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Sometimes, human muscles can collect in taut bands that become tender and immobile, radiating pain throughout the body.
They’re called trigger points, and sometimes they result from acute trauma or continued strain. As the modern workforce has taken to hunching over computer screens for eight hours a day or more, many people develop painful trigger points in their necks and backs.
One way to heal those muscles, according to Nick Hopson, is by damaging the tight ball of muscle with a needle.
“It’s been encapsulated and nothing’s moving, so you’re trying to break that trigger point up so blood comes in,” said Hopson, a physical therapist with Sheltering Arms Physical Rehabilitation Centers. “Blood is what heals the body.”
The practice is called dry needling, and although Hopson has been doing it at area Sheltering Arms locations since 2010, it’s still a fairly new technique within the field of physical therapy, growing in popularity only in the past decade or so.
“I’ve had some patients with acute pain, and I’ve treated them once or twice and their pain never comes back,” Hopson said.
“And then I have my chronic pain people where after multiple treatments we can get them to a good stopping point, where they won’t have flare-ups for a year or so. I’m very happy with that. It all just depends on the patient.”
Alternative pain management tools are becoming increasingly indispensable as providers start shifting away from prescribing opioids, powerful and highly addictive painkilling drugs.
Virginia’s ongoing opioid epidemic resulted in 822 overdose deaths in the first nine months of 2016, from both prescription and illicit opioids such as heroin.
Earlier this month, the state’s Board of Medicine implemented new regulations for providers, encouraging them to use alternate pain management methods before jumping to opioids as the best option for their patients.
“Most of my patients will know within the first couple of treatments whether or not (dry needling) is going to be a viable option for them,” Hopson said. “I tell them, this isn’t a miracle. It’s not a cure for everything, but it’s a different tool in our box that we can use.”
Richmond resident Tabitha Pitts has experienced enough concussions in her life that she knows almost immediately if she’s suffered one after a head injury.
“I immediately become tearful and confused and am not able to make decisions for myself,” she said.
She is a recreational therapist, which means she rehabilitates patients not only physically but through activities that can engage them mentally and emotionally as well.
She frequently participates in recreational sports and has experienced multiple concussions.
In December 2015, it happened again: Pitts, 32, got hit in the head with a kickball, and knew right away it was a concussion.
For a year, she worked with her physical therapist to restore her daily living skills and to address the intense pain she was feeling in her neck and back.
“They put me on muscle relaxers, I was on pain killers, we did injections — I tried several modalities and nothing would help the pain,” Pitts said.
Then in December, she tried dry needling for the first time. As soon as her therapist inserted the needle, her muscles started to relax.
“It was miraculous,” she said. “I was like, is this what normal people feel like?”
Her second experience was even more dramatic. She had a tension headache, and once half of the needles were inserted into her neck and upper back, it was gone.
“I never experienced that kind of pain relief,” Pitts said.
Hopson said that placing the needles in the trigger points can cause pain, but everybody responds differently.
Some patients consider the pain therapeutic and love the way it feels, others are indifferent, and still others find it very painful, so he typically reassesses their viability for it.
New research has shown dry needling can be used in other ways than just relieving trigger points, according to Hopson.
It can relieve pain in connective tissues, addressing problems like tennis elbow, as well.
“It’s the same idea; you’re creating localized bleeding so it’s allowing the blood to come in and heal it,” he said.
It can also be used to treat sciatica, when the patient is experiencing pain in their back that radiates down their legs. Hopson said the needles can follow the sciatic nerve and bring blood into it.
The ultimate goal of dry needling is to return blood flow to areas of the body where it is supposed to go.
“It’s kind of like hitting the reset button; that’s what we’re trying to do,” Hopson said.
Although only those familiar with physical therapy may know about dry needling, most have heard of a similar practice that’s been around for more than 2,000 years: acupuncture.
“They both use similar techniques,” Hopson said. “They both use thin, solid needles. It’s just that the reason for using them is different.”
Acupuncture is based on lines of energy running through the body called meridians. So if someone has neck pain, the practitioner might put a needle in the leg if it’s on the same meridian as the pain.
Dry needling, by contrast, is based on modern anatomy. If someone is complaining of neck pain, Hopson’s needles will not stray too far from the neck when trying to find and heal trigger points.
Physical therapists have been allowed to do dry needling in Virginia since at least 2010, when the state’s Board of Physical Therapy updated its regulations and stated that the practice is within the scope of the practice of physical therapy.
In its guidance, the board stipulates that dry needling should not be confused with acupuncture, and states that, “A complete acupuncture treatment might yield a holistic benefit not available through a limited dry needling treatment.”
The same is not true in all states, though.
Angela Shuman, director of state affairs with the American Physical Therapy Association, said that while 34 states allow physical therapists to perform dry needling, it is contested in some states, such as Hawaii and North Carolina.
“It’s a matter of the wording of interpretations of the physical therapy practice acts, and because this is something that has evolved over time, back when those practice acts were written they may not have envisioned the inclusion of needles (in physical therapy),” Shuman said.
Physical therapy practice acts dictate what therapists are legally allowed to do under their licenses in specific states.
Hawaii’s practice act specifically prohibits puncturing the skin in acupuncture, but in other instances Shuman said the American Physical Therapy Association believes states have misinterpreted the acts.
In North Carolina, acupuncturists have challenged the ability of physical therapists to provide dry needling to patients, claiming it is a variation of acupuncture that should be done by a licensed acupuncturist, but dry needling is currently still allowed there.
Virginia requires that physical therapists practicing dry needling receive a prescription from the patient’s physician.
When Hopson started the practice in 2010, his biggest challenge was just educating physicians about dry needling after sending them a prescription to sign.
He was inspired to pursue the practice after dealing with more and more patients with chronic pain, and other physical therapy techniques weren’t solving their problems.
“They kept saying, ‘It feels like it’s deeper than that,’” Hopson said.
For patients like Pitts, one of the appeals of dry needling was its ability to ease her pain without using medication.
“I tried to really limit (taking pain killers), but it was painful not using them,” she said.
“I would definitely recommend (dry needling) to other people who aren’t into medications or putting things in their bodies. I think if people are desperate and they’re experiencing chronic pain, it’s worth trying.”
Photo: Joe Mahoney/Times-Dispatch. Sheltering Arms therapist Nick Hopson, (PT,DPT,Cert. DN) displays the needle used in the dry needle pain treatment program.