I am very excited to announce the latest evolution of treatments at Optimum Function!
Over the last 12 years, I have integrated massage, chiropractic, myofascial therapies, neurodynamics, nutrition and more. In addition, an, in my opinion, more importantly, I have also been paying very close attention to research, evidence and am constantly seeking out the truth, as best as possible, and questioning the so-called gurus of nutrition and manual medicine.
It’s been a long and sometimes lonely 12 years! This latest evolution of Optimum Function is a reflection of the last 12 years; but it’s also a work in progress.
I know, some of you have contacted me about the recent changes in the info on my main site, www.OptFunction.com. A few of you have asked where the pages for Fascial Manipulation, The Graston Technique and other named techniques have gone. Well, I can now say that the mechanisms behind MANY named techniques out there, especially when they seem overly complex and far-fetched….. are.
What I have found is that, through updating my knowledge on neurophysiology and pain sciences, nerve mobility and mobilizations and how our body views and uses movements for pain reduction, Many of the successful named techniques share common effects in our bodies:
- They mobilize nerves
- They produce novel stimuli which help to improve movement and reduce pain
- They encourage you to keep moving in novel and therapeutic ways
- They empower you by teaching you about the benefits of your pain system, rather than fearing it or thinking it is a reflection of damage in your body
Well, this is what I am aiming to do at Optimum Function from here on out. In addition, you will notice new pages at the Optimum Function Website:
These new pages were created to help educate you about various ideas that I will use during your appointments. I used the term “Myofascial” because it is a commonly-searched keyword for manual medicine. This is NOT to represent a technique, or even a propensity toward treating fascia, just that, through movement and hands-on work, I will help to encourage mobility of your nervous system. This system travels on and through fascia and muscles and may be affected by these structures. “Myofascial”, at Optimum Function, means that, through neurodynamics and nerve mobilization, I will work to eliminate pain and dysfunction in your “neuromyofascial” system. The “Pain Relief” page is all about education; pain education is paramount to pain relief. This will be a big component of your appointments at Optimum Function and you will get handouts and even “homework” to help your pain knowledge be as current and accurate as possible.
My Twitter and Facebook pages will reflect this too, please click on the links to the right to follow me on various social media venues to stay current. I pass along great, current and accurate articles on topics relevant to physical medicine and nutrition. In addition go to the main site to browse through the new pages and learn more about Optimum Function 2.0
So, if you currently have pain; whether it’s upper back pain, lower back pain, muscle pain and dysfunction or need someone to help you with your diet and nutrition to live pain-free and functional, Optimum Function is your place in Portland, Oregon.
I am currently offering 2 tiers of visits. The initial visit will be the same for everyone, follow-up visits are usually 20-30 minutes but I am also offering 1hr follow-up visits for those of you who would benefit from more hands-on soft-tissue work and massage. For more info about prices, click here: Prices at Optimum Function
As always, you will leave your visits knowing more about what’s going on with you and understanding what you can do and what I can do to help reduce your pain and get you moving better, more functionally and more often.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
The idea that poor posture contributes to neuromusculoskeletal pain, and that important, or even possible to properly rehabilitate posture, has been around for a long time and continues to be very popular. We have still been unable produce any good evidence to support this model. There is a ton of mis-information on this topic; a provider could choose any weekend during the year and probably find a seminar somewhere that is on postural treatments.
Here’s my take on posture:
It’s not an issue of posture, it’s an issue of the quality of your body position from which you move. This means, your posture can be crappy, as long as when you move from a biomechanically-sound position. Does you sacral curve need to be “x degrees”….. no! Does your head need to be exaclty over your shoulders…..no!
For every “guru” that’s out there selling this ignorant and potentially harmful (monetarily at the very least) idea, there are hundreds of examples of individuals who have what most clinicians would call “bad posture” and are completely, functionally ad biomechanically fine, in every way.
Existing evidence supports rehabilitation using a biopsychosocial model over a traditional biomedical (i.e., posture and body mechanics) model, but a biopsychosocial model has been very slow in adoption for various pain states. This model looks at the individual’s relationship, thoughts, ideas, and fears with regard to pain and the clinician helps to dispel myths about pain, teach the patient about why the pain exists and helps them resolve whatever issue is causing the pain. Posture is not usually one of them.
Postural-based approaches to pain have been found ineffective and no longer recommended by clinicians who are “in the know”. This shift has occurred in part because these biomechanical messages are not backed by very good evidence, they can often impede the resolution of a patient’s pain and can convey negative messages to patients about the cause of their pain.
The idea that we can change our posture via exercise, manipulation, soft-tissue work and the like is simplistic, attractive and makes sense to a lot of people. Unfortunately, this idea contradicts current evidence. Many ideas that were once thought to be “common sense” and logical have been proven wrong. Disease was once thought to be caused by evil spirits, the world was once thought to be flat and the earth was once thought to be the center of the universe, are you picking up what I’m putting down? The relationship between posture and pain is complex and there is no consensus on a valid definition of “good posture” or a reliable way to measure it. Postural evaluation procedures show poor reliability validity.
The correlation between posture and pain is tenuous at best, with most studies suggest there is no relationship. Therefore, the therapeutic investment in correcting postural and biomechanical factors is irrational, since it is unlikely to influence the course of a patient’s pain.
- Linsmeyer A. “The Effect of Flexibility and Posture on Neck Pain and Common Treatments in Physical Therapy.” Aurora Baycare Annual Spine Conference, Nov. 8, 2011.
- Cote P, van der Velde G, Cassidy JD, et al. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. JMPT, 2009 Feb;32(2 Suppl):S70-86.
- Linton SJ, van Tulder M. Preventive interventions for back and neck pain problems: what is the evidence? Spine, 2001;26(7):778-87.
- Weiniger S. Strengthening Posture for Rehab, Performance, and Active Aging. Seminar sponsored by Northwestern Health Sciences University., Dec. 10, 2011.
- Waddell G. The Back Pain Revolution, 2nd Edition. Churchill-Livingston, 2004.
- Toward optimized clinical practice. Guideline for evidence-informed primary care management of low back pain. Edmonton (AB): Toward optimized practice; 2009 Mar 2.
- Lederman E. The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. J Bodyw Mov Ther, 2011 Apr;15(2):131-8.
- Dagenais S, Haldeman S. Evidence-Based Management of Low Back Pain. St. Louis: Elsevier Mosby, 2012.
- Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, Macchi C. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil, 2010;24:26-36.
- Hrysomallis C, Goodman C. A review of resistance exercise and posture realignment. J Strength Cond Res, 2001 Aug;15(3):385-90.
- “Good Posture Defies Easy Definition.” The BackLetter, 2003;18(11)124.
- Dunk NM, Chung YY, Sullivan D, Callaghan JP. The reliability of quantifying upright standing posture as a baseline diagnostic clinical tool. JMPT, 2004 Feb;27(2):91-6.
- Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado M, Pareja J. Neck mobility and forward head posture are not related to headache parameters in chronic tension-type headache. Cephalalgia, 2007;27:158-64.
- Van Nieuwenhuyse A, Crombez G, Burdorf A, et al. Physical characteristics of the back are not predictive of low back pain in healthy workers: a prospective study. BMC Musculoskel Disord, 2009;10:2.
Have you wondered about bunion treatments, toe braces, overlapping toes, toe separators or toe straighteners? Have you seen a runner or athlete wearing a toe separator or toe shoes and wondered why?
Well, one of the most popular toe separators is Correct Toes by Dr. Ray McClanahan in Portland, OR. The premise is to improve the separation of your metatarsal bones to support the structural integrity of your feet. Here’s a press release from Dr. McClanahan’s office, NW Foot and Ankle. Do you want to get FREE SHIPPING on your order of Correct Toes? Use this code: IrvingFreeShip during checkout
PRESS RELEASE: ELITE DISTANCE RUNNERS TRAIN WITH CORRECT TOES AND QUALIFY FOR THE 2012 LONDON OLYMPICS.
(Portland, OR, 7/11/2012) — Correct Toes—the revolutionary toe-spacing product designed by sports podiatrist Ray McClanahan—has found their way onto the feet of a prominent group of elite, Oregon-based runners. Dr. McClanahan, himself a former elite distance runner, thought Correct Toes might be helpful in improving performance and reducing injuries in this talented group, so he furnished team members with pairs of his silicon toe-spacing device. The response was overwhelming.
“Correct Toes are a great product, and I like wearing them because they make my stride more efficient and powerful,” notes Matt Tegenkamp, who will compete in the men’s 10,000-meter running event at the 2012 London Olympics later this summer. Lisa Uhl, who will represent the US in the women’s 10,000-meter event in London, is also a Correct Toes fan. “I feel more balanced when I put my Correct Toes on, and my feet feel stronger,” states Uhl. Brent Vaughn, the 2011 US Cross Country Champion, has also benefitted from consistent Correct Toes use. “My use of Correct Toes has greatly reduced the achiness and pain I get in my feet from running 100+ miles a week.”
Pascal Dobert—the runners’ strength and conditioning coach, three-time US steeplechase champion, and 2000 Olympian—says, “I think Correct Toes are an amazing product. I strongly suggest all my athletes wear them during functional training and throughout the day.” Heeding this advice is Evan Jager, recent winner of the Olympic Trials steeplechase, who has used Correct Toes as a recovery tool. Jager, who has posted a personal best time of 13:22 in the 5,000-meter event, states that, “Correct Toes were an important part of my rehab program coming back from foot surgery, and I continue to use them in training.”
Dr. McClanahan and the Correct Toes team are buoyed by the positive response from these elite athletes and are happy to be a part of this group’s gold medal ambitions at the upcoming 2012 London Olympics. Dr. McClanahan, who himself narrowly missed the Olympic Trials qualifying mark in the 5,000-meter event in the run-up to the 2000 Sydney Olympics, has long harbored ambitions of Olympic glory. “Participating in the Olympics has always been my personal dream, so it’s with absolute passion that I wish these runners a strong wind at their back as they pursue their own personal bests this summer.”Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
In the first part of my blog entries about pain, I wrote about pain and how much is too much versus how much is to be expected. Basically, laying out the guidelines to figure out if the pain you are experiencing is “normal” or if it requires treatment.
This part is about myofascial pain and stretching.
Stretching does Not Help Prevent Injuries:
The best way to avoid myofascial and/or musculoskeletal pain is to no injure yourself. At my Portland Brazilian jiu jitsu gym, Straight Blast Gym, I find many people stretching for various reasons and in various ways. Static stretching, dynamic stretching and even stretching with a buddy occurs in gyms everywhere. Why?
Often, when asked, people respond by stating that it keeps them from getting injured. Well, there is little to know research evidence that suggests this is the case; in fact, there is quite a bit of evidence suggesting that stretching (depending on the type of stretching), can actually pre-dispose you to GETTING INJURED.
Rather than writing a very opinionated post about stretching, I decided to grab some convincing research evidence to back my claims:
Effect of stretching on sport injury risk: a review: This review paper surveyed research from 1966 to 2002 and found no statistically-significant link between stretching and a reduction of injury risk.
Stretching before exercise does not reduce the risk of local muscle injury: a critical review of the clinical and basic science literature: This study (another literature review) did a more comprehensive search and still found no link between stretching and decreased injury risk.
A randomized trial of preexercise stretching for prevention of lower-limb injury: This was a very well-designed study that found no reduction of injury in study participants who performed a pre-exercise stretching routine.
There are so many research papers on this topic, none seem to clearly link stretching to decreased injury.
Stretching to Reduce Pain:
Another reason people often cite when asked why they stretch is because it reduces pain for them before and after exercise or activity. Well, this may be true is they are performing active “stretches” or what I like to call self-mobilizations (more on this in a bit, it has to do with joint motion, not muscle length), it probably has no real effect on pain at all.
Again, the evidence for this is overwhelming, I have picked out a few studies to illustrate my point:
Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review; this study showed no significant decrease in soreness with stretching before or after exercise.
The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise: This study also showed stretching has no effect on pain when performed before an activity.
Stretching to prevent or reduce muscle soreness after exercise: And yet another one that showed no reduction in soreness in those who stretched before and/or after activity.
Warm-up, Not Stretching:
OK, so many people stretch as part of a warm-up. The evidence is clear about stretching; skip it, but DO perform a warm up. Here is some evidence showing that warming up can help prevent injury although it probably still does not prevent soreness or pain.
Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial: Although the original premise that warming up would prevent lower extremity injuries was not proven; warming up does seem to reduce the risk of severe injuries and overall injuries.
Compliance with a comprehensive warm-up programme to prevent injuries in youth football: Here’s another study that showed a reduced risk of injury when young athletes perform a warm-up.
Again, skip the stretching but perform a warm-up; I’ll touch on my warm-up recommendation at the end.
Stretching and Trigger Points:
I have even heard that massage therapists, trainers and other health care providers are telling their clients/patients that stretching reduces the risk of developing myofascial trigger points. There really is no evidence for this idea; I think the idea came from (erroneously) the Travell and Simons trigger point books. I further believe it came from this part of the books; Simons et al. Myofascial Pain and Dysfunction, pp127–135.
Travell and Simons’ well-documented “spray and stretch” method seems to be promoting stretching for the treatment and eradication of myofascial trigger points. The point of the vapocoolant spray is to “distract” the nervous system from the pain of stretching a muscle that is both dysfunctional and painful because it is riddled with trigger points. These book go on to further suggest (possibly true) that myofascial trigger points have both small patches of hypercontracted muscle fibers (trigger points) and long stretches of fibers that are overextended. Without the spray, muscles in this predicament may contract defensively if stretched. Interestingly, Travell and Simons do not recommend stretching trigger points without the spray.
Stretching and Pain (Soreness):
So, does stretching help to reduce soreness from activity and exercise? No.
I have seen many patients with myofascial pain, trigger points and other musculoskeletal pain syndromes; stretching is rarely something I recommend. Here is some evidence supporting my stance on the matter; at the end of this post, I will write about my recommendations for warming up and self mobilizations:
Stretching to prevent or reduce muscle soreness after exercise: Stretching does not reduce muscle soreness after exercise…. sorry.
Warm-up and Self-Mobilizations:
The common thread here is that static stretching does not decrease activity-related pain. What does? Well, a good warm up and some mobility exercises. Here are areas of your body that really need optimal movement and mobility:
- Thoracic spine
If you tend to have joints that are mobile or hypermobile…. you don’t need to worry about mobilizations and PLEASE DON’T STRETCH. How do you know which of these areas you need to focus on? Well, if you have a history of low back or knee pain; you should focus on your thoracic spine (upper back), hips and ankles. If you’ve had a lot of shoulder injuries or neck pain, focus on your thoracic spine, shoulder and hips. Stay tuned to my new website:
In the months to come, I will be posting both free and paid lessons on this topic and more.
Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
In a recent article, Chronic Pain Fuels Boom in Opioids, the issue of opioid use for pain has sky-rocketed. It’s an interesting and VERY relevant topic; and it’s not just about people taking these medication illegally. Addiction to opioid pain medication is just as much an issue in those who get their medications legally as in those who get them on the black market. Feel free to read the article, it really is a great read on the topic; I am not going to write about these issues. What I want to write about is, what happens when we over-treat pain and how could it potentially create a reward system in which we are conditioning ourselves to be in pain.
Let me explain, I’ll use opioid medication as an example. Most opioids work by connecting with receptors in the brain to simulate or release chemicals that reduce pain, often, these chemicals “reward” s for their efforts. What does this mean?
This reward system produces a scenario where we tend to be attracted to the stimulus (cause) of the reward; in this case, a squirt of dopamine. This means that we are literally rewarding ourselves for being in pain. Does this occur naturally….. yes, but not to the extent that opioids do it.
How does this translate to everything else we do for pain? Possibly the same way! I know, you’re reading this thinking, “…are you saying that I shouldn’t get chiropractic care, massage therapy, myofascial work, dry needling, acupuncture, and other treatments for pain? Are you telling me that taking anti-inflammatory medications and natural products, stretching, soaking in a hot tub and other things I can do to relieve pain are bad?”
Well, no, that’s not what I am saying. What I am saying is that maybe we have created a scenario where, by paying attention to every ache and pain and giving ourselves rewards (in the form of nice and/or therapeutic treatments) for that ache and/or pain, we have created MORE pain. We may be literally producing pain in our nervous systems at a level that’s higher than needed. This is pure clinical speculation but here’s an interesting observation; the incidence of painful conditions has risen site a bit over the last 20 years, especially in the last 10. Is this because there is a lack or deficiency in treatments to alleviate pain? No, on the contrary, there are more.
How Much Pain is OK? How much is too much?
- Is below an intensity of about 4 on a 0-10 scale
- Disappears shortly after beginning activity
- This would imply that movement is good for it, this is great.
- The morning pain should be mild, if it’s more, you need to see a doctor about it
What is pain?
Pain is an interpretation of a signal by our brain. Under normal conditions, it often tells us that there is the potential for damage of a tissue or tissues. This is not ALWAYS the case though; our brains can interpret non-damaging signals as pain and it often does. This is one of the most promising theories about the cause of chronic pain…. that our central nervous systems are creating pain when it shouldn’t.
In conclusion, pain, like any other signal in the body is just that, a signal, but that signal may be going off for the wrong reason. It is my heart-felt opinion that we need to connect to our bodies better so that we can know when a certain pain is normal and not a signal that we are damaging anything versus when a certain pain is a signal that we need help.
I will be addressing this topic in future posts and will be talking about movements and movement patterns you can do to determine if pain you are feeling is a normal part of being active or if it is a sign that it’s going to cause long-term issues with movement and possibly be a sign that certain tissues are being damaged.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Well, just a short post about an article by Leon Chaitow entitled: Breathing Pattern Disorders and Lumbopelvic pain and Dysfunction: An Update.
Those of you who have seen me in my Portland Oregon Chiropractic and Functional Movement Clinic, Optimum Function, or at my NCNM teaching clinic shift, may have wondered why I recommended breathing exercises as the first line of low back pain treatments; well, Dr. Chaitow will help explain it in his article.
Enjoy….. and take a few deep, belly-breaths today to honor your core and exercise your diaphragm.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
As a Chiropractor and educator in Portland, Oregon, I see patients with pain of all types and intensities; I also lecture on myofascial pain and mechanical pain (low back, shoulder, neck, etc.). A subject that recently came up with both my students, interns and colleagues is, how much pain is OK?
Can you answer this? How about your medical doctor, naturopath, chiropractor, physical therapist? I was playing devil’s advocate with some interns in my teaching shift at NCNM and I asked them,
“Should we be treating every little ache and pain our patients have and if so, is this teaching them to be hypersensitive?”
In addition, what impact does this have on their pain coping mechanisms, both internal and external? I believe it gives the message that any and all pain is bad and makes patients much more likely to overuse pain medications. There has been some speculation amongst researchers and clinicians (doctors and therapists) alike that we are conditioning ourselves to be in pain. By taking pain medication and other remedies every time we feel, even the slightest pain, we may be conditioning our nervous system to SENSE PAIN ALL THE TIME.
Now most know that in my Portland chiropractic, nutrition, myofascial therapies and functional movement clinic, Optimum Function, I often treat patients to improve function instead of treating pain. The simple fact is, we have to help patients with their pain because often, that is why they are coming in; the unanswered question is, how much is OK?
I have been training in Brazilian Jiu Jitsu (BJJ) in Portland at Straight Blast Gym for almost a year now and recently, been training harder . We have some fighters going to the worlds at the end of this month and our competition team has been going at it in practice. This past Friday, my back just couldn’t take the pace and today, it’s hard for me to move around, in fact, writing this is painful as sitting seems to be the offending position. Is this OK? Well, in my opinion, it is…. let me explain.
I overdid it, I kept playing in people’s guards and they kept trying to break down my posture, the is the game of BJJ. I should have known better, my back has been feeling tired after practices for 2 weeks, I should have modified my game. Now I am in pain, I didn’t damage anything, just some minor strains and sprains but in an area that is fairly crucial to functional movement and one that is affected by just about any position I put myself in. I have no doubt, that in 2-3 days, I will be back to 100%
Why am I writing this? Because I am planning on doing a more in-depth article series on the topic and will use this information to help educate my patients and students on this topic so we don’t over focus on normal, physiologically-beneficial pain.
Stay Tuned…. feel free to leave a comment, maybe I’ll use it in the articles to come on this topic.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
OK, for the last 12 years, I have been learning and applying fascial techniques, myofascial release, Fascial Manipulation©, trigger point dry needling, chiropractic adjusting and mobilization, instrument-assisted soft tissue techniques (like Graston© therapy) and more in unique ways to restore movement, stability and dynamic physical health.
This year (2012), I am dedicating my clinical practice to further develop a system to use these myofascial techniques and more and will work on developing a curriculum to teach this system so no matter what fascial technique you use, you can use them more efficiently and effectively. I have decided to call it Fascial-Applied Soft-Tissue TherapySM or F.A.S.T. TherapySM.
In fact, I am in the process of developing an adjunct tool to be utilized for various fascial therapies. I have been developing this tool for a while and it is going to blow the doors off of everything else out there….. stay tuned for F.A.S.T. TherapySM and the F.A.S.T. Therapy ToolSMYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
In a recent article published in the Journal of Manual and Manipulative Therapy by Jan Dommerholt entitled, Dry Needling: Peripheral and Central Considerations, Dr. Dommerholt discusses some updated theories and ideas as to the mechanism behind the benefits of dry needling (DN) and other related topics. Dr. Dommerholt has his doctorate in physical therapy and is one of the world-experts in the field of DN with regards to myofascial pain.
Over the last 10-20 years, DN has grown in popularity among chiropractors, physical therapists, naturopaths, acupuncturists and medical doctors. The indications for the use of DN vary by profession but most include some sort of myofascial disturbance. These myofascial disturbances or lesions often lead to aberrant biomechanical forces being transmitted through the neuromusculoskeletal system which can lead to further damage and injury. In addition to treating these structural lesions, DN also works on pain mechanisms mediated by the central and/or peripheral nervous systems.
In his paper, Dommerholt addresses the various models used to explain how myofascial lesions affect the entire neuromusculoskeletal system. One model, the pain-spasm-pain cycle, often referred to as “the vicious cycle” has not stood the test of time and research, as such, other models have since surpassed it. The pain-adaptation model is another model that suggests muscle pain from trigger points and other myofascial lesions lead to a cascade of antagonist activation which leads to an overall decrease in motor function. Neither of these models explains the role of myofascial lesions in neuromusculoskeletal pain and dysfunction. Later in the paper, Dommerholt discusses Hodges and Tucker recently proposed a new motor adaptation theory. This theory, although not specifically referring to myofascial trigger points or lesions, best represents what occurs when muscle pain causes a redistribution of activity within and between muscles leading to overall biomechanical dysfunction.
Dommerholt discusses the various schools of approach for DN, including, Yun Tao Ma’s approach, Gunn’s approach and Dommerholt and Huijbregts’ approach, this discussion is an interesting one and helps to explain why there may be some confusion as to exactly what Dry needling is and what it treats. The next couple of pages are devoted to an excellent and clinically-relevant discussion on the physiology behind active and latent trigger points. For a more comprehensive discussion on this topic, I suggest getting Dommerholt and Huijbregts’ book entitled, Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management (Contemporary Issues in Physical Therapy and Rehabilitation Medicine)
The section on muscle pain is quite interesting and what I would refer to as a concise summary of information pioneered by Mense and Gerwin in their books Muscle Pain: Understanding the Mechanisms and Muscle Pain: Diagnosis and Treatment . The section on central sensitization as a result of myofascial trigger points is another wonderful summary on this topic. The neurophysiology behind central sensitization, while complex, is clinically-relevant and a topic that all clinicians dealing with pain should understand. DN can disrupt this process, presumably through disrupting the neurochemical links developed during sensitization, effectively breaking the cycle.
The concept that Dommerholt seems to challenge is that trigger points are solely a peripheral problem. In this paper, he does an excellent job of presenting research to the contrary and how DN not only works to treat the peripheral neuromusculoskeletal system but acts on the central nervous system too. The implications of this evidence is broad and may explain why those with peripheral (local) myofascial lesions like trigger points receive both local and system wide benefits from the application of DN. This may help to explain why there is a good deal of variability in the DN approaches as discussed in the beginning of the paper.
In addition to all this great information, Dommerholt tackles the subject of Acupuncture and Dry Needling. This is a topic that is germane to current discussions and legal feuds here in Oregon. DN is a technique that should be in the scope of practice for physical therapists and chiropractors who diagnose and/or treat myofascial trigger point on a daily basis. The acupuncture community and chiropractic community are at odds right now in the Oregon legislature about this topic. Dommerholt tackles this task with ease and grace, presenting a cogent discussion that concludes with the idea that DN is yet another tool to treat myofascial trigger points and should be within the scope of practice for physical therapists, chiropractors and acupuncturists.
In the summary section, Dommerholt pulls it all together in a way that my writings would not do it justice; here are quotes from his summary:
“Dry needling or trigger point inactivation rarely is a stand-alone kind of intervention and is just one aspect of a comprehensive manual physical therapy approach.”
“Dry needling is not solely in the scope of any one particular discipline. Overlap in scope of practice is not only inevitable; it may even be desirable to best meet the needs of patients. Dry needling is an easy to learn technique in the hands of qualified health care providers.”
“In this review, we have postulated that dry needling is a potent therapeutic measure to remove a constant source of peripheral nociceptive input originating from myofascial trigger points. As such, dry needling does not replace other manual physical therapy technique, but may be useful in facilitating a rapid reduction of pain and a return to function. A thorough understanding of the role of trigger points in peripheral and central sensitization is important in manual physical therapy practice. Trigger points can be inactivated with manual techniques and joint manipulations, but dry needling may be a more efficient and quicker method.”
Reference: Dommerholt, Jan, PT, DPT, MPS, DAAPM; Dry Needling: Peripheral and Central Considerations; Journal of Manual and Manipulative Therapy 2011, Vol.19 No.4; pgs 223-237Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health