Dry Needling Performed by Qualified Chiropractors in Wichita, KS
Why Should I Trust ICT Muscle & Joint Clinic with Dry Needling?
In Kansas, there is no requirement for a healthcare practitioner to have a license or certification to acknowledge a base level understanding of how to perform dry needling or the contraindications to dry needling. The only current requirement is having a certain level of professional degree – DC, MD, DO. Our chiropractic doctors have gone above this standard, or lack of a standard, and are credentialed through various dry needling certifications.
How Dry Needling Works
There are three largely accepted models of dry needling: Radicular Model, by Gunn; Spinal Segmental Sensitization Model, by Fischer; and Trigger Point Model, by Travel. With these 3 models there are 5 known mechanisms for the effects of needling: local, segmental, extra-segments, myofascial trigger point, and central. To summarize the above, dry needling has many facets. How dry needling works and the different models of dry needling is commonly misunderstood amongst the general population and healthcare professionals alike. However, we do understand that dry needling can provide significant pain relief to myofascial pain.1
Most healthcare providers do not understand or go into the complexity of understanding how, when, and why a customer might be finding positive results with dry needling regarding these three “pathways.” Largely, healthcare practitioners and patients alike just care if dry needling is working, will work, or if it will not work. This is perfectly acceptable too. Sometimes it is better to be lucky than good. It is important to us to be honest that healthcare is equal parts science, art, and philosophy. No one practitioner, specialist, field, etc., has all the answers. Textbooks are constantly evolving. This means science is not ever settled. Experimentation must occur to find improvement within the science. Therefore, sometimes it is better to be lucky than to be good.
If someone is wanting to understand the interplay with dry needling and which concept is primarily happening with regard to results, our chiropractors integrate three strategies, when applicable, and based on your pain categorization – soft tissue remodel, neurological, chemical.
The 10,000 Foot View of How Dry Needling Works
Dry Needling works by targeting and releasing trigger points (TrPs). Trigger points are hyper-irritable, palpable knots within a myofascial unit that lose good oxygen and blood supply. These TrPs alter the firing rate and potential output of a muscle, minimizing its efficiency, ability to function, the position of associated joints, and even the effectiveness of corresponding tissues.
Our chiropractor’s approach to dry needling TrPs is to create micro-trauma inside a soft tissue (i.e. fascia, muscle, tendons, etc.) structure to elicit a twitch response. This twitch response is a neurological sign of released tension, which ensures our expert chiropractors are targeting the trigger points effectively.
Dry Needling and Soft Tissue Remodel
According to Dommerholt J. 2004, there are three major effects which take place within the soft tissue with dry needling.2
- Disrupts integrity of dysfunctional motor end plates - Motor end plates are where the nerve meets the muscle fiber. This junction sometimes becomes non-functioning. Using a needle, by “stabbing” the area, the trauma can help to reset the firing rate of the muscle or improve the communication of the nerve and muscle fiber.
- Causes a local twitch response (LTR) - This local twitch response is the process we can see or feel of “restarting” the firing rate of the muscle again.
- Alter muscle fiber length - When a trigger point is present, the muscle is pulled inwards to the center of the trigger point. As a result, the aspect of the healthy muscle fiber(s) becomes stretched or pulled inwards to the trigger point. This causes a non-ideal resting state of the muscle which in turn does not allow the healthy muscle fibers to work correctly.
Dry Needling and Neurological Release of Tension
According to Baldry PE. 2001, there are three major neurophysiological effects which take place with the brain-body connection.3
- Stimulation of A delta nerve fibers (type III) for 72 hours post-needling - These are the fast nerve fibers of our body. Simply, the nerve fiber which reaches the brain faster wins and in so doing the brain registers these fibers versus the painful fibers first.
- Prolonged stimulation of these A-delta fibers may activate enkephalinergic inhibitory dorsal interneurons - When a nerve is stimulated from an injured area of the body, the nerve communicates this injury to the spine. The spine then sends signals back to the injured tissue and the brain. Once the signal reaches the brain the brain then sends signals back to the spine and the injured tissue. When A-delta fibers are stimulated, this stimulation helps to reduce or shut off the pain pathways which travel within the spinal column. This process makes things feel better again.
- Activate descending inhibitory systems which would block noxious stimulus into the dorsal horn - This is very similar to the above situation. The dorsal horn is part of the back aspect of your spinal cord. Instead of blocking pain fibers within the spinal cord, this is stating it blocks pain fibers from entering the spinal cord.
Dry Needling and Chemical Release (Anti-inflammatory Effect)
Once an active trigger point is stimulated by a needle, and a local twitch response is felt or seen, there is a decrease of inflammatory chemicals. Shah J. et al. 20054 notes three chemicals to be significantly altered with needling. All three of these chemicals contribute or cause vasodilation, or the constricting of blood vessels.
Bradykinin
- Bradykinin causes inflammation. Dry needling helps to decrease the amount of bradykinin at the site of the trigger point which in turns makes the area feel less uncomfortable. The release of bradykinin directly causes the release of calcitonin gene related peptide and substance P.
Calcitonin Gene Related Peptide (CGRP)
- CGRP has many roles within the body, but “without doubt, CGRP is one of the most potent peripheral microvascular vasodilators.5
- CGRP may have a role in pain and itchiness associated with arthritis and skin-related disease.
- It has many known effects but even more unknown effects currently. Outside of its neurological effects, CGRP affects blood flow related conditions such as migraines.
Substance P
- Substance P is well known for its neurotransmitter and a modulator of pain perception effects by altering the signal pathways within a cell.
- Substance P affects gastrointestinal (GI) function, memory processing, angiogenesis (blood vessel growth), vasodilation (opening of blood vessels), and cell growth and proliferation (reproduction).
- Dry needling helps to reduce substance P levels within multiple locations of the body.6
Is Dry Needling Covered by Insurance?
Dry Needling is not covered by insurance at this time. It is considered experimental or investigative. At this time, we do not have an idea of when or if dry needling will be covered by insurance in the future. If it does become covered under insurance, we believe it will fall under a person’s deductible plan and not the co-payment.
Why Should I Try Dry Needling for Pain?
Outside of explaining how dry needling is effective, Dry Needling, or at least the use of needles to alleviate pain, has been around for thousands of years. The ultimate power of Dry Needling is its capability to alter the physical, chemical, and neurological inputs at the target tissue quickly to which other treatment certifications, methods, and protocols cannot reach at all, as effective, or as fast. Dry needling can be quick and relatively a painless experience.
How Dry Needling and Acupuncture are Different
The question, is dry needling the same as acupuncture, is a common theme. Since it’s “inception” in the 1980’s, dry needling has branched into many different models, techniques, certifications, and certifying companies. With the evolution of these dry needling companies, we can largely view the difference between dry needling and acupuncture as being the assessment, method, and/or justification for a needling intervention.
A true acupuncturist will claim dry needling is a branch of acupuncture, even though the method between the two are different. A “mixer” (person who does both acupuncture and dry needling) or a dry needling specialist typically do not argue with the above statement; however, the assessment and method associated with the various dry needling certifications do not resemble acupuncture’s method of assessment. Within acupuncture there are ~2,000 acupuncture points on the body. Dr. Ronald Melzack (1977)7 found that more than 70% of the classic meridian acupoints correspond to commonly used trigger points. As a result, there are overlapping dry needling points with acupuncture points on the body. Either way, the length of history associated with needling is well established with positive results.
The Additional Layer of Dry Needling and Healing Timeframe
If you have tried dry needling, with us or with another chiropractic or physical therapist healthcare provider in the past, you can often identify 30% improvement in a single visit. The question here is, how can that degree of pain reduction be possible in reference to the time frame with the healing chart?
It is simple, just because you are experiencing pain, it does not mean there is an injured tissue at the site of pain (perception of pain – central sensitization), or that the pain you are experiencing is entirely local to the site of the also injured tissue (peripheralization). Pain is simply an interpretation of something is wrong; not necessarily where it is wrong. Ron Donelson, an orthopedic surgeon, and former vice president of the American Back Society notes, “The only time it really matters where the pain is coming from is if some invasive treatment, like an injection or surgery, is being contemplated.”8 Pain is not linear in the statement “pain here must mean problem here” but merely an interpretation or an awareness of something is less than ideal.
The brain, in the brain-body connection, is contributing to or producing the pain as a warning sign. When we dry needle, and we see a significant reduction in pain (30% or more), we then have identified a neurological brain-body hack. The brain produces protective patterns for various reasons but primarily to restrict you in a position or movement that the brain-body connection perceives as a threat. This does not mean that we have started the healing process for the locally injured tissue, if there is one present, but merely a reduction of pain to allow the healing process to begin with less intensity of symptoms.
