Dr. Douglas Pepple joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about trigger points and dry needling.
Read the transcript of Dr. Pepple's talk on trigger points and dry needling or listen here
Health Matters: All right. Welcome back to Integrated Rehabilitation Group, Health Matters, Maury Eskenazi and Shannon O'Kelley. And, joining us, from The Everett Clinic in Lake Stevens, it's Dr. Douglas Pepple. We are going to talk about dry needling. What is dry needling?
Dr. Pepple: Dry needling is the process of taking a fine needle and placing it in an area of muscle that is tight and painful. We call those trigger points.
Health Matters: A trigger point means the muscle has become tight and it has developed kind of a knot in it. And the dry needling, is almost like…
Dr. Pepple: Unlike acupuncture, you're actually trying to fix a physiological problem. Muscle we can think of as a rope with many small fibers. Those fibers work by pulling against each other, pulling toward each other and if that muscle does not let go, if it shortens then remains short, that is what a trigger point is. We believe that dry needling helps by disrupting that chronically tightened process and, depending on who you ask, the needle itself causes an electrical signal that propagates along the muscle and gets it to reset to its baseline relaxation. Other researchers think that it disrupts where the nerve is connecting with the muscle and gets that nerve to stop sending it such a signal for contract, contract, contract. Some folks think that it is actually resetting the pain perception, either at the local level or at the brain level. But, the research will yet prove what the mechanism is behind it, but clinical trials have proven putting the needle where it is tight gets it to relax, gets that to relieve the pain.
Health Matters: In theory, what is going on here, is basically the muscle has tension in it. When a muscle has tension in it over long periods of time, it almost creates and forms a little ball in it which you would call a knot or a trigger point and then by putting the needle in there, it is going to reactivate or reorganize that contraction and maybe allow that muscle to relax?
Dr. Pepple: Yes.
Health Matters: It sounds like dry needling is a good technique, but it sounds like it works with other treatments in addition.
Dr. Pepple: I view it as something that facilitates physical therapy to be that much more progressive, that much more dynamic, get the muscle to do what you want it to. Health Matters: Where on your body does this happen? Is it in your neck, your arm or just all over?
Dr. Pepple: There are many places where trigger points can happen. I would say most commonly, you have the neck and the head, so the sternocleidomastoid in the neck, the upper trapezius and the upper shoulders, can have the shoulder girdle muscles themselves, shoulder blade muscles...
Health Matters: Where would that be? In the back of your neck?
Dr. Pepple: The sternocleidomastoid goes from the jaw to the clavicle. So, that is in your neck. The trapezius is this kite-like muscle that goes from the base of your skull to your shoulders and then down again toward the middle of your back.
Health Matters: I can feel it. I know exactly what you are talking about.
Health Matters: These muscles that we are talking about, predominantly, are what we call posture muscles, and, more specifically, cervical posture muscles. People need to realize your head is a fairly heavy object and, when you sit and work, for example, in the world a lot of folks live and a lot of people live based on ergonomics, they are sitting a lot, all during the day, usually at a computer or working on a bench or working out in front of their body or driving long periods of time. What happens is, your head gets out in front. So, gravity is trying to pull your head down to the floor and these cervical posture muscles, the trapezius, the levator, sternocleidomastoid, suboccipital, all of these muscles in your head and neck are trying to keep your head from falling forward. When they do that over and over, they fatigue, and then when they fatigue they become tight and when that tension is chronic they develop a trigger point. A lot of people can touch these trigger points and they will produce a headache or they will cause muscle tension type headaches. What Dr. Pepple is talking about is putting a needle in that trigger point to release it, essentially, and then, once you release that muscle, people relax, versus using a muscle relaxer. Sometimes massage helps, but sometimes massage is a great early intervention but does not provide a long-term solution. That is when you have to change your mechanics or do some exercise.
Health Matters: We are talking to Dr. Douglas Pepple from The Everett Clinic in Lake Stevens. We are talking about dry needling. How about, how many treatments? I mean, is it something that you are going to feel after the first treatment, you are going to feel good right off the bat or does it take a few of them to get you feeling good.
Dr. Pepple: You do get immediate benefit but typically you need repeated sessions to have that benefit persist. For me, there is nothing more satisfactory than feeling a tight muscle, putting the needle right there, feeling that tight muscle melt beneath your thumb, having the patient report feeling better that instant. But, typically, that tension will return in a few days unless you work on flexibility each day, coming back for repeat sessions, trying to build up your strength, correct your technique, correct your posture, teach the muscle the right muscle memory to have.
Health Matters: That is important. What you just talked about is correcting posture or body mechanics and then doing exercises for flexibility, strength, etc., because you and I both agree that our goal as providers, you being a physician and me being a physical therapist, is not to treat people forever. We ultimately want people to understand and be able to do this independently. Take care of themselves at home and give them the tools so this does not have to be a problem in the future. One of the things we have been doing a lot, and seems to be really effective in conjunction with some of these techniques is working on people's core strength.
Health Matters: A lot of people, the last time they did a sit up was maybe high school physical education class, I mean a real sit up. Our core naturally becomes weak because you are not using it. So, we strengthen the core up which then stabilizes the neck and shoulder posture.
Health Matters: All I can think of is when we talked to Jamie Moyer and we asked him how can you still be pitching at your age, and that is the thing that he said he is working on his core.
Health Matters: He said transverse abdominus which is the core. Health Matters: So, dry needling, is there any kind of risk?
Dr. Pepple: Your provider has to know what they are doing. That's number one on the list. You have to sterilize the skin, certainly minimize your risk of infection. The needle should be advanced gently and just a few millimeters into the muscle just enough to make it relax. You are really not advancing all that far. You should not be touching anything other than a little bit of skin and just the surface of the muscle.
Health Matters: As a provider, seeing folks and prescribing this to people, have you seen some pretty good results?
Dr. Pepple: Oh, yes. Folks with neck pain or shoulder pain, back pain, gluteal pain and in conjunction with getting that regular strengthening, getting that flexibility back breaks the cycle and they feel much better.
Health Matters: There are a lot of people out there looking for relief for these postural dysfunctions and these cervical irritations and tightness. And here is what is neat they are not injecting anything. It is just facilitating or stimulating that muscle knot to relax or change it's, you know, neurological intervention or course.
Dr. Pepple: Correct.