Wednesday, November 24, 2010

Dry Needling - Like an arrow to the heart of the Trigger Point

Huzzah! Have you ever heard of Dry Needling? Its amazing for mayofascial pain! Its awesome for weakness, lack of range of motion, chronic muscle pain, and everything Fibromyalgia related!

Here it is in a nutshell. In a normal muscle contraction, when the muscle contracts, the Actin and Myocin ratchet together pulling the muscle shorter. (lots of other stuff happens, as well, but we are going to go with the simplified version here.)

If your muscle is told or stimulated to stay contracted, either by physical work or pain stimulus, sometimes the muscle, or part of it, can become ischemic, meaning that it lacks blood supply. If the structure doesn't have blood supply, it can't pull nutrients from that blood supply to create ATP (energy), which it needs to finish the contraction and release.

Because it lacks the ability to form ATP and fire again, unratcheting the actin and myocin fibers, the muscle stays short and lacking in blood. This becomes painful over time (sometimes over a very short period of time, and suddenly), and a taught band or nodule forms in the fibers. This is our friend, the trigger point.

When you push on the trigger point with your finger, it radiates pain to another part of your body. For instance, if you push on a trigger point in your levator scapulae, it will commonly refer up your neck and into your head.

Sometimes, if those trigger points are active and sensitive enough, they refer pain and sensation whether you are touching or pushing on them or not. They refer pain because the nerve closest to the trigger point is in a continual feedback loop: "ow. contract. ow. contract. ow. contract." (The nerve is essentially telling the structures all around the trigger point that there is an injury, and it would be a good idea to guard all the muscles around the injury to protect it. Yes, our body is genius that way. Sometimes, however, that protective nature goes past what serves us and creates its own problems.)

When the nerve is overloaded like that, the trigger point needs to give its information to someone (it reminds me a bit of when Bodhi was six... Hey mom, hey mom, hey mom hey mom....) and so when the main pain signal is full and busy all the time, it turns to the next one and begins to send pain information through that nerve signal as well.

Over time, a trigger point like that can beget little satellite trigger points, like a beautiful, painful little family all clustered around one mother-load, lacking nutrients, the ability to let go, and all talking at once.

Fibromyalgia is a condition where this is happening all over your body, all the time. You can reduce the amount of pain you are in by being really dedicated to a regime that helps soothe the nervous system. Here is what works for me:

An hour to five of hard cardio a day, (start with 20 minutes, walk around the block. Just walk. Move your body!) One yoga class a day, acupuncture twice a week, 90 minutes of massage therapy with someone who knows Neuro Muscular Therapy REALLY WELL twice a week, and soaking in hot springs or Epsom salts twice a week. I also have a large heating pad that is wet which I lay on twice a day, moist heat is the anathema of trigger points.

Palates and core strengthening seem to help a LOT as well. Staying away from refined sugar and eating a vegetarian diet helps me as well. The less refined sugar I eat the better I feel in general.

This is expensive, and a difficult schedule to maintain if you have a life, job, kids, you know... but it is rewarding in several ways, you get immediate feedback, if you work hard, you feel better. It takes a babysitter at $20 an hour, a gym membership, a hot springs membership, a yoga membership, and about $600 a week in manual therapy cost. Lets say its about a grand a week, including all of it. Unfortunately, insurance does not cover any of these treatments. Some massage therapy can be covered, but its rare, and hard to find a practitioner who has the skills you are looking for who also bills insurance.

Enter the therapies that the insurance company will cover: taking a drug called Lyrica, which leads to confusion, balance issues, weight gain and "brain fog". Injections of cortisone into the spine to reduce inflammation (although recent studies show that there is no reduction in inflammation, but that there is temporary pain reduction. According to the study, if you do these often enough, the steroid over time contributes to instability in the tissue, actually weakening it.) And Physical Therapy.

Now, if you are lucky enough to live in Aspen, you will find a progressive and open minded physical therapy department at the Aspen Valley Hospital, where an amazing woman named Tina Anderson practices the exquisite art of Dry Needling.

This therapy, based on the exhaustive work of Dr. Janet Travell, a myofascial pain specialist who first mapped trigger points and their referral patterns, is at once incredibly intense, and incredibly effective.

 Dr. Janet Graeme Travell, M.D. (December 17, 1901 — August 1, 1997) was an American physician and medical researcher. She was appointed the personal physician to President John F. Kennedy in 1961. Educated at Wellesley College and Cornell University Medical College, she was the first female doctor to be the personal physician to a sitting United States president.
The practitioner locates the triggerpoint by palpation, and then inserts an accupuncture needle deep into the heart of the taut band, sweeping it back and forth. This causes the muscle to have a massive spazm in the locus of the trigger point, the trigger point fires all at once, to its maximum capacity, radiating sensation to its terminus in either direction. The trigger point has a massive twitch response, in other words, and then "dies".

It is intense. It makes me sweat, feel dizzy, drool, makes me feel alternately like I'm both in and out of my body. I can feel it coming when she grabs the muscle, I know right where she is going to put the needle, because the trigger point between her fingers is loud, obnoxious, painful, and begging for attention. At the same time, I'm wary of her needle, because I know that the exquisite pain that is about to follow is almost beyond my comprehension. It is a 10. It is a momentary 10, but it is a 10 nonetheless.

The resulting sensation is that the segment releases, and feels exhausted, and a little bit "shut down" or dead. The sudden intense pain, followed by the sudden absence of pain referral feels akin to emotional exhaustion; its similar to going through a traumatic experience, spending the day crying, and then reaching that exhausted point where there are no more tears and everything is just a bit quiet and numb.

Tina Anderson has a deep and dedicated understanding of myofascial pain, and the map in her incredibly intellectual mind of trigger points and their referral patterns is complex and complete. In my first appointment, I explained to her that my shoulder hurt from a neck injury, and my left arm was weak and numb.

When I go to a massage therapist, I always hope that they will be able to locate the major perpetrators of this pain and weakness that I feel in my arm, neck and shoulder, and sometimes, when they get it just right, the way in which the segments are tied together makes sense to the practitioner, and I get relief.

Tina took out her box of needles and got to work, hitting only the points that were firing and painful, and hitting all of them, without exception. She was brutal in her willingness to continue, solicitous in asking if I could handle the intensity, and sure of the extent of the therapy I needed for relief.

I got off the table feeling like I'd been run over by a truck, exhausted and weak, but no longer in pain. We made our way over to the Gyrotonics machine, a beautiful wooden machine that was developed by Juliu Horvath, an ethnic Hungarian born in Romania. Horvath, who was trained as a ballet dancer, sought asylum in the United States in the 1960s and developed the Gyrotonic system there, after an injured Achilles tendon brought his dance career to a halt. He began to practice yoga, and developed a system called "Yoga for Dancers", which eventually evolved into GYROKINESIS.

This gentle, elegant stretching system did in one fell swoop what hours rolling myself on a foam roller and stretching in yoga could not do. My teres major, lat, delt and trap were suddenly open, long, and relaxing.

I had to go home and lay on my wet heating pad for about an hour and a half after this intense treatment, but the next day, for the first time in two years, my arm was strong, and pain free. It was fatigued for two days, but the difference in pain and overall weakness was incredible. Sign me up, I'm a fan!

1 comment:

Anonymous said...

Wow, Kate, that was fascinating.
I hope you continue to heal quickly and deeply!