Dry needling involves the application of very fine sterilised acupuncture needles into muscle and surrounding tissues to assist in the release of myofascial trigger points, reduce tightness and spasm, improve muscle function and relieve pain. It is commonly used as an adjunct to physiotherapy and myotherapy techniques to improve treatment outcomes.
There are two types of Dry Needling, the first called Superficial Dry Needling (SDN) works by inserting the needle only 5-10mm under the skin. Secondarily is Deep Dry Needling (DDN) where the needle is inserted to the depth required to penetrate the targeted myofascial trigger point.
How does it work?
Myofascial trigger points are hyper-irritable, taut bands within muscles, which are painful to touch and can contribute to muscle shortening, weakness and pain (both locally and referred). They often develop following muscle, joint or nerve injury and sometimes persist well after the initial tissue injured has healed. This leads to persistent pain and discomfort.
Dry needling releases these trigger points by encouraging local blood flow to the trigger point and by modulating nerve pathways that erroneously cause them to persist. The needling also stimulates your body’s own endorphin system to provide pain relief and help allow the muscle to relax.
Dry needling can be extremely effective in the treatment of:
Needles used in dry needling are much thinner than those you receive when you see your GP for an injection and so usually cause much less discomfort. This does vary depending on what techniques your therapist uses. You may also experience the very satisfying response of the muscle twanging and releasing quickly. A sure sign of a successful trigger point release.
The initial treatment is conservative to determine the patient’s response. This varies from person to person. It is expected that there will be some post treatment soreness during the first 24-48hrs and sometimes minor bruising is experienced.
What sorts of conditions can Dry Needling be beneficial for?
Dry needling can produce excellent results as an adjunct to standard physiotherapy and manual therapy treatment. It can be used in both acute and chronic painful conditions.
Dry needling can be extremely effective in the treatment of:
Back, neck and shoulder pain
Hand and wrist pain
Tendinopathy pathologies i.e. Tennis elbow, Achilles pain
Many other musculoskeletal injuries (You can discuss dry needling with your therapist to see if it may be useful for your condition)
What is the difference between Dry Needling and Acupuncture?
Dry needling revolves around Western Medicine philosophy and involves inserting needles into muscular trigger points palpated by your therapist and consistent with your area of pain.
Acupuncture is based on ancient Eastern Medicine, with needle placement over specific points along meridian lines or ‘energy’ lines which are thought to associate with particular illness and disease.
To understand why back pain recurs, we need to first look at why pain occurs to begin with and then how back pain physiotherapy can help. Back pain generally stems from some form of trauma or loading placed on your back, which may occur as a one off incident or be repetitive loading over time. Normally your core muscles will control your spine and allow an even distribution of load in the appropriate tissues. However, in an acute incident or with poor biomechanical control these muscles will not be able to withstand the load placed on them and trauma will occur. This trauma may cause damage to the tissues within your spine including the disc, joints and muscles.
It is essential to determine how and why the injury occurred
Once your back has been subjected to trauma the damage sustained may alter thestructure of your spine, including arthritis within the joints, disc disruption or bone alignment. Whilst physiotherapy will aim to alleviate your pain, regain full spinal movement and prevent further spinal damage it is important to determine why the injury occurred to understand the underlying cause and surrounding factors so that the same incident is not replicated and your back can be appropriately managed in the long term. The most important aspects of this management include altering your biomechanics to optimise your back function, modifying any activities which may aggravate your back, having optimal sleep postures and implementing an exercise routine including stretches and strengthening to maintain appropriate muscular stability and flexibility.
Biomechanical corrections are vital
Biomechanical corrections are vital to allow appropriate load distribution throughout the spinal column. The spinal column is very long, thin and has attachments to the other major structural components within your body. There are many different muscles which attach to it which can pull each individual spinal segment in a different direction. Those with back pain will often be overactive in particular muscle groups and under active in others, particularly their ‘core’ muscles. Your physiotherapist is likely to discuss these with you and may make alterations depending on your particular posture. It is important that following your treatment you continue to maintain these alterations. This may mean the need to continue stretches and specific strengthening exercises longer term to prevent reverting back to previous postures.
Activity modification is often required
Activity modification is often required to prevent re-injuring your back after your injury. Most people will have specific movements or activities which will cause them pain during the recovery from a back injury. It is important to take note of these activities and understand why they are painful so that once your pain is gone you are still aware of activities which are most likely to cause you pain in the future. You may need to modify these activities to prevent ongoing loading of your spine in a particular way, such as changing your work setup so you don’t have to lift from the ground repetitively or altering your desk setup so you can sit or stand during the day to prevent stiffness and slumped spinal postures. And it is important to remember, that whilst you don’t have pain currently, factors that contributed to a back injury in the first place are likely to be the contributing factors in recurrence of an injury.
Sleep postures are vital in the care of your back as such a large proportion of your life is spent in bed. It is important to maintain a neutral spinal position, where your spinal is relatively flat and straight, to prevent unnecessary stress being placed on particular spinal segments. You should make sure that your back has appropriate support from your mattress and pillow and that these are replaced and turned regularly to maintain their optimal shape.
Exercise is a necessary long term part of treatment
Exercise is likely to be given to you as part of your treatment for your back injury and should become part of your long term management. This may include a combination of stretches and strengthening exercises which are required to maintain your spinal alignment and prevent you from reverting back to your previous posture and biomechanics. Clinical Pilates or specific gym exercises are a great medium for this, particularly in a supervised environment where your physiotherapist is able to monitor your posture and positioning at all times to gain the most benefit. Hydrotherapy is also a fantastic way to complete your rehabilitation due to the reduced weight bearing placing less impact on the affected areas and allowing greater flexibity in the warm water. By completing these structured programs the resistance, intensity and difficulty can be regularly monitored and adjusted for people at all stages of rehabilitation.
Seek early intervention if pain recurs
If you feel like your back pain is recurring it is important to seek early intervention. Your physiotherapist will be able to analyse your symptoms and resolve your pain much more quickly if you return earlier and have less associated tissue involvement.
The Instituto de Biomecánica (Biomechanics Institute-IBV) has developed SUNfeet, insoles which are customized to the anatomy of the user’s foot, which increase the comfort of footwear and reduce pain and fatigue in the feet. This product is now available in Europe.
These insoles display an innovative technology used in their development: a combination of a system for capturing and digitizing the shape of the foot which is easy and intuitive for the user via smartphone and a 3-D printing system which allows insoles to be manufactured in a totally personalized manner.
SUNfeet arose from the idea of combining the latest trends in health, technology and fashion to develop exclusive insoles which make footwear more comfortable and care for the feet, thus promoting an active lifestyle.
The SUNfeet smartphone app was designed for the 3Dcapture system, making it possible to obtain the shape of the foot extremely accurately and conveniently from any location.
The process is very simple: while seated, the user places the bare foot on one side of a sheet of paper. The app itself will guide him/her until three images of each foot are obtained. The files are then sent to a server which reconstructs the foot in 3-D, using pattern recognition and shape analysis algorithms. The 3-D image of the foot can be displayed on screen in less than one minute. Finally, the system assigns a unique identification code to each image, which will subsequently be used to design the customized insole.
At the same time, this technology is also present in the manufacturing process through 3-D printing, opening the way for more creative designs and the customization of the functional properties of resistance and flexibility, adapting them to the specific needs of each user and activity.
The power and precision of SUNfeet technology allow for optimal customization: not only are the insoles adapted to the anatomy of the foot, but also to the characteristics and lifestyle of each user. With this in mind, three different models of insole have been created (Sports, Casual and Elegant), taking into account the type of activity and the characteristics of the footwear in order to select the most suitable materials and thicknesses. Thus, the impact cushioning, energy return and pressure distribution requirements are adapted to each use and to the characteristics of each individual.
The Instituto de Biomecánica (Biomechanics Institute — IBV) has introduced, as part of the Science Museum “Príncipe Felipe” of Valencia, this SUNfeet technology, incorporated as a new module of the exhibition “We Take Care About Your Quality of Life.”
IBV director, Javier Sánchez Lacuesta, reminded those present that “this exhibition -promoted by CVIDA association- was developed by IBV in collaboration with the Science Museum and opened in October 2007 in order to make available to the citizen technologies, products and services that take care of their health and wellbeing. This is an interactive show in which the visitor can check their skills in different environments and attractions.”
The foot care is essential to reduce hassles that come to limit the way of life. Using comfort insoles helps keep feet healthy during daily activity. SUNfeet combines a precise system of capturing and digitizing the foot and a 3D printing system that allows develop fully customized insoles.
The user can select the insole that best suits his lifestyle: Casual insoles for continued use shoes that achieve comfort and reduce foot fatigue; Elegant insoles that fit with most elegant and formal shoes; and Sports insoles that improve performance and help to prevent injuries.
Juan Carlos Gonzalez, IBV Clothing Director, showed attendees the performance of this system, highlighting the ease of use, accuracy when carrying out the capture of the foot and versatility of the system that allows getting perfectly tailored insoles to the needs and characteristics of the user and the function to which they are intended.
Asociación RUVID. “SUNfeet technology for the customization of comfort insoles using a smartphone.” ScienceDaily. ScienceDaily, 19 October 2015. <www.sciencedaily.com/releases/2015/10/151019072208.htm>.
Custom-made insoles known as foot orthoses can reduce foot pain caused by arthritis, overly prominent big toe joints and highly arched feet, a new systematic review shows.
A team of Cochrane Researchers found that custom orthoses were safe interventions for foot pain in a number of different conditions. However, more research is required to develop an in depth understanding of their effectiveness.
Approximately one in four people are affected by foot pain at any given time. It is often disabling and can impair mood, behaviour, self-care ability and overall quality of life. People suffer from foot pain for a variety of reasons, but pain is more common in the elderly and those with chronic conditions such as arthritis. In the majority of cases, patients undergo a combination of different treatments, one of which may be custom-made foot orthoses (insoles moulded to a cast of the foot).
The Cochrane Systematic Review focuses on the results of 11 trials that together involved 1,332 people. Researchers found that custom foot orthoses can relieve pain within three months in adults with rheumatoid arthritis, as well as in children with juvenile idiopathic arthritis, an early onset form of the disease. Adults with painful highly arched feet or painfully prominent big toe joints also benefited from treatment with orthoses over three and six month periods respectively.
“Custom foot orthoses can be an effective treatment for a variety of conditions, but there are still many causes of foot pain for which the benefit of this treatment is unclear. There is also a lack of data on the long term effects of treating with orthoses,” says Fiona Hawke, the lead researcher, who works at the Central Coast campus of the University of Newcastle, Australia.
Wiley-Blackwell. “Foot Pain? Custom-made Insoles Offer Relief.” ScienceDaily. ScienceDaily, 18 July 2008. <www.sciencedaily.com/releases/2008/07/080715204834.htm>.