The Chain Effect Podcast
A Physical Therapist and a Registered Dietitian discuss health, fitness, kiddos, and fun in practical ways for real people and families.
Dr. Taylor Pope and Caroline Pope founded Chain Effect, a comprehensive wellness and fitness studio combining physical therapy, nutrition counseling, personal training, and active recovery services under one roof in Raleigh, NC in 2015. Their mission is to show people how every link strengthens the chain of health to feel better, move better, get strong, and increase health span.
Learn more about Chain Effect at www.chaineffect.com
The Chain Effect Podcast
Dry Needling: How the heck it works
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In this episode we discuss Dry Needling, a super popular physical therapy technique, and sort our way through the latest evidence and research as to why it is so effective in decreasing pain and improving muscular function.
Welcome to the Chain Effect Podcast, where a physical therapist and a dietitian married with two kids juggle the struggle of running a business, raising a family, and prioritizing our own health, all while trying to have as much fun as possible.
SPEAKER_01We are your host, Taylor Pope, Doctor of Physical Therapy, and Caroline Pope, registered dietitian. Together we own and operate a health facility bringing together physical therapists, dietitians, personal trainers, and active recovery services to create what we call the chain effect. All right. Big topic.
SPEAKER_00Yep, yep. What's it gonna be today?
SPEAKER_01We're doing dry needling.
SPEAKER_00So something you do every day, up to seven times a day.
SPEAKER_01Yeah, this is huge. This was um this was something really big for me. Um, I started doing dry needling back in 2014, and at the time, no one in my clinic did it. I worked in a clinic with 12 physical therapists, and no one did it, and no one really around town did it.
SPEAKER_00How'd you hear about it?
SPEAKER_01I had gone to some continuing ed courses, and some of the instructors had referenced that if you can do dry needling for this, you might want to go ahead and try it. If this is a good technique to incorporate with dry needling, and and so I was asking about it, and it just seemed so foreign to me. And um I went and researched and saw that there was a course coming to Raleigh, and I begged, begged my boss at the time to let me take it, and she was really reluctant. She was, you know, very much not really wanting me to do it and bring it to the clinic, but I wore her down. As you do, as I can do sometimes, and eventually she let me do it. And when I went to the course, I took the first course, then I had this, I had to see 200 volunteers.
SPEAKER_00Yeah, I remember that.
SPEAKER_01Yep. Then I had to take the second course, and then I could finally do it to patients. And within about a month, my schedule was booked out three to four months. People loved it. Just yeah, every I was seeing everyone's patients all around the clinic, and people were just you know all over it. And that's what really gave me the confidence to go out on my own. I felt like I had this tool that you know was just a higher level of service within physical therapy, and I could, you know, bring that to uh clients and you know, they would be willing to pay out of pocket for it.
SPEAKER_00So tell us what is dry needling and what's the history behind it?
SPEAKER_01Sure. Um, dry needling has some different names. You know, sometimes it's called trigger point therapy, intramuscular stimulation, intramuscular manual therapy. You'll see that sometimes in the literature. It's pretty well known right now as dry needling, different than acupuncture. Acupuncture, you know, as far as like using a needle, is similar, but acupuncture. Uh, we use dry needling needles, they have a little bit better glide than acupuncture needles, but in general, they're about the same size and about the same diameter. We do tend to use some longer ones because we go more into the muscle and they are more in that fascial space, so a little bit more superficial. Sometimes I like to say that you know, acupuncture is a little bit like snorkeling and dry needling is a little bit like scuba. That's a good analogy. So, yeah, like getting into the muscle a little bit more. But really, acupuncture is just a totally different profession. So while the tools may overlap, the use of the tool is completely different. And, you know, there's some really cool research out there about acupuncture. So I'm not trying to poo-poo it at all. It's just a different philosophy than what we do with the needles. You know, it's sort of like um, you know, Western versus Eastern type medicine thing. So dry needling really came about um back in the 70s, was one of the first documented um uh studies about it. And it was Carol Lewitt, and she or he, sorry, he was um performing uh some dry needling with a hypodermic needle, and he was just noticing that there was an effect just by inserting the needle, and so there was an effect to the tissue just by who is he? He is a doctor. Oh, yeah.
SPEAKER_00So he like why is he? What is his business like sticking needles in people?
SPEAKER_01Well, you know, a lot of times they'll do injections, but he was noticing that there was an effect outside of just doing the injection. So then he started doing doing just the needle without the substrate that you would inject in people, and that's where the term dry needling came from. And then that work was um pushed forward by Janet Travell and um and she really did she was really cool. She was the White House physician for JFK, but uh she developed the trigger point pain model, which is what I have hanging in my office.
SPEAKER_00That's where you know where to insert the needle.
SPEAKER_01Well, we know where to insert it for different reasons, but that is a great representation when you can show your clients that they're having this, it's kind of that referred pain pattern. I don't know if you've ever seen that, but the issue might be in one part of the muscle and they might be feeling pain in a completely different referred pain pattern. Yeah. So for instance, you might have be having pain in your, or you might be having problems or dysfunction in your glute or your gluteus minimus to be exact, and you might be having referred pain all the way down the side of your leg into your ankle, but the problem is in your glute. So we don't bother treating the side of your leg or your ankle, we just treat the glute and the pain. Yeah, the pain goes away. Um, so that is the trigger point um pain model, and that's what really sort of kicked off the practice of dry needling. Um, you know, the definition of dry needling is that we're using a filament needle to effect a change to body structures and functions for both the evaluation and management of neuromuscular conditions, pain, movement impairments, and disability. So that's like the APTAPT definition.
SPEAKER_00I was gonna ask what the dry was for, but it's said it was not a substrate in the needle. Okay, because they're a wet needling. What does that mean?
SPEAKER_01Yeah, you're just not injecting anything.
SPEAKER_00That's that's basically okay, cool. So that's a little bit about the history and what it is. Yeah, very cool.
SPEAKER_01So from there, we're about to get into some science. So the reason that we like to use dry needling is that it is a powerful and a very precise tool. So it's a manual therapy technique at the end of the day. So just like you might go and get a massage and they're doing a trigger point, deep tissue massage, they're affecting big parts of tissue and they're getting in on those same trigger points that we're getting after, but it's not as precise. So when we think about the body, a lot of times we have to think three-dimensionally. Our our muscles are stacked on top of each other. And we tend to have the primary movers on the outside, and then deeper into the tissue are the stabilizing muscles. So those stabilizing muscles are really responsible for controlling the finer movements of our joints. So, for instance, your deltoid might lift your arm, but your rotator cuff is going to precisely move the ball in the socket. And we sometimes need to go deeper into the muscle to get to those deeper levels to um to treat those areas because otherwise you just can't do it like with your thumbs. Like, think about the glutes, right? There's three layers of glute muscle, and to get to that deepest one, you're I mean, you're going several inches into the body. I was gonna ask how many inches you typically with that needle, like we don't want to scare people, but you know, sometimes we'll use a needle that's you know But they're very tiny. Yeah, they're very thin in diameter, but you know, sometimes we will need, especially in a bigger person, we will need a needle that's you know, three to four. I have some ones that are a little bit longer, like five inches long. Wow. And you know, that's only for the you know, the deepest, you know, biggest glutes that you might need to go in.
SPEAKER_00But that's a good, that's a good analogy. Like when you get massage therapy, like I want someone's elbow. I don't want to massage if I don't come out bruised, basically. Like I want someone's elbow, and that seems sharper and like more precise, but not as it's not going deep at all. I want them like digging in there, but it's not gonna hit what actually needs to be hit.
SPEAKER_01Um so a quick rundown of you know the ways we use this in the clinic. One is that we're affecting length-tension relationships in the muscle. So every muscle has an optimal length tension relationship. So length is just think about the origin of the muscle to the insertion of the muscle. So you can think about your bicep. Your bicep connects in your shoulder and then it connects down to below your elbow, and that's the length of the muscle. And that can be changed by posture, that can be changed by the tightness of the tendon at times, and that can be changed by you know strengthening the muscle or the position you're holding it in. Um, then we think about tone, and tone is like, you know, if if you hold a rope, but then you hold a rope with even more taut, it's gonna have more tension internally in the rope, and that's kind of how we think about it. It's like more tone. It's almost like a bulking of the muscle because it's more contracted, and so every muscle has an optimal sort of equilibrium state where it's balanced with its opposite muscle because also every muscle has an opposite muscle.
SPEAKER_00This is why I didn't do so good in anatomy and physiology, I'm gonna be honest. This is wow, I could not have been a physical therapist.
SPEAKER_01But if you think about, but if you think about your, you know, your bicep and your tricep, right?
SPEAKER_00Yeah.
SPEAKER_01Um, you know, what what holds your arm bent and what holds your, you know, what allows you to straighten your elbow, those are opposite muscles. And so if you walk around in a in an arm sling for two weeks, then you go and try to straighten your elbow after that, your arm is going to be stuck in that bent position until someone helps you straighten that, straighten it out. And that has to re you have to relieve that tension in the bicep. Well, you can do that with massage, but dry needling is just so powerful and so effective and quick. We can do that in you know, in seconds, what might take a massage, you know, 10 or 15 minutes to really loosen up. Yeah. So we're just able to create these changes in, you know, in dramatic fashion. And when we're when we're using it in the clinic, a lot of times we're affecting a pattern. So for instance, you know, you think about your typical office worker hunched over the computer, they're having, you know, a cross pattern of tightness and weakness. So they're having tightness in their pecs, tightness in their upper traps, tightness in their suboccipitals, which is at the base of the skull in their neck. We're able to treat all of those areas very quickly and really unravel that. And then we get them in the back and do some strengthening exercises on those weaker muscles, and you're just able to create a more powerful change in just a in one session.
SPEAKER_00Well, and you talk to me about, especially I know you do a lot of people's necks and upper back, like you're just saying, because of how we live and how we are postured. That release also releases emotions sometimes too, right? Oh, yeah, like crazy emotions, like tear, like people start crying or they feel the kind of a fight or flight response just right after, right? Because it's so powerful.
SPEAKER_01Well, and sometimes, yeah. You know, a lot of people will carry tension in certain areas of their body and they're just holding on to it. You know, the shoulders, upper traps are a great example. You know, the upper traps are actually innervated by a cranial nerve, cranial nerve 11. So a lot of people don't know that, but the same nerves, you have cranial nerves that innervate your face. And just like you can look at someone and say, Oh, you're having a rough day or you're happy or whatever, your upper traps will also carry that same sort of stress. And when we're stressed, we tend to tense up our shoulders. So when people say, Yeah, I carry a lot of you know, stress and emotion in my shoulders, sometimes it's real. And for those people, yeah, you'll get in there and they are blocks, and we can, you know, pretty effectively release that with some dry needling to the upper traps. Um so that's one way that we will use the dry needling, is you know, sort of a direct technique, you know, getting it's it's called a local response where we're going into that muscle. What tends to happen with that is there's what's called a twitch response because that muscle has been taught and that and contracted. And so when we insert the needle, and and what's happening with that is when the muscle's really tight, it's not getting the same amount of blood flow that it would otherwise get. So it's having lower vascularization. And so then what happens is when it's not having the same amount of blood flow, it's not getting the same amount of oxygen. So it takes energy to contract a muscle, but it also takes energy to relax a muscle. So if you're not if you have a muscle that's really tight and bound up and it's not getting oxygen, it's not able to get the energy it needs to relax. Then over time you get a buildup of what's called ischemic, which is basically without oxygen byproducts in the muscle, which further cause dysfunction in the muscle, but also creates a biochemical uh situation that is sending pain signals up to the nervous system. So you have this situation where this muscle is tight, it's contracted, and it's constantly bombarding the central nervous system with pain responses. And that's where you can have, that's where chronic pain tends to come from. Chronic pain is, you know, part mechanical, but it's also part biochemical.
SPEAKER_00And I mean, the pain, pain science is literally a knot when people are like, oh, I feel like you have a knot up here. It's like a knot, future knot, but it's cutting off like oxygen, blood flow and oxygen.
SPEAKER_01Exactly, exactly. Every time I hear knot, I always think like you better not mention that again. Um, but anyway, so that is what's going on with that, you know, link tension relationship. You have that tight muscle, and we're releasing that. And so what that feels like for the patient is that they're having, you know, you insert the needle. Typically, you don't really feel much from the needle itself. That is, unless you like are touching on a capillary or like a little skin nerve. And then in those cases, you just move over like a millimeter and you don't even feel it. So you insert the needle, and then when you hit that trigger point, the whole muscle tends to cramp up and it's brief, but it is powerful. Yeah. And it's kind of hard to explain. You know, it's it that whole muscle cramps up, and then afterwards you're sore, but that cramping sensation is like very momentary.
SPEAKER_00Yeah, it's like a little spasm. Yeah cramp. But I'm not sure if you mentioned this. And the difference between acupuncture most of the time is also the needles go deeper, but you are going in and out. Yeah. So whereas acupuncture, there's stain in there.
SPEAKER_01Right. And and that's true. We will do that some for dry needling as well. Um, and I'll get to that in a second, but that's called pistoning. And so what's going on there is you know, when the painful part of inserting a needle is typically inserting it into the skin because we have so much uh sensory nerve endings on the skin. And so when you um when you insert the needle and you do pistoning, you can affect by because you you're able to sort of bend the needle and redirect it sort of within the same hole, you can have what's kind of what's called a cone of influence where you're affecting bigger parts of the muscle with only one needle stick. So that's where you'll see people sort of going in and out, but they're really sort of bending the needle or changing its trajectory just slightly to hit different parts of the muscle. Okay. And so they're not just going in and out on the same exact spot, but again, part of that is to help increase some of the vascularization that's going on there. And that that part of it is really cool because you'll see changes a day after, and you'll even see changes. They've they've been able to do studies on histological studies where they've shown changes up to five days later of improved vascularization in the tissue from one treatment. From one treatment. Yeah. So it can take a, you know, one of the things that we like to tell people is, you know, you're it's gonna take a day or so, 24 to 48 hours to fully recover from the dry needling treatment. That doesn't mean you can't exercise during that time, but that just means that you're gonna probably feel some level of soreness or you're gonna feel some level of trauma from the needling. Typically, after your first time, it's it's something that, you know, once you understand that it's a therapeutic pain, it's not something that's you know weighing you down much. And a lot of times your pain has changed. So the pain you came in with is no longer there, it's been replaced by a little bit of soreness from the dry needling.
SPEAKER_00Most people feel a little better instantly, right? And then it gets better. You're saying up to five days, yeah. In five days, it can be even better.
SPEAKER_01Well, yeah. So, what I always tell my patients is, you know, don't contact me tomorrow with how you're feeling. Like, wait until a little bit later in the afternoon after you've moved around a little bit because you might be a little bit sore. Yeah. Sometimes when you leave treatment, you might be feeling a little bit worse. But after 48 hours, you should be feeling much better than baseline. And that's what I always like to reinforce. And the more you move, the better it is. Because again, and I'll get to this, but we we always want to reinforce loading after the treatment because what we're doing with dry needling is we're helping restore those muscles to an equilibrium, or you can think about like a reset. And then with that, we have think a blank canvas, and now we load the tissue the way it's meant to be loaded. Yeah. We're training that muscle with brand new muscle memory. We're laying down brand new muscle memory on that muscle. This is how we're supposed to load. This is how we're supposed to hold our body. This is how you're supposed to organize all your muscles together to hold your posture better, to do this different movement, to run, to exercise, to squat, to hinge.
SPEAKER_00That's what's so cool. Because in the same sessions, like you were saying, you'll do these treatments, dry needling, then get your patients back in the back of the gym and doing these movements and loading properly and all this stuff. And that's so cool. You can do that all in one session.
SPEAKER_01And you might have like a low back pain patient who's been scared to bend over or scared to lift at all. And you take them from coming in in pain to doing some dry needling, doing some STEM, and then you take them in the back and you're deadlifting 25, 30, 40 pounds, and they're like, I haven't been able to lift this much in forever. And it's just because they're more organized. So that brings me to the second way. Yeah, the second way that we will um use dry needling in the clinic is we'll use it to inhibit overactive or spasmed musculature. So that's kind of that it's it's thought of as the energy crisis model of thinking. And basically, again, there's that devascular, you know, that lack of blood flow going into the muscle. And so it just stops working properly. So at the same time, you have this overactive muscle, it's having a tough time relaxing.
SPEAKER_00It's trying to signal like I need help.
SPEAKER_01Yeah, it's like the muscle saying, I need to relax. Yeah, I need to relax and let this opposite muscle do a little bit of work. But this opposite muscle is not doing anything, and this you know, primary muscle is doing all of the work. And so we're able to inhibit those spasmed muscles. And for a lot of people, if you injure your back, one of the complaints that they have is that they're having a lot of spasming going on in the back. That is a protective measure. And a lot of times it's because people aren't activating their core properly. So they're the you know, the muscles in the abdominal, the abdominals are opposite of the muscles in the back. And so if you're not activating your core correctly, then your back is trying to do all of the work supporting yourself, and then you're gonna get that spasming. So it's a protective mechanism in the back. And so we're able to inhibit a lot of that and get those muscles to calm down. Then we do some good core activation.
SPEAKER_00Calm down. Yeah, calm down.
SPEAKER_01Then we do some good core core activation, yeah, and then they're they're on their way. So, in one hand, we're gonna inhibit, but we're also going to activate inhibited muscles. So that's the third way. So I know I just said that we are going to inhibit overactive and spasm muscles, and now we're also going to activate inhibited muscles. And how could that be? Well, there's many ways that we can have dysfunctional tissue, and sometimes the muscle is overactive, but sometimes it's just been asleep. It hasn't been working because we haven't placed the body in the right position.
SPEAKER_00Like the core, like you were just saying, right?
SPEAKER_01Right. Like the core, but also a really big one is the little muscles, the little stabilizing muscles in the spine called multifidae. And that is a huge, really big thing that we uh treat whenever we're treating the spine, is we'll go, you know, especially like in the lumbar spine. Let's say we're treating uh a low back. I'll go from L1 down to L5 and needle on both sides of the spine, all the way down each segment. And then I'll hook up some stem. And I have a You did that to me.
SPEAKER_00Yeah. I had upper upper back when I was having that pain. And then you were doing the stabilizer muscles. I think it's the same thing.
SPEAKER_01Exactly, exactly. And so you're going pretty deep because these muscles are are deep, but it's not scary because your spine is is designed to protect you. And you remember you had an epidural, right? Yeah. So when you had the epidural, you and I'm acting like I wasn't there, but I was there.
SPEAKER_00Um twice the first time because the first one didn't take.
SPEAKER_01And I had to turn away because that was just crazy.
SPEAKER_00Right in the back.
SPEAKER_01This needle was huge, huge, and he's going all the way in. And I like, you know, I needle people every day, but I'm about I'm like getting nauseous watching her. And so hunched over while he's yeah, and for that, exactly, you were hunched over. And so, you know, when you're dry needling the back, you're always laying in prone. So you're you're basically extended. And to get the needle anywhere near the spinal cord, you have to flex the spine a ton.
SPEAKER_00That makes people feel better.
SPEAKER_01Yeah, so we can treat all, in fact, when you learn dry needling, you learn by doing the spine as one of the first things. And I was like, oh my god, like I'm needling right next to the spinal cord. They're like, No, you have armor plating basically to protect you from uh a rear attack.
SPEAKER_00And so I was just thinking about when you when you told me in your first course, I think you were dry needling yourself in the arm, and and a guy near you was like passed out, dry still moving his fingers with the needle in and out of his arm.
SPEAKER_01This it's kind of legendary. I don't know that this happened. This uh definitely doesn't happen.
SPEAKER_00I would have passed out, that would have been me.
SPEAKER_01I took us I took another course and they referenced that story, and I was like, I was there. But basically, yeah, the first thing we did was uh we dry needled your own, you dry needle your own forearm, and we're all we all do it, and they're like, Okay, dry needle, piston in there for like, you know, 10 or 12 seconds, and we're all just doing it, trying to get a twitch response. And then he just like scans the room. He's like, Okay, take the needle out, put it in the um the sharps container. And then he's just scanning the room and he just fixates on on this one guy, and this one guy has literally leaned over on his partner and he's still moving his hand up and down, but he's completely passed out. And the guy, his partner, he just met this guy like an hour ago. He's like elbowing him to get like, get off me, bro. Like, what are you doing?
SPEAKER_00What in the world is going on?
SPEAKER_01And we finally realized, and then they like swarm in, you know, raise his legs. I mean, he came right back. All you gotta do is get your legs above your heart and you come right back to. But um, yeah, that was that was that was a crazy story.
SPEAKER_00Why is his arm still moving?
SPEAKER_01So, anyway, back to those multifidae. So, when we're dry needling the lumbar spine, one of the things that we're gonna do is we're gonna, you know, do all those segments, we're gonna hook it up to some rhythmic electric stimulation. And so I have a four-channeled uh system where I have these alligator clips, and I can hook up all you know four different segments of the spine and turn on a low frequency. So that means that it's pulsing like a heartbeat, like boom, boom. Yeah, that was weird. That is a weird and what it does is it feels basically turns the muscle on and off. So it's giving it the stimulus it needs to turn on, and then it's allowing it to then relax. And so think about like priming your lawnmower. You're like, you know, putting some gas in there to get that thing going and get get it moving. You're priming the system, and then what's awesome about that is we, you know, take off the, you know, take off the clips, take the needles out, get them doing a couple exercises, and then we go to the back, and now they're able to better activate those multifidae. And those multifida are so important, but they're hard to get to because they're deep, and they're hard to get to with exercise because they're small. And so they really serve an important purpose in low back pain. Because if you think about your spine as like a stack of blocks, if you turn that your, you know, okay, so you have a stack of blocks on your hand. If you turn your hand sideways, all the blocks fall down because of gravity. But if you take your other hand and you put it on top, now you're having that compressive force. So it's globally stabilizing the blocks. And that's what the multifida do for your spine when they all work together. So think about going into your deadlift and you're trying, you're like keeping your back straight, you're getting getting nice and extended. Your ability to help organize that is part of the job of the multifidae, but also they work individually to help you extend the spine concentrically. So the active shortening uh motion. But then when you bend forward eccentrically, it helps to lower you down. Because if you think about it, when you're bending forward, you're most of the time you're not using your abs to do that. You're just kind of hinging over and gravity's like taking you down toward the floor. Well, those little muscles in your back are allowing that motion to happen, kind of like letting out a rope. And if they if those aren't working properly, it feels kind of scary to bend forward because you're relying on bigger muscles that aren't really designed for that. Yeah.
SPEAKER_00So that's a great example of activating those inhibited muscles. Exactly. So that's cool, yeah.
SPEAKER_01And then we can use that, you know, once we have better activation there, we can get better activation in the core. Then we can start doing some functional movement patterns in the back, which is really how we sort of tie it all together in the clinic. So one of that's that's basically one of the like most important ways that we're using dry needling. Again, it's a soft tissue technique above and beyond anything else. So people always ask me, is there another way that we can that we can do this? And the answer is yes. We can we have a variety of different techniques, and dry needling is only one of them, but it is our most precise and our most powerful treatment. And a lot of times it can be diagnostic too, because you know, if I'm, you know, sort of palpating along, you know, think about your lower leg. There's a bunch of muscles all jammed into your low into your shin, you know, below the knee. If I'm palpating it on the back, I might be on your gastroc or your calf muscle, but underneath that is the soleus, and underneath that is the tibialis posterior. Well, how am I gonna know which of those muscles is most affected or is is driving that trigger point? Well, with dry needling, I can go into that muscle and then I can apply some stem. And when you're like, oh yeah, right there, I can apply the stem and I can actually see the action of that muscle as I'm doing it. Or I can dry needle it and say, Okay, you know, press into my hand is moving.
SPEAKER_00You see what that East little spasming going on aware.
SPEAKER_01Sometimes I mess with my clients, I'm like, hey, stop moving. And they're like, I can't. I'm like, yeah, I know you can't. But um, so anyway, those are you know some of the bigger, the the most important ways that we're using it. Um, now I want to talk a little bit about how dry needling works, and that is a question I just get all the time. So, why does it work? And there's a couple different things. This is going to get a little more sciencey, but there's a couple different things that are going on with dysfunctional musculature. So one of them, again, is that biochemical nature of sensitized tissue. So when you're having a pain sensation for a long period of time, that's when we're thinking like chronic pain, injured tissue, you're you're changing the biochemical nature. And there's a higher concentration of biochemical nocioreceptors, which are is another way of saying pain, pain chemicals or pain signaling chemicals that's building up in that tissue. And dry needling can help restore some of those the normal levels of the biochemicals by reducing the transmission of the pain signals to the central nervous system.
SPEAKER_00So basically the muscles it's opening it up. Well it's like that's relaxing it so that the pain signals decrease.
SPEAKER_01Well, so that's kind of going back to that vascularization. So it that's allowing more blood flow, which is bringing in, bringing in more of the um sort of the healing byproducts, but also flushing out things that have been sort of trapped in the tissue. But what this is actually is when you're in pain, your body is that muscle is signaling to your spinal cord, I'm in pain, I'm in pain, I'm in pain, I'm in pain. When we dry needle and we have that twitch response and we interrupt that signal, now we're no longer having that same pain because we've sort of reset the muscle and restored it to equilibrium, but now we're not sending those same pain signals. So then we allow for um a re-sensitization of the tissue, and you're not gonna have those biochemicals going to the muscle.
SPEAKER_00Oh, cool.
SPEAKER_01Yeah. So that's one way. Um, or that's one way that it works. Um, muscles also have an electrical act, they have electrical activity. And in normal muscle, the electric, the electrical activity, it's called spontaneous electrical activity, that should be pretty stable. It should be, you know, just kind of like a maybe small fluctuations. And just think like if you're not using a muscle, it should be pretty relaxed. Yeah. But in dysfunctional muscle, it's all over the place. And as soon as they insert the needle, the studies have shown that that electrical signal levels out again.
SPEAKER_00Wow.
SPEAKER_01And so that is sort of the evidence that they've used to prove that dry needling does reset the muscle. And that's and that's what a lot of this is getting at. Like when you're when you're thinking about how does something work, how does something work like dry needling? It's really tough to answer that because it's hard to do double blind randomized control studies with someone getting dry needled and someone being sham needled, which means that they're not actually having a needle insert into them, right? Yeah, how do you even do that? Exactly. So then going further than that, like what is exactly going on in the tissue is just really hard to understand. So we have these theories and then we prove out these theories in different ways by histological studies where they actually, you know, this is unfortunately done on animals, but they'll take, you know, the tissue of the animals and examine it under a microscope, or they'll, you know, do these different like electrical signal studies to really try to understand. So we talked a little bit about that. We talked a little bit about the um vascularization. That's another big way. Um, and what's interesting about this is that when you are, okay, so we talked a little bit about the trigger point pain referral pattern. Yeah. And so that means, okay, I'm gonna treat my glute, but then I'm gonna have a pain referral pattern all the way down my leg. Now I'll have people where I go into their gluteus minimus, gluteus medius, and I hit that right just exact spot, and they're like, oh my gosh, I just felt that like all the way down my leg. Yeah.
SPEAKER_00Or like up in your brain, right? In your head.
SPEAKER_01Well, don't you feel sometimes like Okay, that's more when you're doing upper trap. You'll have the you'll have the question mark go around your head.
SPEAKER_00Yeah, you'll just feel it like in other places besides where the knee is.
SPEAKER_01Exactly. And it so the upper trap referral pattern is like a question mark on the side of your head. Oh, and so a lot of people will have um what they think is a migraine or what they'll think is like a tension headache, but really it's coming from their upper trap, which is basically the muscle that connects your shoulder to your neck or to the to the head. And so, you know, it's the it's the thick thing right on top of your shoulder there. And that, you know, a lot of people will have that same referred pain pattern. But what's crazy about this is that it not only will you have the referred pain pattern going down the leg, but you will have increased blood flow to that referral pattern. So think about that. I just treated the glute, but now I'm having improved vascularization in the muscles distal to that in that referred pain pattern.
SPEAKER_00Oh wow. So you're like gearing up, you're like ready. Yeah. So I mean I'm ready for training.
SPEAKER_01What it I'm basically like treating a point proximally and having a distal response, an increase in vascularity. So I mean, the it's it's just a lot of things that they're finding out about the the benefits of of this technique and you know, all the different ways that they're showing that it works. It's just it's really cool. So lastly, we want to talk a little bit about the nervous system. So um CNS and PNS, which stands for central nervous system and peripheral nervous system. So a lot of times when you're affecting a local tissue, you can have a significant impact on the spinal cord. And so there's a couple different ways that we like to think about this. One is just let's say you pull your hamstring, all right, um, and you're sending those pain responses to up to the spinal cord, and you're just sending it to that same level dermatomally, which means that basically you have a certain segment of your spine that is shooting out a nerve, and that nerve goes to your hamstring. That's called the sort of dermatone or the or the or this the way it's actually called a myotone, but the it's the way that the nerve is going into that muscle. And so every muscle has an efferent, it also has an efferent, and then it has these pain fibers, which means it has a motor, it has a sensory, and then it has a pain. So the the motor is turning the muscle on and off, the sensory is telling the um body what's going on. Is the muscle on stretch? Is it under load? What angle is it at? It's telling all that information, and then there's the pain fiber. So the pain signal is going right into the spinal cord. And so you're having these this signaling, it's being bombarded in the spinal cord over and over and over again. And so we can see that there's changes when we do the dry needling. You can see those changes in the spinal cord, which is yeah, which is cool. So really cool. You're affecting that that pain, that pain science. And uh, you know, some of that is called gate theory. Um, there's also a the peripheral sensitization, which is the elephant uh elevated levels of substance P that's also in that dorsal horn, and dry needling will help normalize these levels, and so you're decreasing that uh substance P, which le which when unmitigated leads to hypersensitivity. So you think about someone who you know you touch their tissue and they're like, oh my god, that hurts. And this and the amount that you touch them wasn't really representative of the pressure, yeah, yeah, of how much it should hurt. And that's hypersensitivity. So a lot of people have that, and so you're able to um affect that. And then the last one is the remote effect, which it means that sometimes, you know, you you may not want to dry needle a muscle directly, but if you dry needle the muscles around it, the muscle that you avoided still gets benefit.
SPEAKER_00Oh, cool.
SPEAKER_01And so, yeah. So there's just, yeah, like I said, there's a lot of science here, and you know, a lot of people think that it's just you know, going into the muscle, stirring the pot, but there really is this sort of you know neurophysiological, neuromechanical nature of what's going on when we are doing the dry needling, and it's affecting multiple systems from both a mechanical standpoint, a biochemical standpoint, and a neurological standpoint.
SPEAKER_00Yeah, wow, so fascinating. Well, thank you for all those explanations. This might be an episode where people have to rewind, listen again, rewind like me to really understand it. Um, but I hope that this really cleared some things up for people who've been wondering what is dry needling? Is there a wet needling? Why is it called dry needling? Is it acupuncture? Um, because there is a lot of confusion out there. Right. And so if you have any questions for us or really for Taylor about this topic, email him at Taylor at Chain Effect.us. Um, he'd be happy to answer any of their questions. And thanks for listening. We'll check you later. All right.