It is very likely that you, or a close friend or family member, have been treated by a physical therapist. Whether it was for pain management or recovery from an automobile accident, hip replacement surgery, or a badly sprained ankle, manual treatment and exercise were likely part of your physical therapy treatment plan.
At Foothills Sports Medicine, we specialize in a “hands-on” treatment approach and are experts in manual therapy. We utilize many techniques while treating our patients. For example, trigger point release, instrument assisted myofascial release (commonly referred to as “scraping”), cupping, and manual stretching are just some of the many ways we help our patients recover from injury and movement dysfunction.
Dry Needling vs. Acupuncture
Dry needling is another common technique we utilize that many patients are unclear about. While many people have heard of “dry needling,” there is a common assumption that it is synonymous with acupuncture. This is not the case. Read on to learn how dry needling is used in physical therapy.
Acupuncture, by definition, is inserting very thin needles through the skin into specific acupoints. According to the Mayo Clinic, this technique is derived from, “traditional Chinese medicine which explains acupuncture as a technique for balancing the flow of energy or life force — known as chi or qi (chee) — believed to flow through pathways (meridians) in your body. By inserting needles into specific points along these meridians, acupuncture practitioners believe that your energy flow will re-balance.”
Dry needling practice at Foothills involves the same small filiform needle used in acupuncture, but with a very different theory. Functional dry needling stimulates nerves, muscles, and connective tissue at the site of insertion. Early dry needling was based solely on research about trigger points and now, functional dry needling combines theory about trigger points with our knowledge of radiculopathic pain.
How Dry Needling Works
In layman’s terms, we use needles to treat neuromuscular dysfunction directly at the source, and also at the correlating spinal segment. We have all heard that pain and numbness in the legs can come from the low back and pain and numbness in the fingers can come from the neck. Using this theory, functional dry needling works as a pain management technique by treating the proximal/spinal source of pain, as well as the actual dysfunctional muscles in your body.
These small filiform needles are solid and therefore referred to as “dry” because they are not hollowed in order to inject a liquid medication. The needles are so thin, on average 0.25 mm thick (which is about 1/3 the size of a wet needle used to inject intraarticular cortisone), that the patient can hardly feel one enter the skin.
The dry needles are inserted from depths of 3 cm to 10 cm (1 to 4 inches) into the skin, past underlying subcutaneous tissue, directly into dysfunctional muscle trigger points. This causes multiple physiologic effects including an increase in blood flow, decrease in muscle banding, a decrease in spontaneous electric activity (which causes a buildup of nasty chemicals in our muscles), and other biochemical changes.
What To Expect From Dry Needling
Once the needle has been inserted to the depth of dysfunctional muscle or a trigger point, the patient usually complains of a deep ache or muscle cramping. Often, the muscle will spasm, causing a quick muscle twitch which essentially “resets” the muscle, similar to turning your computer on and off when it’s been frozen on the same screen. This muscle “reset” can help an over-active muscle “quiet down” and also help an under-active muscle “work harder” by stimulating the muscle and underlying nerves.
Many therapists will also use an electrical stimulator, attached directly to the needles, in order to elicit a twitch response. Some frequencies of electrical stimulation have been studied and can cause an increase in endogenous opioid production, which can further decrease pain.
Patients will commonly demonstrate an immediate change in flexibility, strength, or pain after just one treatment, however, it is common that multiple treatments are required in order to retrain a dysfunctional neuromuscular system. This is why your physical therapist will also prescribe certain stretches and exercises around your dry needling treatments, in order to maximize effectiveness, change dysfunctional movement patterns and most importantly, relieve pain so that you can return to the activities you love to do.
If an injury or nagging pain is stopping you from your favorite activities, Foothills Sports Medicine can help with your pain management. Come in for a complimentary Rapid Recovery® Injury Assessment and our physical therapists will determine if dry needling should be part of your treatment plan.
Now that we’ve survived the countless high school and college graduation parties, the monotonous three-hour ceremonies, dinners with the in-laws, finally, summer is upon us. The out of town visitors have flown back to their Midwest and Northeast homes, leaving the pools, malls, and hiking trails free at last for the locals to enjoy. I recommend that anyone who has had a past injury and is looking to have some fun in the sun to first check in at one of our Foothills Sports Medicine locations for hands on physical therapy. But if you’re ready to go, here are some healthy tips to make sure you enjoy your summer break.
Take a Hike, but Do It Right
In the valley of the sun, we have more than 41,000 acres of desert and mountain preserves and over 200 miles of marked trails. There’s practically a mountain or trail to hike everywhere you turn. Here are a few tips to maximize health and safety while you hike or bike.
Avoid Midday Heat
The sun’s UV rays are strongest between the hours of 10am and 4pm when the sun is highest in the sky. Try scheduling your next hike to be early in the morning. Once your hike is finished you can reward yourself with a local cold pressed juice or fresh acai bowl. Don’t forget to eat some protein within 30 minutes of physical activity to help rebuild your strength.
Bring and Drink Water
Hydrating before physical activity is key to preventing dehydration out on the trail. Bring plenty of water with you in a bladder or bottle sold at local sporting goods stores.
A hat, sunscreen, and sunglasses are a must all summer long. While sunglasses and a hat and are always effective, sunscreen needs to be re-applied often when outdoors, even in water.
Keep in Contact or Bring a Friend
Avoid hiking alone unless you have a mobile phone with you in case of emergency. Many smart watches now have GPS capabilities, which can help you if you get lost. Keep your furry friends at home till the temps cool down. They’re prohibited on all city of Phoenix trails if its 100 degrees or warmer.
Don’t Trail Blaze
Stay on the trail and marked paths when hiking this summer for your safety, as well as to protect our beautiful desert preserves. Going off the trail could result in a painful brush up with a spiny cholla cactus or a dangerous rattlesnake. Always take a look at the trail map and plan accordingly.
Mall walking is a great way to get some free A/C and burn calories. Most valley malls open their doors prior to store hours for just this purpose. Chandler Fashion Center opens at 6am, Scottsdale Fashion Square at 7am, and Arizona Mills at 8am every day except holidays. If you can refrain from the temptation to window shop, head to your local mall for some urban hiking.
What once was just a gooey sticky lotion now comes in all shapes and sizes to make wearing sunscreen less of a hassle. For each type of sunscreen, remember to check the expiration date. The active ingredients in sunscreens do not last forever, and exposing the bottles to heat and sun can further degrade sunscreen. Throw out old sunscreen left last year in the boat or with the pool toys, and pick up new a product for 2017.
- Lotions: These are good for a first application before activity. Make sure to apply to tops of ears, feet, and forehead.
- Sprays: Ideal for re-application during activity while keeping your hands mess free!
- Powders: Many mineral make-up brands now come in travel size brush applicators, which I have found to be great for faces, hands, and décolletage.
- Sticks: Perfect for protecting fresh scars and incisions. I recommend this type sunscreen for all my patients to avoid a sunburned scar.
Summer is the time for fun in the sun, but living in Arizona presents its own set of challenges. My tips will help you stay safe throughout our hottest months. The trails are clear, the sports fields have vacancy, and many of us have some free time. To help get you prepared for the upcoming season, stop by one of our Foothills Sports Medicine locations for hands on physical therapy. Our amazing team love our patients, and will get you on track to dominate the miles of bike paths in our great city.
Whether you’ve been suffering from chronic knee pain for five years or you traumatically tore your ACL during last month’s ski trip, one way or another you’ve found yourself in need of a surgical intervention.
You’ve been referred to an orthopedic surgeon whom you have never met, for a surgery you thought you would never need. After consulting your family, friends and the infinite knowledge on Google, your calendar is marked and the surgery date is set. Your neighbor volunteered to drive you to and from the surgery center, and a coworker has already brought over a mysterious casserole and some chicken noodle soup for your recovery. In spite of all this planning, you are still scared and unsure of what to expect in the days, weeks and months following your surgery.
Prehabilitation or “prehab” is when a patient seeks physical therapy prior to their orthopedic surgery. This approach improves the odds of a successful surgical outcome by combining knowledge and specific exercise. It’s also an opportunity to become acquainted with the office, staff and physical therapist that will be guiding them through the rehabilitation process.
Traditionally, patients are referred to physical therapy within 3-14 days after their procedure. During this time, patients can be in pain, under heavy influence of pain medication, and scared that physical therapy will hurt them. When a patient opts for prehab instead, she can establish a rapport with her physical therapist, and her PT can answer any questions she may have about using braces and walking devices after surgery. Answering a patient’s questions so she knows what to expect will increase her confidence in achieving a full recovery.
In addition to the emotional benefits of prehab, the primary focus is to establish an exercise routine prior to surgery, which makes recovery easier. Outcomes after surgery are determined 50% by the surgeon and 50% by the patient’s commitment to recovery before the surgery even takes place, according to Vonda Wright, Associate Professor of Orthopedic Surgery at University of Pittsburgh’s Center for Sports Medicine.
Studies have shown the positive effects of prehab in patients undergoing artificial hip and knee replacements. Those patients who complete strength, aerobic, and flexibility exercises prior to surgery are less likely to need inpatient rehabilitation and typically recover faster.
If your surgeon recommends it, prehab therapy is usually started six weeks prior to surgery. During this time a physical therapist will prescribe exercises to improve both strength and flexibility which helps jump start recovery. Under the guidance of a PT, you’re less likely to exacerbate current injuries and you can prepare as your surgery date approaches. Some patients are stymied when their insurance doesn’t cover six weeks of visits prior to surgery. In these cases, a physical therapist can teach the patient a land or water-based home exercise program that she can complete at home.
While in prehab, it’s important to consider adjusting your diet as well to decrease inflammation and help with the healing process. The reduction of inflammatory foods like unhealthy trans fats and saturated fats found in processed foods is a good first step towards cleaning up your diet prior to surgery. Limiting food high in sugar such as candy, soda, and pastries is also recommended. Patients can satisfy their sweet tooth with the natural sugars found in fruit. It’s important to eat healthy fats, protein, and fiber instead. For a healthy source of omega-3 fatty acids, try snacking on walnuts, chia and flax seeds, or cooking up some wild salmon for dinner—these foods fight inflammation that causes joint pain. Adding foods high in fiber is easy with the abundance of whole grains and dark leafy vegetables, available year round at your local grocery store. In addition to being high in vitamins and minerals, fiber can prevent unpleasant bowel issues like constipation that is a common issue postoperatively when patients are taking high doses of pain medication. Be sure to consume lean proteins like poultry, fish and other seafood, nuts, legumes and tofu, so your body is fueled to build healthy tissue during your recovery. Cleaning up your diet before your operation will drastically help your recovery in the weeks following surgery.
Prehab is an opportunity for patients to become proactive in their recovery, even before their surgery takes place. Be sure to consult your local Arizona physical therapy expert prior to your next surgery to establish a prehab program that is right for you!