The In’s and Out’s of Needling

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BY MAUMAHARA KEELAN – SENIOR PHYSIOTHERAPIST

“Acupuncture” involves the insertion of very fine needles into the skin for pain relief, healing and general health and well-being.  Acupuncture is one branch of Chinese Medicine which has been used for over 3000 years. There are also different methods of using acupuncture that may not involve needles such as acupressure, moxibustion, laser and cupping.

In New Zealand, the term “Acupuncture” is generally considered to be a broad “umbrella” term which encompasses different philosophies of needling.  You may hear it being referred to as:

  • Traditional Chinese Acupuncture (TCM)
  • Western/ Medical Acupuncture
  • Dry Needling

Physiotherapists’ in New Zealand may practice one or a mixture of these.

At North City Physiotherapy we can provide Dry Needling.  This involves “rapid” short term needling to dysfunctional tissues in order to improve or restore function.  This is a practice utilised by both Traditional and Western Acupuncturists.

When Physiotherapists’ use Dry Needling, a needle is placed into the trigger point in the affected muscle until a “twitch” is felt in the muscle, aiming to reproduce the patient’s symptoms and the needles are generally not left in place.
The muscle may then be stretched or activated to improve muscle function.  Heat or ice packs may also be applied after treatment to help relieve post-treatment soreness.  As this is a very strong stimulation of the nerve endings, the patient will usually feel a very strong aching sensation and may also feel the twitch response as the trigger point is needled during the treatment.  Post treatment aching may continue for up to 48 hours.
See the table for a summary of Dry Needling and it’s comparison to Acupuncture:

Should I buy compression socks/sleeves?

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BY JO SULLIVAN – PHYSIOTHERAPIST

What is a Calf Compression Sleeve?

A calf compression sleeve is a tight, elasticated fabric tube that is worn around the lower leg. They usually provide graduated compression – tighter around the ankle and a lesser compression towards the knee.

Compression garments were initially designed to help improve blood flow in post-surgical patients, people with diabetes or circulatory issues or individuals prone to swelling, phlebitis, varicose veins, and deep vein thrombosis (DVT). For these often inactive and bed-ridden patients, the tightly fitting leg wraps help blood return to the heart so it doesn’t pool in the lower extremities and cause swelling. The compression also reduces and risk of blood clots. It is for the same reason they are now used on long-haul travel.

Athletes started using compression socks for the same reasons. Furthermore, they recognized that compression can potentially can prevent injury, help rehabilitation with existing injuries, improve performance and enhance recovery time.

How do they work?

  1. Increased Circulation

A constant compression will cause the arterial walls to dilate, and this allows a greater volume of blood, and therefore oxygen, to pass through to the muscles and then back again to the heart. The constrictive effect will also increase the speed at which blood travels. This prevents blood from pooling. The increase in oxygen to the muscles results in more fuel called ATP energy and can improve the athlete’s endurance as well as aid recovery and rehabilitation.

Also, muscles produce a waste product called lactic acid. Lactic acid causes cramping and stiffening of the muscles when it builds up. Due to the improved circulation, there is improved lactic acid elimination. By preventing lactic acid buildup, athletes are able to work out longer without cramping or stiffening and are able to recover faster.

2.Loosening Muscles

This is achieved by reducing the rate of muscle oscillation. Muscle vibrations occur constantly while they are being used. These vibrations use up energy and so can weaken the muscle’s ability to sustain lengthy physical activity. Compression therefore can make a massive difference in the way muscles feel after intensive activity. They are often not as sore while in use or while resting.

Quite simply, wearers of a calf compression sleeve can find that they are more efficient while using those muscles, experience less of a sore sensation after strenuous activity, and recover much faster than they otherwise would expect to. Still not sure they are a true training aid or just another fad? The best way to discover if the socks work is probably to experiment with them yourself and see what you think. They may not be for everyone, but they certainly won’t harm your recovery.

The Guru’s?

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Physiotherapy is an evolving profession.  Gone are the days of treatments that are based on “it worked last time” or “this is what I have always done.”  These days Physiotherapy intervention is heavily evidence based.  In other words, academics and researchers have identified exactly how and why treatments work and what they can be used for.  This doesn’t mean however that Physiotherapy management approaches in the past did not work, it just now means we know why they work.

These are exciting times for Physiotherapists as it means we can be more accurate and effective in our treatments.  It also means that we can justify using certain techniques and methods and; it also means that the revolution of Physiotherapy that introduced certain methodologies are now being proven as to why they are effective.  It therefore seemed an appropriate time to introduce some of the Guru’s that Physiotherapists base their practice on so, over my next few newsletters I would like to introduce Brian Mulligan, Robin McKenzie, James Cyriaz and Paul Chek (who is more of an exercise guru but still influences Physiotherapy practice).

Brian Mulligan is the father of Mobilisations with movement.  A concept where joints of the body are moved into what is considered their best position and then the joint is moved.  Then, if we are accurate the joint will move more freely and pain can be resolved.  It almost sounds like witchcraft but evidence and research support this concept and, anecdotally, I have seen countless occasions where a mobilisation with movement technique has almost instantaneously solved an injury.  So, who is this man Brian Mulligan?

Brian Mulligan trained as a Physiotherapy at the New Zealand school of Physiotherapy in Otago.  Graduating in 1954 he then opened his own private practice in Wellington where he continued to practice until the year 2000.  Throughout his career manual therapies were always Brian’s interest and background.  In 1968 Brian and (the above mentioned Robin McKenzie) formed the New Zealand Manipulative Therapies Association which went onto start and teach a post graduate programme for the Diploma of Manipulative Therapy.

In 1983 Brian ceased his teaching role on the Diploma programme and began teaching his own techniques in the field of Mobilsations with movement.  The techniques and Brian’s teaching became world renowned and gave rise to the Mulligan Concept.  This concept now forms the basis of many Physiotherapists practice and I can vouch for the success of it and applicability to acute, subacute and chronic injuries; so, if there are any aches and pains or old injuries that have never full recovered please come and see us and perhaps the Mulligan concept can help.

Best wishes and yours in health

The Team @ North City Physiotherapy