it is a great adjunct to many other therapies.  At Revive Sport & Spine, we typically utilize dynamic cupping after dry needling, while incorporating movement and IASTM practices with cups in place. We have found that creating the right mix of treatment for the right patient aimed at their specific goals often yield faster than expected results.  

 

We look forward to more data being produced on dynamic cupping as a stand-alone therapy and in conjunction with joint manipulation, dry needling, and IASTM therapies.  We have much to learn about the human body and every day is an opportunity to grow and improve. Dynamic cupping could be a great therapy for you and help you achieve your goals and recover faster...it could also just be another feel-good therapy.  Either way, the risk is minimal so….If it makes you feel better and the risk is low, do what you need to do to stay in the game and out of pain. 


Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

7 Things You Need To Know About Dry Needling

The more we study dry needling, the more we understand its benefit and expand its use in the treatment of musculoskeletal injuries.  Addressing everything from low back pain, migraines, and sports injuries; dry needling proves beneficial in the most common muscle, tendon, ligament, and joint issues seen in a physician's office.  

As more practitioners utilize this technique, it is important to know the basics about dry needling, what to expect from treatment, and what conditions can benefit from this therapy.  Below are seven important items to understand when seeking treatment.  

1. WHAT IS DRY NEEDLING?

Dry needling is a skilled technique performed by trained Chiropractic Physicians and Physical Therapists aimed at managing neuromusculoskeletal injuries and pain while addressing movement dysfunction.  Dry Needling utilizes a thin filiform needle to penetrate the skin, fascia, and muscles to address adhesions, trigger points, and connective tissue.  This speeds healing and relieves pain by decreasing muscle hypertonicity, increasing joint range of motion, and correcting movement dysfunction through releasing a trigger point adhesion.

2. DRY NEEDLING IS NOT ACUPUNCTURE. 

Acupuncture is an ancient traditional Chinese technique that utilizes the knowledge of meridians.  This focus allows an acupuncturist to work on a person's inner balance, energy, qi, and one's life-force.  Work up and exam includes physical, tongue, and pulse examination.  Traditional acupuncture has been widely studied and practiced for thousands of years.

Dry needling relies on the practitioners expanded knowledge of skeletal and neuroanatomy.  This knowledge allows one to identify damaged and sensitive tissues, taut bands, and trigger points as well as injured and overused tissues.  Dry needle practitioners utilize an extensive examination that includes movement analysis, orthopedic evaluation, and a neurological workup that includes myotomal and dermatomal testing.

3.  WHAT IS A TRIGGER POINT?

A trigger point is a spot of muscle/fascia that is hypersensitive, painful when compressed, composed of a taut muscular/fascial bands that restrict oxygenated blood flow, and can refer pain and tenderness while causing motor dysfunction.  According to a recent article in Current Pain and Headache Reports, muscle overtraining or direct trauma to the muscle can lead to the development of trigger points. Trigger points may develop during occupational, recreational or sports activities when muscle use exceeds the muscles capacity to handle stress, disturbing normal recovery.  Dry needling differs from other types of therapy because it focuses on stimulating these trigger points and releasing the tension in order to alleviate pain.

4. WHAT IS A TWITCH RESPONSE

The twitch response is a localized, reflexive response of a dysfunctional area of muscle to palpation, or in our case, a dry needle.  When needling a trigger point, this is one of our goals as it leads to a rapid release of a taut muscle band, decreasing tightness and sensitivity of the surrounding area.  A tight muscle or one with a trigger point will feel an achy discomfort with an occasional twitching or cramping sensation. This twitch response returns the muscle to a normal state by releasing inflammatory chemicals from the trigger point and restoring blood flow to the area.  According to a recent study in the Journal of Orthopaedic & Sports Physical Therapy, The twitch may be a sign that the treatment will be successful.  A local twitch response is a spinal cord reflex that creates an involuntary contraction that can be triggered by a snapping palpitation or penetration with a needle.  When the patient has an involuntary twitch response, that suggests that the needle has hit the right spot.

5. IS DRY NEEDLING THERAPY PAINFUL? 

Dry Needling utilizes a thin filiform needle to penetrate skin, fascia and muscles to address adhesions, trigger points and connective tissue to speed healing and relieve pain.  Often, patients will experience a mild, dull ache during treatment and up to 24 hours post treatment.  Some discomfort is experienced during the rapid ‘twitch response’ but this discomfort is minimal and last only a few seconds.   It is normal to have mild to moderate muscle soreness after dry needling treatment.  Drinking lots of water, stretching, moving your body and heating the sore muscles can reduce the duration of the soreness.  Side effects include mild muscle soreness and bruising in some patients.

6. CONDITIONS COMMON TREATED WITH DRY NEEDLING. 

  • Headaches
  • Neck Pain
  • Low Back Pain
  • Knee Pain (Osteoarthritis)
  • Shoulder Dysfunction (adhesive capsulitis, impingement, rotator cuff strain)
  • Tennis & Thrower's Elbow
  • Carpal Tunnel Syndrome
  • Hip Pain
  • IT Band Syndrome
  • Patellofemoral Pain Syndrome (Runner's Knee)
  • Medial Tibial Stress Syndrome (Shin Splints)
  • Achilles Tendinopathy
  • Plantar Fasciitis
  • Ankle Sprains
  • Muscle Strains

7.  WHAT DOES CURRENT LITERATURE SAY & WHO CAN BENEFIT?

Dry Needling is an extremely effective treatment for acute and chronic pain, decreased flexibility, joint dysfunction, and recovery from physical activity and competition.  Patients who undergo dry needling therapy experience less pain quickly, with most finding relief after their first treatment. According to reports published by the Journal of Orthopaedic & Sports Physical Therapy, patient function is restored much more quickly when dry needling is incorporated as part of the care plan.

Chronic upper-quarter (neck/upper back/shoulder) headaches and spinal movement dysfunction have all been associated with myofascial pain syndrome (trigger points).  Kietrys et. al. published a meta-analysis on the effectiveness of dry needling on this syndrome.  Based on their research and findings, they recommend dry needling as an effective option for treatment of upper quarter myofascial pain syndrome.  They found that pain measures decreased for most patients immediately after treatment and at the four week follow-up meeting.  - Effectiveness of Dry Needling for Upper-Quadrant Myofascial Pain: A Systematic Review and Meta-analysis. http://www.jospt.org/doi/pdf/10.2519/jospt.2013.4668.   

A 2015 study looking at ankle sprain rehabilitation found that adding trigger point dry needling, of the lateral lower leg peroneus muscle, to a rehabilitation plan of proprioceptive/strength exercise the four weeks following an acute lateral ankle sprain, had greater improvements in function and pain than the controlled group of just exercise.  - Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial.  http://dx.doi.org/10.1155/2015/790209

It is normal to take several dry needling therapy sessions before the muscle is fully functional again. This is because trigger points are located under deep layers of muscles, so it typically takes several sessions for the changes to take full effect. But patients will usually notice the difference right after each treatment.