On Saturday, March 14, most of the US pretty much went into quarantine because of the Coronavirus pandemic. Schools all across the country (and many places in the world) shut down. We are doing online schooling. Retail stores are closed. 

People are scared of this virus, and I am doing my best to follow quarantine rules and haven’t been out of the house to go anywhere except the grocery store. There is one place I’ll still be going this weekend, though. It’s a place I visit every 3 weeks-- so often that when I asked Jared “What’s my favorite place to go?”he said, “to see Ron”. 

Ron is my physical therapist. He works for Sports Rehab Consulting (SRC), a private, self-pay physical therapy business that calls itself “concierge physical therapy”, because some of their PTs make house calls. (We’re not talking about home health care, or PT for the elderly. We’re talking about working with world class athletes, or going to see a wealthy client at their home in Vail. SRC was started by Lindsey Winninger, who was a trainer for the US Ski Team and is now Lindsey Vonn’s personal physical therapist.

SRC recruits therapists who are certified in dry needling, have extensive experience with manual therapy, and who are immersed in the sports scene. Many of their PTs also serve as therapists for professional teams (One works with USA Rugby, another with the US ski team). But they don’t serve these populations exclusively. 

We learned about SRC as Kenna was getting ready for hip surgery in 2015. Ron was recommended by her surgeon and highly recommended by my good friend, who jumped on the labral reconstruction train a year before us and whose advice probably saved our lives. Or at least it saved Kenna’s hips. 

Hip arthroscopy was the new surgery, but not all PTs are created equal, especially when it comes to protocols for newer surgeries. We had no PTs in our area with experience rehabbing labral repairs or reconstructions--as my friend found out rather painfully--and Ron had had a labral repair with Kenna’s surgeon.  As a former collegiate athlete, patient, and PT who worked with many athletes, he could see all the angles; in fact, he could feel what he was doing as he did it to his patients. He knew exactly what they needed at each phase of their recovery. Under his care, Kenna recovered from two consecutive surgeries, going on to play sports for two more years with no complications. 

Enter me and my complex history of compensating.  

In the fall of 1989, I was a high school volleyball player in New York State. I sustained an ankle sprain that kept me on crutches for weeks.  When I was feeling improved, we went to our school doctor--an older, Italian man who probably didn’t have orthopedic experience--and he flatly denied my request to play.   Deep down, I knew he was right; I wasn’t even walking well. But I was an athlete, not a spectator.

I missed the entire season. And I didn’t do any rehab. (Did anyone rehab ankles back then?  Most people don't  now.) 

Fast forward about 5 years, to my sophomore year of college. I was very active, lifting weights, swimming, and jogging. Running was what I enjoyed most; I was relatively new to it, and I loved the euphoric runner’s highs. During the summer, while working in California, I ran with my friend, Sherrie, who acted like  my trainer. She was an ex-collegiate runner. Twice my age, she was used to running at altitude, was much more efficient than me, and she smoked me.We ran portions of the Pacific Crest Trail together, ending our runs at Rattlesnake Hill, which was a rocky incline that doubled in elevation from beginning to end. (A big deal when running at 7,300 feet to begin with.) It was tradition that Sherrie would beat me to the top and wait while I struggled to finish, usually stopping at the end. I think I almost made it up toward the end of the summer, but it was a killer. Every step felt like I had lead legs. 

The high point of the summer was the day Sherrie and I ran the 6 miles into town together. I started planning my future, which would be full of 10ks and half marathons. 

But things fell apart. 

Back in Provo, I was running alone and running on pavement. Immediately, I had knee pain. 

I couldn’t put my finger on it: Why so much pain, when I’d been pain-free just  weeks before?  Every time I ran I’d ice my knees, but the pain persisted. Finally, I had to quit running. Instead, I walked the hills of Provo. I was sad; my running days had only lasted about 18 months.

I visited an orthopedist, who diagnosed me with patellofemoral stress syndrome (PFSS),  a common if vague knee pain. Take a break from running and get orthotics to correct that walk, I was told. 

I followed that advice, but fifteen years later, I was still not okay. 

I developed severe pain and trigger points in both scapulas. I had knots in my muscles that hurt constantly. I had had five kids within eleven years; the youngest was two or three. I had gained weight with four of the pregnancies, and after my fourth child was born, I didn’t lose much. It was hard to work out with little children underfoot and older kids involved in afterschool activities. I walked a lot, but my days of weight training and swimming were long gone. I had sacrificed the things I loved in the name of being a Committed Mother.   

Finally, I started to address my pain. At this point my youngest child was two, and I had started working a few hours a week at our local fitness center. With the extra money, I began seeing a massage therapist. This helped some, and I looked forward to my appointments.  After a few years, a physical therapist told me about dry needling. I tried it and was amazed by the relief I felt.I started to incorporate regular needling with massage. 

Eventually I switched therapists, working with someone who did more manual therapy. After needling my shoulders, she would work my neck. Although I had been to a chiropractor and watched chiropractors work on others’ necks, I’d never experienced anything like Becky cranking on mine until I thought it would snap. Eventually I learned to relax through it, and I experienced a good deal of relief after about 9 months of treatment. In fact, I had a period of time when I thought I was better. I was able to go over a month without an appointment and without pain. But then volleyball season began, and I was coaching and using my arms to throw balls over the net and playing ball after practice. It wasn’t the best thing for me, and I became problematic again. 

During this time period I also noticed that one of my shoulders was lower than the other, and my upper body was rotated to the right. I had actually noticed this a few years beforehand, when I started working as a personal trainer. In fact, I bought a book at a class I attended: The Pain Free Program: A Proven Method to Eliminating Back, Neck, Shoulder, and Joint Pain. The book was basically for people with compensation issues; it was a guide to self-evaluation, and it included lots of corrective exercises, some for rotation compensation issues.  However, I knew that I couldn't self-evaluate very well and that the best way for me to get the help I now knew I needed was to see Ron. Although I was already seeing physical therapists and being needled, they were not evaluating me like he evaluated his patients. He would spend one third of a session looking at a person’s biomechanical movement patterns, then treat them, then watch their new patterns based upon the corrections. He always prescribed corrective exercise. He was methodical and thoughtful and deliberate; there was no cobbling together a halfway treatment plan and hoping it worked. I needed this deliberateness and thoughtfulness. 

I started going to SRC for treatment in the fall of 2017, a year after Kenna’s last surgery and a couple months after she’d “broken up” with Ron. At the first visit, he asked me what was going on, and I explained my neck and scapular pain and the treatments I’d had for years. Then I simply said, “You’re good at figuring out puzzles, so I thought you could help.” He laughed, a kind of unspoken acknowledgement of my assertion. 

I haven’t looked back. 

I always recommend Ron and Sports Rehab Consulting, and not many people try him. It’s far away, and it’s self-pay (I’m sometimes surprised this is an issue for people; I could go see him 2-4 times and see another therapist once for the same price).  I get it. But I’m not breaking up with him yet. Maybe not ever. 

He’s treated my condition, not just my symptoms. We spent about 9 months addressing my scapular pain, tight and overactive lats, and rotator cuff weakness. I felt perfect for awhile, and thought we were done. But Ron was interested in what was going on with my ribs, and soon his perceptiveness paid off; I needed more help. We spent a lot of time working on my feet, correcting my left foot supination, which likely had existed since I sprained my ankle almost 29 years ago. We think it was the weak and me that caused my knees pain and then cascaded, causing the hip rotation and scapular compensation. Compensation is truly horrible. 

Today, I am once again thinking we could be nearing the end of our time together. For the past year we’ve been addressing my rotational issues, fixing my hips’ tendency to settle and dip during certain exercises, strengthening the glutes and hamstrings, working out the tightness in the quads and hip flexors. Ron has worked on my calves and anterior tibialis to get them to release and help my foot stay neutral. I sometimes think he’s worked on everything there is to work on. 

So, here I am at the age of 45, feeling better than I have since my early 30s. Sure, I’m still overweight, but I’m also getting some mental health care and learning about mindfulness; I have every reason to believe I can fight that battle, too. Plus, when I exercise now, I can use my time to work hard, instead of investing so much time in stretching without making progress. My pain is gone, and I’ve started hiking again, which I hadn’t done since my late teens. My feet don’t hurt, my hips extend correctly, and I just feel good. 

I love you, Sports Rehab Consulting. I’ve had a great time learning from you and rekindling my interest in all things sports medicine. Thanks to you, maybe I’ll even work toward attending PT school. The biggest thanks to you, Ron. I owe ya. 

Changing Course: A Look at the Mind-Body-Spirit Connection

I wholeheartedly embrace everything you will read below, but it is not mine.  I'm sharing a column from Runner's World, published in March 1994. The author? George Sheehan, a cardiologist who ran, thought, and shared via a long-running column in the iconic running mag.

At the age of reason, I was placed on a train, the shades drawn, my life's course and destiny already determined.  At the age of 45, I pulled the emergency cord and began running for my life. It was a decision that meant no less than a new existence, a new course, a new destination. I was born again in my 45th year.

The previous "me" was not me. It was a self-image I'd had thrust upon me. It was the person I had accepted myself to be, but in fact I had merely been playing a role.

"It took me a long time to discover that the key to acting is honesty" and actor once told anthropologist Edmund Carpenter. "Once you know how to fake that, you've got it made"

In time, many of us fool even ourselves.  Sooner or later, however, we come to question the trip planned for us, the goals we are given, our itinerary along the pathway to death. Sooner or later, it becomes important that we feel important and believe that what we are doing is important.

When I stepped off that train, I had lost my sense of purpose, my faith in what I was doing, my caring for creation and its creatures. I was not alone. Millions of Americans who had been told Sunday after Sunday to be born again were now going through the shattering experience of rebirth.

...Finding one's reality does not come without plan or effort. Being born again is no easy task. Technique and training and much hard work are needed. And we are always faced with the knowledge that it is an undertaking that will never be completed. Every day must be a fresh start. 

Most experts suggest we start a new career, develop new interests. I say begin and the beginning. Begin with the body. 

The body mirrors the soul and the mind, and is much more accessible than either. If you can become proficient at listening to your body, you will eventually hear from your whole self--the complex, unique total person you are. 

Note: This is my favorite paragraph in this essay. I loved it so much that I saved the article, glued it to card stock, and kept it safe for twenty-six years. I have come to know myself well by listening to my physical self. It's been a learning process. It's involved formal education, just-for-fun, informal research, lots of thought, paying attention to how I feel, thinking, praying, and, often revamping and going back to the drawing board.  I respect people who have artistic talent or who know how to invest or who sing well or have immaculate, well-organized homes, but those things aren't my strength. My strength is in being true to myself. My strength is self-care. I want to live a long life. I want to do so happily, with a sense of balance and purpose and accomplishment. And I am learning those things as I make my way through life and practice becoming proficient at listening to my body. 

I did it that way. I stepped off that train and began to run. And in that hour a day of running, I perfected my body, I began to find our who I was. 

I discovered that my body was a marvelous thing and learned that any ordinary human can move in ways that have excited painters and sculptors since time began. I didn't need the scientists to tell me that man is a microcosm of the universe, that he contains all the elements of the cosmos in his body. In the creative action of running, I became convinced of my own importance, certain that my life had significance. 

Fitness may have something to do with this.  Physiologists have show that those of us who remain 'perpetual athletes' are two to three decades younger physically than our contemporaries. With this comes an awareness, a physical intelligence and a sensual connection with everything around you. Active participation in sports enlarges your existence.

Any rebirth is a long and difficult task.  It must begin with the creative use of the body, in the course of which we will explore pain and exhaustion as closely as pleasure and satisfaction.  It will end only when we have stretched the mind and soul as far as the body.

Of course, there is an alternative. You can always get back on the train.


(If you like this article, you might be interested to know that there's a book with many of Sheehan's columns. It's called The Essential Sheehan:A Lifetime of Running Wisdom from the Legendary Dr. George Sheehan. It'll be one of my next Kindle purchases.)

What is Dry Needling?

Maybe you've heard the term "dry needling". What is it?  Isn't it the same as acupuncture? 

Dry needling is a not the same as acupuncture.  It's a "technique used by qualified physical therapists to manage muscular pain and improve movement" (see mayoclinic.org) in certain patients. While dry needling uses the same needles used in acupuncture, the purposes of needling and acupuncture are completely different, as are their origins. Acupuncture is an ancient practice used in Eastern medicine and is based on the flow of energy (chi) via meridians in the body, while dry needling uses neural pathways and Western physiology to manage pain, improve posture and movement or as a part of a program to correct long-standing compensation situations.  The difference between the two practices and the purposes of needling are explained by the North Shore University Health system as follows:

Acupuncture is a complementary medical practice rooted in traditional Chinese medicine that entails stimulating certain points on the body – most often with a needle penetrating the skin – to alleviate pain or to help treat various health conditions.

Dry needling is a technique employed by physical therapists and is similar in that a needle is inserted into the skin to alleviate pain. However the primary difference between acupuncture and dry needling is that acupuncture treats for the purpose of altering the flow of Qi (or energy) along traditional Chinese meridians while dry needling follows evidence-based guidelines, recommended “point” locations, and dosages for the treatment of specific conditions.

Physical therapists use dry needling with the goals of addressing neuromuscular conditions, relieving pain, and/or improving range of motion. Evidence to date supports that dry needling improves pain control, reduces muscle tension and normalizes dysfunctions of the motor end plates, the sites at which nerve impulses are transmitted to muscles. This can help speed up the patient's return to active rehabilitation.   (See https://www.northshore.org/healthy-you/difference-between-dry-needling--acupuncture/)

I was introduced to needling about nine years ago when at the beginning of a journey to correct a musculoskeletal imbalance.  The root cause of the imbalance was a nasty ankle sprain that occurred when I was sixteen. Without rehab, my ankle became weak and my proprioception (the ability of my ankle/foot to determine where it was in space and respond appropriately to information from the nervous system) worsened. Over twenty years, my body adjusted with compromised/incorrect movement patterns in my legs, which led to knee issues, which led to hip rotation, which caused rotator cuff compensation with an associated strength imbalance, which caused neck pain and even low back pain and trigger paints in my calves and tibialis anterior (the muscles on the front of the calf). After trying massage and stretching for a couple years with only limited and temporary success, a physical therapist became aware of my situation and recommended dry needling. This moved me up a notch on the treatment tier. Needling brought more thorough, longer lasting relief and allowed me to start communicating with areas of my body that had shut down.  I was hooked.

Here are some pictures of dry needing. These are not pictures of me, but I have had all of these areas needled. (And more. The results of long term compensation are extremely far- reaching, especially once pain in present.)  

Also, just an informational tidbit: Not all therapists are created equal when it comes to needling!  There are level 1 and level 2 certifications. While a lot of study and practice is required to even to be able to needle, level 2 allows a therapist to needle more areas than level one. It is even possible to needle sensitive areas like the face and pelvic floor.  (Needling has been used to successfully treat TMJ, pelvic floor dysfunction, frozen shoulder, chronic Achilles tendon tightness, and a whole lot of other conditions.)  Needling-- with mobilization techniques and corrective exercise-- has helped me stop supinating and maintain a neutral foot, use my foot in correctly in all phases of walking, and regain correct use of my rotator cuff muscles when my lats had begun dominating them. I've even had the muscles at the base of my skull needled (it was the best feeling ever. No more neck tightness.)  Needling can alleviate certain types of headaches, too.

But you need to see pictures!

   photos:  Youtube.com, thefootandankleclinic.com, face

Other family members have also benefited from needling; Kenna's hip PT used needling to help her glutes learn to activate following surgery, and to release her tight hip and core muscles and alleviate pain.  Isaac sustained a yucky hamstring strain which wasn't addressed immediately and caused significant reduction in flexibility and in turn low back pain. After a couple years of (very) intermittent treatments coupled with stretches, foam rolling, and some corrective exercise, he is much more flexible and his movement checks out better on the Selective Functional Movement Assessment. (I have come to be a big fan of this test.  Treat, test, repeat seems to yield very good results when used by someone with a discerning eye and a knack for human body puzzles,  like my PT). 

Dry needling and an excellent physical therapist has changed my life. I spent ten years exercising, learning about and practicing yoga, getting massage, and then doing it all over again without making progress before I tried needling and began to see more results.  I also switched physical therapists a few times before I found one who was able to connect all of my issues and address the underlying cause of my problems, rather than just the symptoms. I have a lot of regard for all physical therapists, but they are not all the same.  It pays to shop around.  A good PT will not just throw exercises at a patient, but will take time to evaluate the patient's movement patterns, strength, flexibility,  proprioception, etc. And many PTs have unofficial specialties, or at least more experience in treating certain conditions than others.

Here's a good introduction to dry needling . (For convenience, I've copied the article below.)

https://colepaintherapygroup.com/about-dry-needling/

5 Things You Should Know About Dry Needling

1. WHAT IS DRY NEEDLING?

Dry needling is a skillful therapy that uses a thin, filiform needle to penetrate the skin and stimulate underlying muscular trigger points or muscular and connective tissues for the management of neuromusculoskeletal pain and movement problems.  As dry needling has evolved, several various terms for the therapy have emerged.  The general term, “dry needling,” includes “intramuscular stimulation,” “intramuscular manual therapy,” “functional dry needling (FDN),” and “trigger point needling.”

2. HOW DID DRY NEEDLING START?

Dry needling has an odd name that differentiates it from “wet” needling for injecting medication.  As early as the 1900s, physician researchers wrote about palpable tenderness in the muscles causing orthopedic problems.  Through the 1930s and 1940s, researchers documented typical pain referral patterns coming from muscular trigger points.  Physicians at this time treated muscular trigger points with a hypodermic needle and injectable medication. In 1940, the father of manual medicine, Karel Lewit, MD, DSc., demonstrated how the simple insertion of a “dry” needle carried more therapeutic benefit than the injected medication.  Over time the “dry” hypodermic needle was replaced with a smaller needle that is still used today.

3. IS DRY NEEDLING LIKE ACUPUNCTURE?

The only similarity between dry needling and acupuncture is the tool – a solid filament needle.  Acupuncture is an excellent health system, which differs from dry needling in its assessment, applications, and intended goals.

4. IS DRY NEEDLING SAFE?

Like any therapy that has an effect, there is a possibility of unintended side effects.  It is important to have a discussion about the benefits, risks, and other treatment alternatives for any type of treatment.  With regards to dry needling, 1 – 10% of people may experience needling insertion pain, muscle soreness, fatigue, or bruising. Anyone with a needle phobia, history of pneumothorax, metal allergy, vascular disease, or abnormal bleeding tendency should discuss this with their doctor performing the dry needling.  In the hands of a skilled physician or therapist, dry needling can be a relatively safe and very effective treatment that follows a careful examination and diagnosis.

5. WHAT CAN BE TREATED WITH DRY NEEDLING?

The majority of nerve, muscle and joint pains are secondary to a movement problem.  Dry needling performed in conjunction with other manual and rehabilitative therapies is an excellent way to improve range of motion and decrease muscle or tendon pain.  So, needling can be incorporated in someone’s treatment plan at Cole Pain Therapy Group for the treatment of headaches, neck pain, back pain, knee pain, arm pain, leg pain, shoulder pain, and any other movement related pain conditions we treat.

Dry needling does a great job of deactivating muscular trigger points.  These are tender knots in a muscle that can refer pain to distant body areas.  For example, someone with pain radiating down the thigh to the ankle may have a trigger point at the side of their hip that is only painful to deep palpation.  The brief insertion of a needle into this trigger point results in a twitch of the muscle, immediate relaxation of the trigger point, and subsequent reduction of radiating symptoms to the leg.

Bottom line: If you haven't tried dry needling, you'll appreciate its ability to help you reach your fitness and  rehab goals. Also, don't be like sixteen year old me and ignore an injury. The pain will go away, but the adjustments your body will make in order to function could be very harmful.  Prioritize self care, and give needling a try if warranted! 

Have you tried needling? I'd love to hear your success stories or even your questions.  (I'm not an expert, but I enjoy the discussion.)