Acupuncture, and Connective Tissue and Dry Needling
Why does acupuncture work well with “dry needling”, and why should it work now if it didn’t before?
Many patients with myofascial pain or chronic pelvic pain who come to see me for “dry needling” have already tried acupuncture earlier in their treatment odyssey, and did not find it to be effective at that time. (The ones for whom it was effective never had to see me!) A look at the role of fascia and its anatomy can provide important insights into why this may be so.
Pain in Chinese medicine
To understand this I will need to explain a little about the concept of pain in traditional Chinese medical theory. In traditional Chinese medicine, pain is often seen as the result of Qi (loosely defined as “animating force”, and corresponding in some degree to electrical impulses, such as those that travel along nerves and across cell membranes) that has become “stagnant”, unable to flow properly in its usual channels (pathways) because its blocked or trapped. Some areas become undernourished, while others suffer from excess, as when a damn causes flooding upstream and parched earth below.
Acupuncture and connective tissue/fascia
Just because you cannot remove them from the body to examine as you can the arteries or nerves, do not think that acupuncture meridians lack biological reality! Current understanding is that they are the manifestation of energy flow along the paths of least resistance between planes of fascia, a connective tissue. Connective tissue is so important in the development of pathology and dysfunction because it can become literally stuck, as it does in frozen shoulder, whiplash or adhesions from endometriosis or surgery. With this in mind, you can see there is overlap between what occurs during traditional acupuncture treatment, which aims to facilitate the movement of blood and Qi in these channels, and the physical medicine treatments that seek to do the same through manual manipulation using modern or ancient means. (Myofascial release and Graston technique are suspiciously similar to ancient practices of tui na and gua sha.)
Acupuncture helps maintain gains made with dry needling
When myofascial or pelvic pain is caused by dense adhesions or stubborn trigger points, then traditional acupuncture (as commonly practiced in the US) may not be forceful enough to break through those blockages. However, as connective tissue adhesion is released through trigger point needling (dry needling) or other modalities, the muscles, tissues and fascia are freed up to move. Energy can now flow along the previously road blocked trajectory. Adding acupuncture or electric stimulation at this point in treatment is like flushing out, cleaning up, and hosing down a worksite after the road crew is gone. Because the channels (myofascial trains) flow from to tip to toe, running acupuncture energy (moving Qi) across the areas that have been “unstuck” can help restore normal movement across the whole body. And, we all know that no part of the body ever really functions in isolation. Finally, acupuncture can help the body to maintain the gains made, by supporting healing and addressing systemic imbalances.
Did you know???
Like all forms of connective tissue, fascia is made up of fibers of collagen and elastin proteins laid down by fibroblast cells in a matrix of extracellular fluid known as “ground substance.” The differences between tendons and ligaments, scar tissue and the fascia that envelops organs and muscles lie in the varieties of collagen present, the arrangement of the fibers and the viscosity and other attributes of the ground substance.