Monday, June 22, 2020

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.)


Sunday, June 14, 2020

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!

Image result for pictures of dry needling



Dry needling vs. acupuncture: Benefits and usesDry Needling Therapy - The Foot and Ankle Clinic







Dry Needling | Intramuscular Manual Therapy | Boston   photos:  Youtube.com, thefootandankleclinic.com, faceLatissimus Dorsi (Upper) Dry Needling - YouTube

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?

Dry needling for gluteus minimus referralThe 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.)