What are the differences between dry needling and acupuncture?

Dry needling and acupuncture are similar in that they both involve the insertion of thin needles into the skin for therapeutic purposes.

However, there are some key differences between the two practices:

Training and background

Dry needling is typically performed by physiotherapists, who have received specific training in the technique. Acupuncture is typically performed by acupuncturists, who have received extensive training in traditional Chinese medicine.

Theory and philosophy

Dry needling is based on Western medical principles and is used to treat specific musculoskeletal conditions. Acupuncture is based on traditional Chinese medicine principles and is used to restore balance to the body's natural energy flow.

Needle insertion

Dry needling involves inserting needles into specific trigger points in the muscle to relieve pain and improve function. Acupuncture involves inserting needles into specific points on the body's energy meridians to restore balance and promote healing.

Length of treatment

Dry needling sessions are usually shorter in duration compared to acupuncture sessions.

Summary

Dry needling and acupuncture are two different practices that involve the use of needles for therapeutic purposes.

Dry needling is based on Western medical principles and is used to treat specific musculoskeletal conditions, while acupuncture is based on traditional Chinese medicine principles and is used to restore balance to the body's natural energy flow.

Is it worth foam rolling your ITB?

If you walk into any gym, you may see someone sadistically foam rolling their ITB, making all sorts of interesting faces.

The ITB, if you are unsure, stands for Ilio-Tibial Band - that is the long fibrous tissue that runs from the hip down to the knee along the outside of your thigh (see pic below).

An irritated ITB can lead to pain and inflammation in the outside of the knee, especially in runners and cyclists. If not addressed early, this can lead to ongoing pain and can be tricky to manage.

To roll or not to roll?

Recently there has been a lot of noise being made about the fact that regular foam rolling and stretching doesn’t physically change the ITB at all.

Some researchers point out that it is impossible to ‘release’ your ITB with a foam roller because it takes thousands of kilograms of pressure to change it.

Proponents for the foam roller say that it helps keep the tightness under control and prevents runner’s knee.

Who is right?

Well yes the ITB is made from very tense connective tissue are it probably doesn’t change all that much. And I’d definitely agree you can easily stir things up if you are constantly and aggressively rolling.

And you don’t want to have super loose ITB’s either - having strong and resilient ITB’s are an important part strong and efficient running form.

Ideally, you want to have them ‘in-tune’ like a musical instrument - not too tight or too loose.

What is really happening when you roll?

While it is hard to say for sure, I suspect most of the benefits from foam rolling are coming from what lies directly under the ITB. Here you’ll find one of the quad muscles called the Vastus Lateralis (see diagram below).

The ITB sits directly on top of the Vastus Lateralis

When you look at the above picture, you could easily believe that the ITB is the main player on the outside of the thigh.

However, on closer inspection, the diagram below gives a much more accurate picture, showing the relative density of the ITB compared with the huge Vastus Lateralis (VL) on the left of the picture.

Cross section area: ITB vs VL (Vastus Lateralis)

As you can see, while the ITB gets all the attention, the vastus lateralis has a huge cross sectional area and is the real workhorse of the leg.

The vastus lateralis muscles tend to become overloaded with lots of downhill running, squats and lunges.

Some muscles in the body due to their anatomy and location, are impossible to stretch effectively. The vastus lateralis is one of them.

Over time, one of the most common causes of pain on the outer side of the knee is from a build-up of tightness in the vastus lateralis (see trigger point referral patterns below).

So learning how to maintain flexibility by foam rolling in this area is hugely important to keep your knee and hip joints moving well.

How to foam roll the Vastus Lateralis:

Benefits to foam rolling the ITB/vastus lateralis:

• improved short term flexibility and blood flow

• releasing the muscles under the ITB (Vastus lateralis)

• stimulate the para-sympathetic system to activate the healing and recovery process

• connecting with your body and bringing awareness to any overly sensitive or tight areas
  

Things to keep in mind:

• avoid rolling directly over the outside of the knee and hip joints

• should never feel more then 5/10 pain. Regulate the pressure by using your upper body and core if needed. In the words of John Rusin, “Stop mindlessly foam roll like a jackass.”

• if you’re getting ongoing tightness, you need to get to the root cause! Consider contributing factors such as shoe wear (time for a new pair?), training habits, too many hills, inadequate glute strength and capacity, inadequate carbohydrates before and during your run, inadequate protein for recovery

• don’t bother trying to actually stretch the ITB - it’s anatomy is too complex to get an effective stretch

When to roll:

• if you have extremely tight leg muscles, you can roll gently before you exercise (30-60 secs max)

• the best time to roll is after you have finished exercising, when the muscles are warmed up

Conclusion:

• above all listen to your own body - if it feels good to you, then keep foam rolling your ITB and outer quads

• don’t spend too long foam rolling (2-3 mins total time to roll the major muscle groups) after you exercise is enough, with perhaps one longer stretching session per week

• an even more effective approach, target the vastus lateralis with the foam roller by rotating 45 degrees onto your front, and slowly bend and straighten your knee as you roll

• if you’re getting ongoing tightness and pain in the ITB, seek professional help with a Physiotherapist to help identify contributing factors

Questions?

Please leave a comment below…

More from the blog:

Get To Know Your Muscles: Upper Trapezius

Get To Know Your Muscles: Upper Trapezius

Upper trapezius trigger points are the primary muscles responsible for neck pain and headaches. The upper traps are also the most reactive muscles in your body to emotional stress.

This blog post discusses:

• how the traps gets overloaded

• symptoms of an overloaded upper traps

• self-care tips

• how Physio can help

QUICK ANATOMY REVIEW:

The traps is the most superficial muscle of the upper back and runs from the base of your skull, along to the tip of your shoulder, all the way down to the middle of your back, (see image below).

FUNCTION OF THE TRAPS:

The trapezius muscle consists of three parts that all have different functions:

• upper part helps raise the shoulder

• middle fibers retracts the scapula

• lower fibers lower the scapula

This blog post will focus on the upper traps.

HOW TRAPS BECOMES OVERLOADED:

The traps can become overloaded from the following situations:

• excessive sitting / computer use

• whiplash (car accident, falling on your head, or any sudden jerk of the head)

• tensing your shoulders

• constantly pulling the shoulders down attempting to have a ‘good posture’

• carrying small children around a lot

• sitting with a chair without armrests, or the armrests are too high

• extended car trips

• looking down constantly at your phone

• any profession or activity that requires you to look down for extended periods (i.e.. dentists/hygienists, architects/draftsmen, and secretaries/computer users)

• bra straps that are too tight (either the shoulder straps or the torso strap)

• a hand-bag or backpack that is too heavy

• anxiety

• recent surgery

• unresolved emotional trauma e.g. PTSD

SYMPTOMS:

The upper traps has an interesting referral pattern, as shown in red in the diagram below.

The upper traps is often the ‘key’ muscle that can trigger other areas such as jaw pain and headaches.

Symptoms of upper traps over-load include:

Upper Traps Referral Pattern (areas marked in red).

• severe neck pain

• a stiff neck

• facial, temple, or jaw pain

• pain behind the eye

• headaches on the temples / "tension" headaches

• dizziness or vertigo (in conjunction with the sternocleidomastoid muscle)

• intolerance to weight on your shoulders

• sinus pain
  
  
  
  

TREATMENT APPROACH:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your traps issue.

Some common manual therapy treatment approaches can include:

• joint mobilisation to the neck and upper back

• dry needling and massage to the traps to stimulate deep blood flow and release the tightness

• addressing any biomechanical issues with stretching, strengthening and foam rolling

SELF-CARE TIPS

• avoid extended periods of sitting

• Think about ‘time in the posture’ vs trying to find a perfect posture e.g. have a short break every 20 minutes

• consider a standing desk

• avoid constantly looking down at your phone

• apply heat to the traps 10 minutes each day to encourage blood flow

• ensure you are getting enough cardio-vascular exercise each day (30 mins minimum)

• take regular breaks on long car trips and consider using a pillow or support under your arm to take the strain off the traps

• learn to breathe through your diaphragm and manage your stress

• Wear bras that fit properly

• If you suffer with anxiety, seek help through your GP or a take a free online course

Some of the following exercises you may find useful:

Pecs stretch - feel the stretch at the front of the shoulder and hold 30 secs

Thoracic foam roller - release your upper back with a few rolls up and down

Upper traps stretch - hold gently 10-15 secs

Diaphragm breathing with legs at 90/90 - helps calm your nervous system

Building capacity in the upper body

Constantly focusing on relaxing and releasing the upper traps can be counter-productive because it isn’t always getting to the root cause.

Focusing on the pain and tightness can keep your body stuck in the ‘zone of stress’ (see picture below).

The only way to get better in the long term, is to gradually start building your physical capacity with a personalised program, so you can create a ‘zone of relaxation’ where you have the capacity to handle all of your daily life without the muscles becoming overloaded.

The trick is to build up gradually - step by step. As soon as you push too far you risk re-activating the tightness by over-loading the muscle.

In the beginning it is best to be conservative.

As your work with your body more, you will get to know and respect your bodies limits.

Some of the exercises you could include would be:

• push-ups

• bicep curls

• triceps

• bent over row

• lat pull downs

• core work

• increasing cardio fitness

Acknowledging underlying emotional issues in chronic pain

When your neck symptoms are chronic, one of the most concerning things is the ongoing pain, which can sometimes go on for months or years, despite seeing multiple health care practitioners and trying different medications.

Understandably, this can create a lot of fear and anxiety about the underlying cause of the symptoms which can keep you in a state of fight or flight (see picture below).

For some people, when they experience pain or injury it may be associated with anxiety and catastrophizing about the pain, like for example whether or not it will ever go away and if it will get worse if they move too much.

Some people become fearful of exercising and being active (known as ‘fear avoidance behaviour' and 'kinesiophobia') and might rely solely on passive treatment and resting, which can have some adverse effects and may lead to decreased function and a lower load threshold which could result in more pain.

As you can imagine, a downward spiral of fear, lack of movement, weakness and de-conditioning can result (see picture below) and become very difficult to break.

Examples of factors that may contribute to dysfunction in the upper trapezius Reference

You are not your scan !

Often there have been some scans showing some damage to a structure such as a disc or nerve issue.

Injuries and structural issues certainly do cause pain initially.

Unfortunately, sometimes the patient is not given a broader context in which to interpret the significance of the results.

The body has a tremendous capacity to heal, and generally tissue damage takes no more than six to twelve months to occur.

If you are still getting pain after this time (and you have been thoroughly investigated by your health care team), your pain is more likely to be coming from a sensitized nervous system (see picture below) than an damaged structural fault.

Maybe the most important picture to understand if you’ve had pain lasting more than six months.

Pain that lasts more than six months is generally related to an overly sensitive nervous system rather than a specific issue in the tissues

(Picture credit: Explain Pain - Butler & Mosely)

One thing is very clear with the recent research is that you can have structural abnormality and have no pain whatsoever (see picture below).

Degeneration, disc issues and arthritis are very common in asymptomatic individuals (i.e. who have no pain - see picture below).

Reference: Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 2015 Mar 15;40(6):392–8

The ongoing nature of the pain is more often to do with tight muscles with restricted and oxygen blood flow.

Just understanding this process can go along way to resolving your ongoing pain issues, but you will need an experienced GP and Physio to work with to help you diagnose and get you back on the fast track.

Get relief from your neck pain or headaches

We have a special interest in helping people overcome their neck pain / headaches and get back to what they love.

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813

Psoas - Get To Know Your Muscles

Psoas - Get To Know Your Muscles

QUICK ANATOMY REVIEW:

The psoas (pronounced ‘so-az’) is one of the deepest core muscles in the body.

As you can see in the picture below, the psoas is a long muscle, attaching above to the upper part of the lower back as well as the intervertebral discs.

It then travels down through the abdomen and attaches to the inner part of the hip, making it one of only two muscles that attaches the spine to the lower limb.

FUNCTION:

The psoas has a number of diverse functions, making it a key factor in health.

There is still some controversy concerning it’s exact role in the body.

The psoas is partly a hip flexor - that helps bend your hip when you walk and run.

It also has an important role in stabilising the lower back and posteriorly tilts the pelvis.

HOW PSOAS BECOMES OVERLOADED:

The psoas can become tight from spending extended periods of time in the following positions:

• sitting

• sleeping in the fetal position

• standing with a swayed back and wearing high heels too often

• sitting in a kayak/canoe

The psoas becomes overloaded with repeated use in the following situations:

• driving

• kicking

• cycling

• excessive sit-ups

Visceral pain

As it passes through, and has some attachments to the internal organs, the psoas can also be activated when there is irritation internally, (in particular the colon).

Stress

The psoas tends to tighten in response to general life stress (activated during the fight / flight response). Think of the fetal position protective response - that is the psoas causing your spine to contract.

SYMPTOMS:

The psoas is known as the ‘Hidden Prankster’ due to it being responsible for a lot of lower back pain (especially related to disc pain), without many people being aware of it.

Pain from a tight psoas muscle may be projected in a vertical direction in a ‘gutter’ along either side of the lowerback as well as to the sacroiliac region and buttock (see red areas marked below).

Pain may be felt during sitting and walking.

Overload of the psoas can also lead to pain and tightness in the front of the hip. 

TREATMENT APPROACH:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your psoas issue.

Some common manual therapy treatment approaches include:

• joint mobilisation to the lower back

• dry needling to the psoas insertion point in the hip and upper attachment point in the back

• deep tissue and manual myofascial release on the mid-section of the muscle (pictured below). It is very difficult muscle to dry needle direclty due to its deep location and proximity to major organs.

SELF-CARE TIPS

• avoid extended periods of sitting. Think about ‘time in the posture’ vs trying to find a perfect posture

• consider a standing desk

• avoid walking and jogging uphills and on sloped surfaces in the short-term

• apply heat to the front of abdomen 10 minutes each day

• sleep on side with pillow between knees, avoiding the fetal position with the hip flexed right up

• use cruise control on long car trips to stretch the legs

• learn to breathe through your diaphragm and manage your stress

  Some of the following exercises you may find useful:

Psoas stretch - gently ease into it tucking the pelvis under as you lean forward (Picture credit: Fiona Melder Photography)

Bridge stretch - tuck your pelvis, squeeze your glutes but don’t overarch your back. Breathe! (Picture credit: Fiona Melder Photography)

Diaphragm breathing

As the psoas attaches to the diaphragm, when you breathe deeply you will naturally help decompress the psoas.

You can do this by putting your hands on the outside of your lower rib cage.

As you breathe in, expand the ribs from the sides, front and back - 360 degrees.

Aim for five seconds breathe in and five seconds breathe out for 1 minute.

Building capacity in the Psoas

Weakness in the psoas causes decreased ability to flex the hip joint.

It’s really important for runners to have adequate capacity in the psoas.

Try this marching exercise below with a theraloop to help build some capacity in your hip flexors.

Need some help with your lower back or hip pain?

We have a special interest in helping people overcome their pain and get back to what they love.

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813

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Get To Know Your Muscles: Latissimus Dorsi

What are the lats?

If you’ve ever experienced ongoing upper back or neck pain / stiffness there’s a fairly chance you’ve had some issues with your lats.

The lats are the biggest (and most interesting) muscle in the upper body, as they have attachments to the upper and lower back, the front of the shoulder and have nerve supply from the neck, so they have a huge influence on your overall posture and spinal movement.

The anatomy of the Lats - they are like the ‘wings’ of our body

What are the symptoms of tight lats?

Surprisingly, tight lats can contribute to poor posture, as they connect your upper back to the front of your shoulder, causing you to adopt a rounded shoulders position.

Often we think of needing to strengthen the lats for good posture, but they can actually pull the shoulders too far down and rotate them forward when imbalanced.

When overly tight, the lats produce pain in the mid-upper back between the shoulder blades.

The pain can be felt as an constant, annoying ongoing upper back ache, that in generally unresponsive to stretching or change of position.

The pain doesn’t normally kick in until the there is significant tightness in the lat muscle, that generally has built up over many months or years, due to repetitive movement patterns or poor posture.

The person with ongoing upper back or neck pain often has tried various unsuccessful treatment methods applied directly to the area of referred pain rather than to its source (in the muscle itself).

Referred pain may also extend down the back of the shoulder and down the inside of the arm (see picture above).

How the lats get tight:

• poor posture (sitting or driving a lot)

• going too hard at the gym e.g. lat pull down machine, chin ups

• over many years of swimming , pulling through the water in freestyle

• rock-climbing

• gardening - pressing down to twist out weeds

• cycling - gripping on too tightly on the handlebars

• driving a car with no power steering

• wearing tight bras that compress over the muscle

• repetitively pulling down with the hands from overhead position

Tight lats - quick assessment:

An assessment from an experienced Physiotherapist would be the most reliable to determine if you have over-active lat muscles.

A quick test you can do yourself is a squat with your arms overhead. Try and squat as deep as you can, keeping your heels on the ground. If you can keep your arms upright your lats are probably ok (pic a), but if they drop forward or your feel stiffness in your back (pic b), you most likely have a lat issue.

Pic a = Good squat - arms stay upright and parallel with shins

Pic b = Tight lats and upper back - unable to keep arms upright in line with shins

How Physiotherapy Can Help:

• perform a movement screening to identify the contributing factors

• perform dry needling to the lat muscles to provide a fast, effective release

• provided a personalised exercise program to maintain mobility and balance in the muscles

Stretches to help keep your lats mobile:

Lats stretch

Sit your hips back towards your ankles with your arms on the roller. Breathe in through the nose and expand the lower ribs. As you breathe out, gently sit the hips back further and lengthen the arms away. You should feel a nice stretch though the back of the shoulders and lower back.

Try 30 seconds straight ahead and then 30 seconds on each side. To stretch the left side. push the hips back to the left with the arms on the right side of the foam roller.

Lats Trigger Point Release

Lie on your side and roll up and down along the outer part of your shoulder blade. If you feel a sensitive spot, breathe and hold the pressure for around 30-60 seconds until the trigger point releases.

Tips to keep your lats working well:

• gradually increase your weights at the gym, don’t try and do too much too soon

• if you are a swimmer, incorporate regular stretching to maintain the flexibility

• if you are an office worker, try a standing stretch by reaching up to the ceiling and bending to the side (the Merv Hughes Stretch)

If you still experience pain in your lats, shoulder, neck, arms or thoracic spine then come in for an assessment and treatment with your Kinfolk Adelaide Physiotherapist.