Dry Needling your back for pain, isn’t just about your back
A person walks into a clinic, after they strained their back last week with ongoing pain. They have tried all the tricks on their own to relieve it: heat, ice, stretching, pain patches; but nothing makes it better. They are offered dry needling, and they start to have some relief, and they start to feel better.
On the surface, the assumption is the needles went into the tight muscles, the muscles relaxed, and the pain went away. But in actuality it's much more interesting than that. Dry needling is not just about a localized treatment to the back. Those needles going into the back are impacting that area, but they are also influencing the entire nervous system.
Once you understand why dry needling works on the local level, you then can also understand why that matters in the long term.
Pain is complex:
Most people just understand the local level influence:
Needle goes into a tight muscle → the muscle relaxes → pain goes away
While this does occur at the specific sight of entry, this is an incomplete understanding of the process. Pain is not just a tissue or biological problem. This is especially true for pain that has been persistent or recurring pain that just doesn’t fully go away.
Pain is an output of the brain/nervous system, and not an input from the body. Our pain is not just an interpretation of what was hurt, but also layers with psychological and sociological aspects surrounding that experience on top of the biological (biopsychosocial). That’s why it’s often referred to as multifactorial experience and only treating the biological or tissue side sometimes doesn't help.
Nervous System Basics:
Our Nervous system is made up of 2 different parts:
Central nervous system (CNS) which is made up of our brain and spinal cord; our body's primary control center for processing information, coordinating behavior, and maintaining homeostasis (balance in our body)
Peripheral nervous system (PNS) which is made up of our nerves outside the brain and spinal cord, acting as a communication network between the central nervous system (CNS) and the body's muscles, organs, and skin.
Our PNS is made of then 2 parts the Somatic Nervous System (SNS) (the side we control our muscles and movement, think voluntary control) and Autonomic Nervous System (ANS) (the side that is involuntary control: Sympathetic and Parasympathetic)
The sympatric and parasympathetics of the ANS require homeostasis or balance for us to be functionally well. We often break this down into parts of a “Fight or Flight” as the sympatheics and “Rest, Relax and Recover" as our parasympathetics. When these two sides are not in a balance with each other, that can “throw off” the ANS and impact how our body perceives pain.
Things that can push you more into the sympathetic side such as poor sleep, high stress, workload balance, postpartum changes, and training load levels, can all impact how that ANS is functioning.
Any pain, and in this case, back pain can be directly influenced by what is going on in the ANS and how “on edge” the system is acting.
Back to the Back Pain:
If someone is in pain, or they strained their back, many times our body will go into a protection mode. The muscles surrounding the area of the perceived pain, tighten to guard the area and protect it. Over time, that area can then have increased sensitivity, meaning, it doesn't take as much influence of perceived injury to the area, to elicit the pain response. Then the brain starts to change how and what you are doing, to reduce the chance of it starting to hurt. We then all of a sudden can’t bend forward without feeling some type of pain.
When this cycle continues for longer periods of time without resolving, we then become more influenced by certain factors. While the back may have started out as the problem spot, it may not actually be the back that is the problem, but its responding to the environment around it.
Examples of this can be the way you are sitting at your desk, while you are stressed with a work deadline; the influence of postpartum mom, who is also now having to lift and carry 10lbs throughout her day; starting a new workout routine and sleeping poorly.
So the treatment for treating the pain is not just about the muscles in the area of the perceived pain, but also treating the whole nervous system.
Dry needling for pain
Dry needling does work at a local level. We know this from studies that show when inserting the needle into a trigger point, you can get a local twitch response, we get increased blood flow to the area, and muscle tone can be reduced in that area, which can be contributing to the local pain. But this is only a part of the effects of the dry needles.
Dry needling also impacts the Autonomic system, allowing for changes in the processing of the pain. The effects of the dry needles on the parasympathetic side of the nervous system causes the body to shift out of that “fight or flight” mode, into more of the calming/relaxing side. This is why people will sometimes report feeling calm, relaxed or sleepy post dry needling sessions. When this is happening, the body is shifting out of that protective mode, contributing to less guarding and less pain sensation. When our body is not feeling guarded or in pain, we have the ability to actually move better. Moving better is actually a key component to getting out of pain, because you are teaching the body that it is safe to move, and the response to stop the movement is diminished. When our bodies perceive the feeling of safety with movements, the alarm bells of pain are quieter.
This is ultimately what leads to feeling less pain post dry needling, and actually feeling better.
Why Exercise Still Matters Most
While quieting the pain sensation is an important part of moving better, dry needling alone is usually not enough. Dry needling isn’t about “fixing” your back, it’s a tool to help you move with less discomfort so you can get back to the strength and mobility work that actually drives long-term change in our bodies, allowing your body to adapt itself. Dry needling needs to be paired with strength training, mobility work, and load management in order for the body to truly recover function. Dry needling with exercise is how you start to feel better, but then also start to move better so the pain does not come back. Exercise also is acting on the nervous system, retracing the brain and nervous system that it is safe.
So that person that comes in feeling better after 2-3 sessions isn’t typically done in their rehab journey. The good thing is the pain is usually no longer the barrier to actually moving. The movement and exercise is what we know actually will help them stay better and help keep their body more resilient in the long term.
It’s Bigger Than the Needle
Dry needling is so much more than releasing a tight muscle. It's impacting an entire nervous system that is influencing that muscle. When we have pain, it does not mean our bodies are broken, it just means our bodies are adaptable to the influences on it. When we can change how the system responds, we can change how our bodies can move.
And because our pain is multifactorial, treating pain just at a local level will help, but doesn’t change the pain in the long term.
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