In the past couple months I have added myofascial dry needling and cupping to my services. I offer it in my remedial treatments, if I think that a client is suitable to the therapeutic benefits these two modalities can offer.
What is myofascial release?
Fascia is a connective tissue that covers all our organs and muscles and groups of muscles. When we stretch we are stretching the facia as well as the muscle. The fascia is connected to everything and so releasing tension in one area can also help ease pain in other areas of the body. There are many myofascial release techniques including massage, stretching, compression, skin rolling, foam rolling, and strain-counterstrain techniques. Cupping works in a similar way to deep tissue massage or skin rolling to release myofascial tension.
What is Cupping?
Cupping is a therapy in which a jar is attached to the skin via suction. It is an ancient practice found in Chinese, Hindu and Egyptian scriptures. Cupping fell out of favour in western regions the early 20th Century with the favour of chemical drugs but recently there has been a resurgence of interest with physical therapists using it for myofascial release. It is very effective for musculoskeletal pain, headaches and migraines, sporting injuries, asthma, chronic cough and gastrointestinal disorders.
It is generally safe and the only side effect are the purple ‘bruising’ marks that are left on the skin. Cupping cannot be applied to open wounds, dermatological problems such as acne, or sunburn.
A flame is inserted into the jar to remove the oxygen and allow the cup to suction. The flame and treatment of cupping can look daunting but it is relatively pain free, most clients describe it as a ‘pinching’ feeling. It works fast to reduce muscle and fascia tension.
What is dry needling?
Dry needling is similar to acupuncture, in that they both use fine, solid needles, inserted into certain points in the muscle. From there, the two practices diverge. Acupuncture works on a Chinese philosophy that pressure points along energy channels running throughout the body can be pin-pointed to treat all of the bodies systems.
Dry needling is a Western based philosophy, pioneered by Janet Travell, MD, where the needles are inserted into the trigger point or ‘knot’ in the muscle to treat musculoskeletal pain. Although, there is a high degree of similarity between the locations of trigger points and acupuncture pressure points for pain relief. Dry needling is performed throughout much of the western world by myotherapists, and is becoming increasingly popular in Australia by various physical therapists, who are seeing the physical benefits of myofascial release.
Dry needling of a trigger point will elicit an involuntary reflex in the muscle fibers, blood, oxygen and inflammation will be forced into the muscle and the nerve endings in the muscle will be stimulated, all resulting in a reduction in pain and release of tension in the muscle. The same response as with non-invasive trigger point therapy and deep tissue massage. There are a number of different techniques used by various practitioners to date from injecting the muscles to just piercing the skin with the needle like acupuncture.
Many studies have concluded various reasons as to why dry needling and acupuncture reduce pain including; stimulation of the spinal reflex arc; eliciting a local twitch response during the application of any needling technique; change in neuropathic condition and a histamine release that causes local irritation and relaxation of the muscle; mechanically breaking up the nodularity of the tissue; decrease in stiffness of the muscle through an electrical event; bleeding causing release of so called platelet derived growth factors, which aids in the healing of the muscle; normalization of the pH and of several biochemicals and neurotransmitters that are involved in regulation of pain.
Unfortunately however, no scientific study to date has reported the reliability of trigger point diagnosis.
Mild muscle soreness or ache is a common side effect after the procedure, bruising is also common. Typically, the soreness lasts between a few hours to a few days. Recovery from dry needling can be aided by the same techniques as deep tissue massage like drinking water, resting, mineral salt baths, gentle stretching, and ice or heat over the effected area.
Like any medical procedure, there are possible complications. While these complications are uncommon, they do sometimes occur and must be considered prior to giving consent to the procedure.
- Any time a needle is used there is a risk of infection. However, using new, disposable and sterile needles, along with sterilising the skin, infections are extremely rare.
- A needle may be placed inadvertently in an artery or vein. If an artery or vein is punctured with the needle, a hematoma (or bruise) will develop. Usually the needles used are too fine to puncture the wall of an artery and bend around to avoid it. If any bleeding from a vein occurs, it is no larger than a pin-prick bleed.
- If a nerve is touched, it may cause paresthesia (a pins and needles sensation) which is usually brief, but it may continue for a couple of days. It is theorised that this can help the function of the muscle and in some practices encouraged.
- When a needle is placed close to the chest wall, there is a rare possibility of a pneumothorax (air in the chest cavity). If you experience pain in the chest, pain on exertion, shortness of breath, dry cough or decreased breath sounds during auscultation up to half an hour after treatment, you should seek medical attention.
Contraindications and precautions for dry needling
You should not receive needling if you are suffering from blood disorders such as Hemophilia or VonWillebrands disease. Those with blood borne diseases need to disclose their condition to their therapist. Patients on Warfarin, Plavix may not be able to have needling, all medications should be disclosed to the therapist before treatment. Infants cannot have needling and children need parental consent. Those with cancer should seek advice from their practising physician before needling treatment. Patients with sensitivity or allergy to nickel or chrome may react to materials in the needles. Epileptic patients also need special attention and strong stimulation is forbidden in treatment. Those with heart disease or recent cardiac surgery also cannot have needling.
Should I have cupping or dry needling?
Ultimately your physical therapist will advise you if they think you can benefit from either modality. Either are rarely a treatment in itself and is usually done in conjunction with other manual and physical therapy treatments, such as massage and stretching.
There is no specific, predetermined number of treatments for patients with myofascial pain. Chronic conditions will require more treatments than acute conditions. In addition, the amount of treatments will also depend on concurrent other medical conditions, your compliance with any at home treatment, your age and physical condition. If your therapist does recommend it, then don’t be afraid to try the treatment and make a decision yourself about how you like the results.