The Auto Pilot Brain; Muscle and Movement Control: Answers to Chronic Soft Tissue Pain and Understanding Dry Needling of Trigger Points

By Carol Cote, PT, CCTT, CODN, CMTPT

In the general medical population we make the mistake that muscles are under 100% voluntary control. This is partially true, however, the majority of our muscles are more automatic (i.e. autonomic nervous system) than voluntary (somatic nervous system). Our muscles are controlled by 2 nervous systems. The somatic nervous system is our voluntary nervous system. When we bend our elbow and move our bodies voluntarily that is done through the somatic nervous system via our motor cortex.

Our second auto pilot nervous system is our autonomic nervous system which is more about bodily functions that help us survive (heart beat, body temperature, blood pressure, digestion, etc). Muscles are innervated by both nervous systems. For example, breathing. We have voluntary control with our breath but breathing is more automatic than voluntary. Muscles of our spine, shoulder blades and pelvis are more autonomic than voluntary. Autonomic muscle control has to do with how we hold our body against gravity. Our brain is blind to gravity, reflexes (such as balance) and habits (motor activation patterns ­
and muscle memory). Holding our head up and balancing is automatic very much like breathing. When it comes to neck and back pain and muscles this problem is an involuntary muscle problem.

Dry needling works to change our autonomic motor control affecting our auto pilot muscle activation pattern by releasing the trigger points (involuntary muscle contractures) that exist in chronic soft tissue pain. Dry needling works faster than traditional manual therapy like massage and even joint manipulations, treatment strategy needs to address the right level of where the problem is. Dry needling works at the three levels of how our bodies process pain:

1. Peripheral (skin, muscle, bones, joints)
2. Spinal (spinal cord, nerve roots) and
3. Brain (motor and sensory cortex along with our thinking/decision making and emotional brain).

Dry needling is a key treatment strategy which works at all levels (voluntary and involuntary) all at once and allows for permanent sustained change.

Dry Needling Clinical Effectiveness/Results At North Jersey Physical Therapy Associates

By Carol Cote, PT, CCTT, CODN, CMTPT

Dry needling of trigger points has unprecedented results in patient care treatment protocols when addressing orthopedic, musculoskeletal, neuromuscular and chronic pain conditions. We at North Jersey Physical Therapy have fully integrated dry needling of myofascial trigger points as part of our rehabilitation treatment protocols that include manual myofascial release, neuromuscular rehabilitation and exercise. Some observations/results with dry needling are unattainable via traditional physical therapy.

Dry needling releases the muscles’ contractures (trigger points) in both muscles and myofascial bands in soft tissue pain while facilitating a more balanced muscle activation pattern. We believe dry needling when combined with manual myofascial release and active release treatment strategies creates a change in the motor cortex, cerebellum and sensory cortex. Dry needling facilitates a change in muscle tone, muscle memory and activation patterns while relieving muscle pain. There is frequently sustained pain relief and perceived lightness/proprioception to the movement.

The human brain learns movement by doing and feeling which becomes habit which then becomes more hard wired. For example, riding a bike is an example of a muscle memory habit. We don’t have to think about how to ride a bike once we’ve learned it (body felt learning). If however, our habits over work key muscles and tendons during our grip, elbow and wrist, tendonitis of the elbow develops as a result when wear and tear exceeds repair. Dry needling the muscles and fascial bands allows immediate release of painful trigger points while also creating an inhibitive influence not to over contract those
muscles that habitually (through muscle memory) get overused. The human brain is
linked to habit and we are unaware of this process.

Myogenic Dizziness

By Carol Cote, PT, CCTT, CODN, CMTPT

Feeling dizzy? It could be related to your neck muscles. Do you suffer from episodic dizziness? Myogenic (from muscles) dizziness is a common reversible condition that can be readily treated and once relieved sustained via key neck/eye and breathing exercises. This is a common but often missed/misdiagnosed condition involving your inner ear balance center (vestibular), vision and neck muscles that orient your head to gravity (head right reflexes).

Our auto pilot brain (autonomic nervous system) is designed to keep us oriented to gravity. Our human instinctive brain is hard wired to have us survive. We have reflexes that are involuntary automatic responses to have us survive. Head righting reflexes keeps your head oriented to gravity (eyes horizontal, nose vertical). Our human brains are hard wired for this because we have to hold our head up and balance our body against gravity to survive independently in this world. This is so automatic that we are not aware that these reflexes are happening. Reflexes are NOT under our control. For example, try sneezing with your eyes open. Our human body is blind to gravity and many of these reflexes that we take for granted.

Myogenic dizziness develops when the signals from our inner ear balance center (vestibular) signals from what we see and the neck muscles of how we hold our head up don’t match up in the brain. Neurologists, ENT’S and ophthalmologists’ are able to diagnose problems of the balance center (vestibular) and vision. The muscular component is not recognized. A trained physical therapist in head, neck and jaw (certified cervical temporomandibular therapist) is able to evaluate and treat this condition. Neck muscles are critical to auto pilot demands of head righting, balance, posture and breathing. Most people who develop this problem are not aware of these faulty habits. Onset can be fast (whiplash, falls and trauma) or gradual from head posture (working at a computer or aging). It can also be episodic related to stress and anxiety (clenching and breath holding).

A physical therapist can quickly relieve the muscle contractures/trigger points within the muscle via dry needling, manual therapy and neuromuscular re-education and key exercises of the jaw, tongue, neck, eyes and breathing exercises. The patient is empowered by being given key exercises and self care strategies (I call it homework). This simple condition can resolve in as few as 4-6 visits. Long standing conditions >6 months may take longer to resolve. The key to sustained relief is the education and self trained awareness of postural breathing and orofacial (tongue, mouth and jaw) habits that are at the root of the problem. Most medical insurances cover these services if provided by a physical therapist.

Strong Support for New Dry Needling Legislature

By Carol Cote, PT, CCTT, CODN, CMTPT

On Monday, March 16 the Assembly Regulated Professions Committee hearing at the State House in Trenton took place. Many supporters were present to support legislative bill (A1648) – The Physical Therapy Practice Act as well as the issue of dry needling.

Testifying at the hearing in support of Dry Needling were:

Group Picture

  • Mr. David Diehl, Retired Offensive Lineman, New York Football Giants (far left)
  • Dr. Brian Mason, President, American Physical Therapy Association of New Jersey (second from right)
  • Dr. Richard Podell, Medical Doctor, Clinical Professor, Robert Wood Johnson Medical School (far right)
  • Dr. Josef Tuazon, Physical Therapist/Owner, A Better Life Physical Therapy (not pictured)
  • Also seen in photo:
    • Daniel Klim, Executive Director, American Physical Therapy Association of New Jersey (second from left)
    • Carol Cote, President and Director of North Jersey Physical Therapy Associates (in front)

The prepared testimony included the following:

  • Dr. Mason provided an overview of the bill to inform the legislators of its contents.  He cited that the biggest conflict lies with dry needling.
  • Dr. Podell followed and provided insight and support for why a physical therapist is more than qualified to perform dry needling.  He gave this from the credible perspective of a double board-certified, Harvard-educated clinician.
  • Mr. Diehl gave the patient perspective and reflected on his 11-year professional football career.  He cited that he used both dry needling and acupuncture as a player, and drew the following distinction: he used acupuncture to relax his muscles, while using dry needling, performed by the Giants’ PT Dr. Leigh Weiss, to rehab from injury and stimulate his muscle recovery.
  • Dr. Tuazon anchored the panel, speaking about the small business side and how he uses dry needling on a daily basis.  As a former professional fighter and Brazilian Jiu Jitsu champion who trained in Asia and studied Oriental Medicine, he distinguished between dry needling and acupuncture and why dry needling is a more effective technique for his patients.

The following legislators were extremely engaged and followed up with questions at the hearing:

Giblin, Thomas P. – Chair (District 34)
Jimenez, Angelica M. – Vice-Chair (District 32)
Ciattarelli, Jack M. (District 16)
Diegnan, Patrick J. (District 18)
Handlin, Amy H. (District 13)
Kean, Sean T. (District 30)
Mazzeo, Vincent (District 2)
Moriarty, Paul D. (District 4)
Muoio, Elizabeth Maher (District 15)

Convincing arguments were presented to the legislators to hopefully have them vote “Yes” on A1648 and permit dry needling to remain in the bill in the future!

Unprecedented Benefits from Dry Needling

By Carol Cote, PT, CCTT, CODN, CMTPT

Dry Needling provides unprecedented benefits when addressing soft-tissue pain and dysfunction. It is the right tool for the problem. It is the right treatment strategy for the diagnosis: myofascial dysfunction (painful muscles that are uncoordinated in the involuntary system that holds your body against gravity). According to “Dry Needling for Management of Pain in the Upper Quarter and Craniofacial Region” in Current Pain and Headache Reports, June 10, 2014:

Dry needling is a therapeutic intervention that has growing popularity. It is primarily used with patients that have pain of myofascial origin.”

Abstract Conclusion:
In order to effective manage patients with the complex problem of craniofacial pain, it is imperative to perform a careful examination, including assessment of upper quarter Myofascial Trigger Points (MTrP), and utilize a comprehensive treatment paradigm {58,59,102}. The increasing popularity of dry needling as a therapeutic intervention should be viewed in light of evidence of it its effectiveness. Although additional research is needed before more definitive conclusions can be made, the evidence to date suggests that dry needling is effective, especially in the short term, for reducing pain in patients with upper quarter myofascial pain. Findings from a small number of individual studies also suggest that dry needling may be beneficial for patients with craniofacial pain associated with headache or TMJ involvement. Clearly, more rigorously designed randomized controlled trials are needed before definitive conclusions can be made about the effectiveness of dry needling for the craniofacial area as well as other regions of the body. A small but growing body of literature has suggested that dry needing leads to favorable outcomes for a number of lower body conditions.

The addition of dry needling to the therapeutic process, when performed by trained practitioners, requires minimal low cost equipment and can be administered in relatively short periods of time, thus, making it an economically efficient means of reducing pain in patients with neuromusculoskeletal conditions. Clinicians interested in dry needling should continue to remain appraised of new studies regarding effectiveness for dry needling and optimal technique and dosing.

58. Mannheimer J. prevention and restoration of abnormal upper quarter posture. In: Geib H. Belb M, editors. Postural considerations in the diagnosis and treatment of cranio-cervical-mandibular and related chronic pain disorders. St. Louis: Mosby, 1994
59. Mannheimer J., Dunn J. the cervical spine: its evaluation and relation to temporomandibular disorders. In: Kaplan A, editor. Textbook of craniomandibular disorders. Philadelphia: Saunders; 1991.
102. Issa T, Huijbregts P. Physical therapy diagnosis and management of a patient with chronic daily headache: a case report. J. Manual Manip Ther. 2006;14(4):E88-123

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