Working with athletes is a rewarding, yet challenging niche.
Working with athletes is a rewarding, yet challenging, niche. They are the first to follow advice on training regimes, nutrition, and supplementation when they are healthy, but they are the last to allow their body adequate recovery time. An athlete represents the optimal health and function of the human body; however, it is a body that is pushed beyond its own limitations on a daily basis. This demand on the body and its structures is not without consequence. Musculoskeletal pain is among the most common reasons for athletes to visit their health-care practitioner. For example, during the 2004 Olympic Games, 34.5 per cent of athletes visiting the Olympic Village medical clinic presented with myofascial pain – legitimate pain of a musculoskeletal origin, but without overt injuries like sprains and strains.
Musculoskeletal injuries and/or pain are devastating setbacks for athletes. A quick recovery with minimal pain and interruptions in lifestyle and training is ideal. Many injuries are related to myofascial trigger points (MTrPs), which can develop through trauma, whether from repetitive strain or blatant injury. MTrPs are defined as tender spots within a shortened band in a muscle. These points can be active, meaning they cause symptoms without provocation, or latent, causing symptoms only on palpation. MTrPs can result in local and referred pain, and limitations in strength, flexibility, range of motion, circulation and nerve conduction, setting the athlete up for more injury. The pain associated with them can also affect sleep quality and quantity, and the ability to train effectively. Identifying and treating these MTrPs can have a profound effect for an athlete in pain and their risk of injury.
Studies have shown that dry needling using acupuncture needles is a safe and effective treatment. Acupuncture needles have an analgesic effect, altering the spinal cord pathways for pain, releasing endorphins, and inhibiting pain receptors. Inserting a needle directly into the MTrP mechanically breaks up the tender spots through a series of “micro-stretches”, decreasing the tension on capillaries and pain-sensitive structures. A needle alters the circulation and metabolism, restoring normal function to the tissue. Treatments such as physiotherapy and standard care are less effective than dry needling. A similar treatment, wet needling, is effective; however it involves injecting local anesthetics such as lidocaine, procaine or botox into the MTrPs. Injecting these substances is associated with a greater possibility for local and systemic adverse effects, and actually paralyzes the muscle for the short term.
While both wet and dry needling have been shown to be effective throughout the literature, dry needling with acupuncture needles is as effective and is less invasive than wet needling. Dry needling MTrPs has the ability to have a positive impact on pain, performance, and quality of life.1
The Dry Needling Technique
The dry needling technique involves assessing and locating the presence of an MTrP, anchoring the point, and inserting a needle directly into it, causing a muscle twitch. A thorough history of the pain must be obtained, ruling out other causes and identifying co-morbidities. For example, sciatica can be caused by a disc herniation, spondylolysthesis, or injury to the piriformis muscle. A proper history and physical exam will determine whether the pain originates from the spinal column or a more distal location, which will lead you to your treatment of spinal manipulations or myofascial techniques, or both.
MTrPs are located by three main types of palpation: flat, pincer and snapping. When palpating, the practitioner must work with the patient to identify the taut band within the affected muscle, and locate the most tender spot within the band that elicits pain and a twitch response with pressure. The band feels like a rope or a string within the muscle. Flat palpation uses your fingertips to move the subcutaneous tissues to detect changes in the muscle. Snapping palpation is similar, but involves rolling over the taut band in the muscle, similar to plucking a guitar string. These two techniques can be used for most muscles. Pincer palpation refers to grasping the muscle belly between the thumb and finger, and rolling the fibres between the digits to isolate the tender nodule. This type of palpation is beneficial for the gastrocnemius, trapezius, or other muscles that can be “picked up”.2
Once the MTrP is isolated, it should be trapped between two fingers or a finger and thumb and then needled to elicit a muscle twitch. Research suggests that regardless of the type of needle used (hypodermic or acupuncture), the effectiveness of the treatment lies in the ability of the practitioner to achieve the muscle twitch.3
With myofascial pain, and MTrPs in mind, athletic performance can be improved by optimizing muscle function. Risk of injury can also be decreased by applying “pre-habilitation” at the onset of pain, which inherently alters biomechanics, instead of waiting for an injury to occur to employ rehabilitation. After all, pain is a signal from our bodies that something is not quite right. Encouraging our athlete-patients to listen to their bodies and seek treatment earlier rather than later will ultimately improve their function, both in everyday life and their sport.
References:
- Teasdale T. Safety, effectiveness and impact of dry needling trigger points in athletes: a systematic review. SIRC. Available online from <http://sirc.ca/research_awards/documents/TTeasdale.pdf >. 2009.
- Simons DG & JG Travell. Myofascial pain and dysfunction: the trigger point manual 2nd ed. Philadelphia: Lippincott, 1999.
- Gunn CC. The Gunn approach to the treatment of chronic pain: intramuscular stimulation for myofascial pain of radiculopathic origin. New York: Churchill Livingstone, 1989.
Dr. Tracey Teasdale BSc (Hons), ND,
obtained her BSc in Kinesiology from McMaster University and her Doctor
of Naturopathic Medicine from the Canadian College of Naturopathic
Medicine. She is committed to gathering and creating knowledge on best
practices in sport and sport medicine, and has received the 2008 SIRC
Research Development Award for Sport and Health for her work on dry
needling for athletes.
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