Sitting in her Highlands Ranch office after working with a patient, Samantha Hovel explained the biggest problem she has when discussing a little-known treatment with some of her patients.
“Nobody likes the word ‘needle,’ ” she …
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I had completed my interview with physical therapist Nicole Stevens and was preparing to leave when she asked if I would like to try a dry needling treatment.
“You really ought to do it if you’re going to write about it,” she said.
Two nights of sleeping on a camping cot the previous weekend had left my lower back tight and hurting, and me with no excuse not to say yes.
After going over possible side effects (possible bleeding or bruising, discomfort and soreness), and disinfecting my skin with alcohol, Stevens worked my back with her hands to find the trigger points my cot created.
She warned me that it would hurt, “like a toothache inside the muscle,” but that I would feel better in a day or two.
“I have tattoos,” I told myself.
“I’ve never flinched at a booster shot,” I thought.
“Ready?” she asked.
“Yep,” I said.
As she pushed a needle through my muscles to my spine, then began to work it back and forth, I understood exactly how it felt to have a toothache inside a muscle.
She connected an electrical stimulator to cause each muscle to twitch individually, rapidly at first, then more slowly as she adjusted the voltage to a comfortable level. Eventually each muscle stopped its spasms and “reset,” and I felt the tension in them subside.
She finished by massaging the area, adjusting my spine and taping my back to support the sore muscles. She instructed me to drink a lot of water and stretch as much as possible.
“Tomorrow you should feel a lot better,” she said.
She was right.
While I was stiff and achy the rest of the day after the treatment, I woke the next morning free of tension or pain.
My back felt so good I almost forgot about the toothaches there the day before.
Sitting in her Highlands Ranch office after working with a patient, Samantha Hovel explained the biggest problem she has when discussing a little-known treatment with some of her patients.“Nobody likes the word ‘needle,’ ” she said.When she sees a patient with soft tissue pain that affects mobility, Hovel, clinic director at Rocky Mountain Spine and Sport, often recommends dry needling, a treatment begun in the late 1970s that has been gaining traction with physical therapists over the past three decades.No drugs are injected through the solid “dry” needle used to penetrate the skin, muscles and tendons, giving the process its name. Hovel locates trigger points, or painful areas in a muscle or tendon, then inserts a monofilament needle, the same kind used for acupuncture, into the tissue until the patient feels a “deep ache” or the muscle twitches. Electrical stimulation from a 9-volt battery is sometimes used to spur the twitching response in muscles.“It can physically inhibit the transmission of pain signals through the nerves,” Hovel said. “My patients see a better range of motion, increased healing rates in tendons and increased blood flow to the area.”Hovel’s patients range from teens with posture issues to athletes recovering from injury to seniors with chronic pain. She stresses that it’s a piece of her treatment plan, not a cure-all, but says 75 to 80 percent of patients report improvement after a session or two.“I tell them it’s 100 percent your choice, but this could help you faster than anything else,” she said.Some patients are skeptical, and some balk at the suggestion altogether, but Hovel said she sees more skeptics become believers than the other way around.Global research, western techniqueDry needling derived from clinical trials in the United States in the 1940s that injected trigger points with corticosteroids, analgesics and saline. In the 1970s, Czechoslovakian Dr. Karel Lewit found that patients showed signs of improvement from just the needling effect, whether or not any drugs were injected.Canadian physician Dr. Chan Gunn took things a step further. Gunn, widely acknowledged as the innovator of the practice in North America, dubbed the technique “intramuscular stimulation.” He theorized that peripheral nerve pain caused trigger points to tighten and compress, but if pain signals were interrupted by the insertion of a needle, the muscle would return to its natural state.Gunn’s decades of research, practice and proselytizing led to his technique being adopted worldwide, and a course in Intra Muscular Stimulation is offered to physicians at the University of British Columbia.Two sides of the same needleDespite a basis in medical science, not everyone is convinced of dry needling’s benefits, particularly acupuncturists.A lawsuit, filed in March by the Acupuncture Association of Colorado, is pending in Denver District Court. No date has been set for proceedings to begin.The suit alleges physical therapists in Colorado are insufficiently trained to perform the invasive procedure, noting that dry needling requires 46 hours of training while acupuncturists must receive 1,905 hours of training to be certified.Nicole Stevens, a physical therapist who operates her own practice, Point in Motion, LLC, disputes the assertion that needling practitioners like her are undertrained.“We all have four years of undergrad and a two-year doctorate or master’s,” to become physical therapists, Stevens said.Stevens received a master’s degree in physical therapy from the University of Colorado Health Sciences Center in 2000, and was certified to perform dry needling in 2010. Hovel earned a doctorate in physical therapy from Regis University in 2007.“All we’re doing is using a needle to reach a point we couldn’t reach with our hands,” Stevens said.Dr. Byron Jones, a Lakewood physiatrist and director of the Lutheran Spine Center, was skeptical of dry needling at first, but an internal study with his own patients changed his mind. He and his staff now incorporate needling, in addition to exercise and other therapies, to treat tendonitis, injuries and a variety of muscle issues.“I have to say I was not a fan of dry needling when they first started doing it,” Jones said. “Physical therapists have proven to me there is a significant benefit. I have found it to be a very effective form of adjunctive treatment. The problem is, some therapists believe this is all you need to do, and the research doesn’t support that.”Relieving pain, respiting surgeryOne of Hovel’s patients, Paul Bergstrom, says dry needling is helping him stave off back surgery.Bergstrom, a 72-year-old Littleton resident, has a herniated disc in his spine. He tried chiropractic to no avail, and he wasn’t eager to follow doctors’ orders to have some of his vertebrae fused. After a recommendation from his son, Bergstrom paid a visit to Hovel.Almost two years later, Bergstrom said Hovel’s regimen of core-strengthening exercise, massage, spinal adjustments and dry needling has allowed him to regain 80 to 90 percent of his day-to-day activity without pain.“It’s not going to cure it, but I don’t know that surgery necessarily will cure it either. Right now this is the best answer and I hope it stays that way,” he said. “When you’re in pain, it’s hard to get stuff done. And I’ve got a lot of chores to do.”
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