Trigger point dry needling

I recently attended a Trigger point dry needling course in Baltimore. It was an excellent course by Kinetacore. You may ask "what the heck is dry needling?". As illustrated by the photo on the left, it is a technique where you us an acupuncture needle to elicit a spasm twitch response from a trigger point within a muscle. It is not acupuncture because, as many of you know, I am trained as a physical therapist not some eastern medicine guru. I do not have much of a clue about treating the energy fields of the body. However, I have plenty of experience in treating musculoskeletal problems.

With dry needling, a PT is targeting trigger points within a muscle. Trigger points are taut bands within a muscle which can be painful to direct palpation. Research has shown that different muscles have consistent pain patterns within their most common trigger points. Recognizing these patterns is something of a fine art because they can be far removed from the actual involved muscle. An example could be the tensor fascia latae:


Looking at the image to the left, the X marks the trigger point within the TFL muscle, and the red represents the pain referral pattern. Pretty cool stuff. If you had a runner come into the clinic reporting pain in the red area to the left, what would you think? IT band syndrome probably. However, if all you did was foamroll, or massage the ITband, you really would not get far. So, back to my point of recognizing the trigger point patterns being important, just like treating them.

How does trigger point dry needling work? Pretty simple really! After evaluating a client via a history, plus strength and flexibility checks etc, I would examine the muscle tissue for trigger points. Once identified, I would use a sterile acupuncture needle to mechanically disrupt the taut band by penetrating it, and pistoning the muscle tissue. Pistoning is just fancy speak for moving the needling up and down within the muscle to try to elicit a twitch response. This response causes the muscle to release the tightness, essentially hitting the reset button on it! The technique will cause these mechanical changes, as well as chemical changes within the involved muscle cells. Releasing the muscle makes it more ready to benefit from the exercises being prescribed. It can also immediately change the range of motion around the involved joints, the flexibility of the involved muscles, and also diminish pain. Pretty great list of benefits.
The acupuncture needles are cone shaped so they are not as painful as syringe needles. That said, the treatment can result is some muscle soreness. A day later, with motion restored and pain decreased, you hardly notice it.

I expect this treatment to be a game changer for my practice as a PT. I have been treated for numerous running injuries myself by colleagues using dry needling. I can speak to its value on a personal level. I have also begun to treat patients myself using the technique and have seen positive results. If you are in DC and would like to know more about it, or give it a try, call me at Sports and Spinal PT at 202-463-7611.

Thanks for reading....

Managing expectations

A month ago I ran the Philadelphia marathon with my buddy Chris Farley of Pacers Running stores fame. My goal was to have it be a different race than my typical marathon. What I mean is that the past few marathon races for me have been a bit less fun than I would liked. I have trained hard, and put in plenty of miles to prepare. Racedays have been somehow disappointing which has left me a bit off my game. Most commonly the disappointment has been related to missing a time goal, or some other performance based goal which was missed. After considering scraping marathons all together, I focused instead on getting back to the root of why most of us do these races in the first place: fun.

Going into the training cycle for Philly, I decided to train without strictly following a training program. Instead, I was committed to kinda winging it. I had join a local run club called The dojo of pain which gave me plenty of opportunities to run very hard. The group was great- cool folks with a common passion for running, and doing it fast. I went into the race feeling speedy and fit. When your primary goal is to have fun, don't make the same mistake I did which was to attach a time goal to it. This basically screwed that plan all together. I have learned that basing your goals on time really does not work for me. The reason this is the case is because if you miss your time goal, then it is hard to be satisfied. At the end of the day, this attitude is just plain silly.

I ran a 2:59 at philly, which basically equaled my PR. It felt good to get to the finish under three hours, though I had expected to be there a bit sooner. Missing my goal by 1% should feel like more of a victory than it did. Changing this will be a goal for 2012. How do you balk at an A-? You don't, right!?!

What I love about sports are the hidden life lessons within the training and competition. Running a marathon teaches you that with adequate time and preparation most anything is possible. This carries over for me to work, and even my relationships. Certainly being married teaches you that sometimes you have to dig a bit to get to that great feeling of crossing the finish line. Missing a goal by 1% teaches us things too. It teaches that we can't hit it out of the park every time. It teaches us that we need to be happy with this . The more we can do this, I feel, the more we can come back stronger the next time. We look to the horizon for the next opportunity while focusing on the next step to prepare, and do the best we can to be ready. Sorry for the corn but thanks for reading.

Ground and pound

This past weekend was the Marine Corps marathon which draws approximately 25000 folks. The MCM is great because it is an accessible race which tends to draw many first timers to take their chances at the marathon distance.
In the clinic , we tend to see a surge in clientele leading up to raceday. Most of the runners coming in to the clinic are at the end of a long cycle of training. Many of the rookies have dealt with building a base, then starting marathon specific training. This combination can take upwards of 6 months. More experienced runners will still put in 3-4 months of specific training. Bottomline is that anyone showing up to the start of a marathon has some miles on 'em! The surge we see in the clinic represents the rather cruel side of marathoning. Simply stated, the miles add up. We see the folks who have broken down along the way. Consider that a long run, which is the cornerstone of any marathon program, can have a runner pounding the ground 12-15thousand times. We see that a tiny imbalance leads to something much larger when it is stressed so many times. This is where we start to see things like IT band syndrome, and anterior knee pain creep up on people. Both of these common conditions are often from mechanical strain dues to abnormal movement patterns in a runner's legs. The movement deviation is typically subtle, say 5-10 degrees off course. However, even 5 % of drift of the leg towards midline of the body can lead to 80% increased strain on the lateral part of the patella. Understanding this makes is easy to see why common running injuries can be so common. There is the ground, there is the pound, and then there is repetition. This cycle, my friends, is what leads to injury and pain. If the painful flareup happens at the start of a cycle, usually it is a runner starting too aggressively and the body can't catch up to the stress. If the injury happens at the end of a cycle, usually the cumulative stress has broken down the body's stress tolerance and this leads to injury. A great example is a stress fracture. This injury is effectively the stress of training causing breakdown of the bone which exceeds the body's ability to remodel the bone. As I said, the marathon is cruel. So much goes into getting ready, and the training is fraught with pitfalls. Overtrain and you are guaranteed to be injured. Undertrain and you are certain to underperform. Guess it is time to start training like Goldie Locks! Just right! From a PT's perspective, this is all about specific and purposeful running. It is also about doing active recovery cross training, targeted strengthening and stretching, plus recovery. If a runner rounds out their schedule to cover these targets, the ground and pound can be minimized.