Friday, June 2, 2023

Dry Needling For Tennis Elbow

How Can Ims Dry Needling Help Reduce Tennis Elbow Pain

Dry Needling Tennis Elbow

As you probably already know, tennis elbow feels like a pain in the muscles/tendon at the side of the elbow. If we palpate these muscles deeply, or exert , we can often reproduce pain.

While you may find relief simply by inserting and removing the needle, the most effective points will be those points that stimulate a twitch in the muscle, upon insertion. Sometimes it takes a bit of work to find these exact points.

Twitchy muscles are generally the most dysfunctional, or unhealthy bands of muscle. Whats more, if we insert the needle and theres no twitch, it suggests your muscles are relatively healthy. In this way, IMS can sometimes provide some diagnostic value as well. An experienced clinician will be able to tell you if the level of twitch youre experiencing is unusual for the muscle in question, and thus, sometimes we can interpret whether we really need to be concerned about the muscles as your pain generator, or look elsewhere for the cause of your problem.

The Causes Of Tennis Elbow

This type of problem can occur at any age, but is most common between the ages of 35 and 50. Predictably, it is more common in your dominant arm but can affect both. The biggest misconception about this type of elbow pain is you dont have to be a tennis player to get this condition. In fact it is just as common in people who repetitively overuse their forearm muscles such as office workers or tradespeople.

Referred PainA huge contributing factor to this condition which can be easily forgotten is referred pain from the neck or shoulder. This can either mimic symptoms of tennis elbow, or most commonly there is a combination of elbow and neck, shoulder or thoracic spine issues. You will need to have a thorough examination by a physiotherapist to determine if you have any referred pain from your neck and shoulder or if your elbow pain is isolated. This will assist in a more direct approach to your problem and a speedier recovery.

How The Electrical Stimulation Machine Works

The machine I use is a high quality one made by hand in California. The brand name Pantheon Research, out of Marina Del Ray.

Its powered by 12v battery, and there are four electrical leads with alligator clips at the end. I attach one clip exactly to the belly of the intended muscle, and/or to the trigger point that is painful. Then the other clip follows the legnth of that muscle and may get inserted, for example, in the case of tennis elbow, right into the tendon as it attaches to the lateral epicondyle of the elbow. That is often where you perceive the pain, right at the bone. That is technically called Periostitis, which is inflamation of the surface of the bone, the Periosteum.

Electrical Pulse Waves

Now the target tissues of your body are receiving beneficial electrical pulse waves. These pulse waves send pleasurable sensations to the very part of the brain that has been registering pain sensations. It competes for bandwith, as it were..

The other thing is that the way our muscles work is via our own biochemically created electrical waves. That is why to test muscles and nerves neurologists use EMG machines, electromyograph machines. But those machinese are diagnostic, and painful, whereas the Estim machinese are therapeutic, and not painfuf.

Adjusting the Electrical Stimulation to the Individual

Three Ways to Adjust the Estim

  • You can adjust the strength or amplitude of the electrical pulse.
  • Vary the amount of time the eStim is applied.
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    Trigger Point Dry Needling

    Dry Needling is a physical therapy modality used in conjunction with other interventions to treat myofascial pain and dysfunction caused by trigger points. Myofascial trigger points are defined as hyperirritable nodules located within a taut band of skeletal muscle . Palpation of a MTrP produces local pain and sensitivity, as well as diffuse and referred pain patterns away from the affected area. Painful MTrPs activate muscle nociceptors that, upon sustained noxious stimulation, initiate motor and sensory changes in the peripheral and central nervous systems. .

    Trigger point dry needling can be used to achieve one of three objectives. First, trigger point dry needling can confirm a clinic diagnosis by relieving the patients pain or symptoms of nerve entrapment. Second, inactivation of a MTrP by needling can rapidly eliminate pain in an acute pain condition. Third, inactivation of the MTrP through needling can relax the taut band for hours or days in order to facilitate other therapeutic approaches such as physical therapy and self stretching .

    Tennis Elbow Dry Needling

    Dry Needling For Tennis Elbow

    Dry Needling for Elbow Pain

    You play golf and your elbow hurts. You play tennis and your elbow hurts. Youre at the gym doing push-ups and your elbow hurts. Gardening? Elbow hurts. Computer? Elbow hurts. The list goes on. You may say to yourself, I dont remember injuring my elbow.

    Youre probably right. You may not have ever injured your elbow directly, so why is it suddenly painful?

    Most of us are aware of what Middle Child Syndrome is and how it can cause that child to play up. The middle child is more often than not blamed for everything that goes wrong, but is rarely ever to blame. It is usually the older and or younger children that create the drama, but the poor middle child gets the blame anyway. Yes, you have it right, your elbow is your middle child and the wrist and shoulder are your younger and older brothers and sisters causing you grief.

    The majority of your wrist muscles also attach to your elbow.The relationship between your elbow and your shoulder is somewhat different though. Your shoulder muscles dont attach to your elbow. However, your shoulder joint movements can affect your elbow joint. If you swing your golf club or tennis racket and your shoulders are not aligned correctly or you do not follow through with the swing properly, then your elbow will take the majority of force from the contact as an over-compensatory reaction.

    This tension or death gripping, in these particular movements , will have consequences that lead to a painful elbow.

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    What Is Dry Needling

    Dry needling is a safe and effective technique for treating muscular pain and myofascial dysfunction. It is a newer technique and is effective in ridding muscles of trigger points , which are believed to cause dysfunction and pain.

    While similar, dry needling is not acupuncture but instead uses small fine filament needles to effect change in pathological tissue, adhesions, scar tissue, or trigger points. Inserting the needles into muscles, tendons, ligaments, or joints alters the physiology and the chemistry by causing a micro lesion that stimulates the body to heal itself. From a physiological standpoint, it improves circulation, reduces any restriction that may be present, and normalizes the inflammatory response, which ultimately helps reduce pain.

    Our Dry Needling Process

    When you make an appointment with us, youll be seen by a licensed therapist who is certified in dry needling. They will go over any questions and concerns you have about the procedure so there arent any surprises when we get started. They will treat the area with acupuncture needles that penetrate under your skin but do not go into any muscles or organs themselves. These sterile stainless-steel needles have been treated so that they wont cause infection, and youll feel little to no pain as they are inserted.

    Generally, most patients can experience a noticeable improvement in their symptoms within one to two days after dry needling therapy.

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    Does Trigger Point Dry Needling Help With Tennis Elbow

    The question, of course, is whether this Myofascial Trigger Point Dry Needling approach to treating Tennis and Golfers Elbow actually works.

    There are a few studies, but not a lot to go on yet. According to this paper, published in International Orthopaedics:

    RESULT: dry needling was significantly more effective than the first-line treatment at six months.

    CONCLUSION: Because of the low complication rate, dry needling is a safe method, and it might be an effective treatment option for LE

    International Orthopaedics August 2017 DOI: 10.1007/s00264-017-3604-1

    I cant help but think that from my perspective ANYTHING including doing NOTHING at all and just leaving it alone would produce a better outcome at 6 months that the standard, first-line treatment of anti-inflammatory drugs, icing, and bracing not to mention Cortisone Shots!!

    These inflammation-chasing, immobilizing and cooling / circulation-reducing treatments do more harm than good and slow the healing process, from what I can see.

    And the average rate of recovery is all over the map, with no meaningful healing time!

    For more on the standard approach, see my Tennis Elbow Treatment Page:

    I also have to point out a problem I often observe in many of these studies: They are rarely double-blind, placebo-controlled.

    Or you seek out the help of someone trained in them.

    What Are Autologous Blood Injections

    Dry Needling for Tennis Elbow

    Autologous blood injection draws a small volume of venous blood from the patient and then re-injects it in and around the tendon origin. ABI is a treatment option for chronic tendon inflammation like tennis/golfers elbow, Achilles tendinitis, and patella tendonitis. As opposed to Platelet Rich Plasma, there is no blood preparation. Also, unlike PRP, ABI is not for early-stage osteoarthritis, bursitis, or other forms of joint inflammation.

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    Does Hypodermic Dry Needling Therapy / Fenestration Work In Helping Tennis Elbow And Golfers Elbow Heal

    We dont really know. There isnt really enough data or studies yet even if we include the studies on Prolotherapy and Platelet-Rich Plasma Therapy .

    These therapies do look promising, however.

    They are certainly trying to encourage, nudge or should we say JAB things in the right direction.

    But I think the question is: Do most Tennis and Golfers Elbow sufferers really need to go to this extreme even if frustrated and desperate?

    I dont think most need the needle especially when factoring in the attendant risks and high costs.

    I believe most Golfers and Tennis Elbow sufferers in the mild to moderate injury range can stimulate their healing and reverse their tendon degeneration by using non-invasive, hands-on therapy techniques

    And, if ones injury has progressed to the point where it involves considerable degeneration and/or a moderate to severe tendon tear significant enough to qualify one for surgery

    Then it will probably make more sense to just have the surgery, since Tennis Elbow surgery has a proven track record of a fairly high success rate IF and when its truly called for, which is less than 5% of the time with Tennis Elbow.

    Although there are invariably cases that are on the line and in those cases maybe Dry Needling will end up making more sense.

    Thats it for now on this topic But be sure to explore all the other free articles and videos I have here for you, as well as my free video course: Tennis Elbow 101

    Dry Needling & Joint Manipulation For Golf & Tennis Elbow : Turn A Chronic Impairment Into A Quick Fix

    First off, golf and tennis elbow are deceiving, misleading, dumb dumb names. Medial and lateral epicondylitis are much more accurate. Either one can happen from either sport. Now that we have that out of the way, why are these two simple impairments such a chronic problem for so many people? As with many chronic impairments, a vital component of pathology is periostitis . Periosteal pathology impossible to directly address without dry needling. With needles, it is super easy. Regardless of the initial cause of the problem, if medial / lateral epicondylitis have persisted for any significant duration, the underlying cause of recurrence is often residual inflammation of the periosteum.

    Muscle tendons attach directly to joints via the periosteum. If those muscles / tendons have been shortened for a while, which they are on the majority of humans, they place undue stress on the periosteum, causing periostitis and joint deviation. Without direct periosteal treatment and full joint reduction, tissue healing and resolution of pain can be next to impossible. Lucky for us, once needling is introduced to treatment, direct periosteal treatment is easy and the results are nothing less than mind boggling. I cant tell you how many patients with decades of chronic, recurring medial / lateral epicondylitis that have been treated with typical interventions without much success, experience full resolution of pain and functional limitation within a handful of needling treatments.

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    Does Dry Needling Work For Tendonitis

    Dry needling can help reduce pain and soreness. A specially trained physical therapist uses a thin needle to release muscle tightness, ease tendonitis and inflammation, and/or promote healing.

    What is the fastest way to cure tennis elbow?

    Nonsurgical Treatment

  • Surgical risks.
  • How many sessions does dry needling take to work?

    How many sessions of dry needling will I need? Results dry needling patients average 2-3 sessions, and will not use more than 5-6 except in rare circumstances. Often we will use dry needling once or twice per week out of 2-3 visits.

    What To Expect After The Therapy

    Dry Needling for Tennis Elbow

    After you finish your physical therapy sessions, we will likely provide you with post-therapy recommendations such as exercises to do at home and in the gym. We know that sometimes it can be difficult for our patients to schedule a second appointment with us after completing their treatment plan, so we want to ensure you are well equipped with all of the necessary knowledge before going back to your normal routine.

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    Dry Needling For Patellar Tendonitis

    One double-blind study evaluated tendon needling with or without the addition of PRP in patellar tendinopathy. A total of 23 patients were included, and all failed nonoperative treatment. The groups underwent ultrasound-guided tendon penetration ten times in total, with or without the addition of PRP. The primary measurement was the VISA score.

    Both groups have shown improvements in the VISA scores. However, the PRP group had improved significantly more than the dry needling group. The biggest differences were captured at 12 weeks, but no differences between groups were noticed at 26 weeks. In conclusion, the addition of PRP in patellar tendinopathy showed significant improvements in the 12-week period compared to the dry needling group, but the differences disappeared after 26 weeks.

    Yes You Can Treat Tennis Elbow Without Surgery

    Surgery is not always the first solution to treating tennis elbow. There are numerous established treatments you can try instead, including physical therapy, dry needling and local cryotherapy.

    Tennis elbow, or lateral epicondylitis, is a common condition that presents with pain and tenderness around the lateral elbow at the site of the common wrist extensor tendon. This condition is frequently associated with a backhand motion in tennis and forced wrist extension, hence its name. It is also common in people who perform repetitive gripping activities, such as manual laborers. In the first three months of symptom onset, the condition is associated with an acute inflammatory process taking place at the insertion of the common wrist extensor tendon as it attaches to the humerus. The extensor carpi radialis brevis is the most commonly implicated muscle. The pathology appears to be consistent with degeneration of the long extensor tendons near the insertion to the humerus when symptoms last greater than three months. Up to 20% of cases persist after one year.

    Tennis elbow affects between 1-3% of the general population, 7.4% of industrial workers, and 40-50% of tennis players. People between ages 35-50 years old are at highest risk.

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    How Are People Trained To Perform Trigger Point Dry Needling

    The exact licensing method for getting trained to get certification in myofascial trigger point dry needling therapy. National certification requires over 100 hours of training both in class and in the field followed by a rigorous exam that includes written questions and a practical skills segment. These therapists also must be trained in universal precautions and the sanitary handling and disposal of needles.

    Dry needling for pain is not an immediate solution, but rather a gradual one that sto cure chronic pain disorders such as lateral epicondylitis without surgery, addictive medications, or invasive treatments. Many patients get permanent relief from chronic lateral epicondylitis pain with dry needling.

    Why Does Tennis Elbow Take So Long To Heal

    Dry Needling for Tennis and Golfers Elbow

    Traditionally its been thought that tennis elbow is caused by inflammation hence the tern -itis at the end of later epicondylitis. But if you dive into the research studies, they have shown this to be inaccurate. What they do show is that the tendon is degenerating .

    So tennis elbow really isnt inflammation at all like most doctors think, its degeneration of the tendon from being overloaded. This also causes nerve irritation.

    The problem with tendons is they dont have their own blood supply they get their oxygen and nutrients from the surrounding tissues and blood vessels. This in turn doesnt allow them to heal as quickly as say a muscle or skin tissue. These tendons also have a great deal of tension on them. When you combine that with repetitive use and overload you get a recipe for pain and long healing times without the use of the appropriate intervention.

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