Acupuncture

Within the field of acupuncture, there are many different acupuncture techniques and disciplines. Most people are familiar with what we call distal acupuncture techniques, meaning the needle is placed distal to (away from) the problem areas. This includes TCM, Dr. Tan, Master Tung, Five Element, and auricular acupuncture techniques to name a few. 

 

Orthopedic Acupuncture falls in the category of “local acupuncture techniques”, meaning that if the pain is in your back, - the acupuncture needles will be applied to the affected muscles and structures in your back. Orthopedic Acupuncture is used to address musculoskeletal pain and discomfort which can be related to injury, overuse, and tension. Orthopedic Acupuncture uses techniques to stimulate muscle motor points (also known as trigger points) to release tension and muscle spasms as well as stimulate inhibited and weak muscles to encourage muscle tone and balance. Direct needling can be used to break up fascial adhesions and scar tissue to restore normal movement. 

 

What conditions respond well to Orthopedic Acupuncture? 

Orthopedic Acupuncture is effective for musculoskeletal conditions related to tension, injury, overuse, and tendonitis. Orthopedic Acupuncture is also appropriate for athletes who want to prevent injury by working on muscle tone and balance and addressing potential problem areas early. The list below is not exhaustive, but includes examples of conditions I have helped patients with. 

​

Conditions I treat with Orthopedic Acupuncture. Pain also includes tension.

• Low back pain

• Mid back pain

• Upper back pain

• Neck pain

• Whiplash

• Tension headaches

• Migraines caused by neck tension

• Shoulder pain

• Jaw and TMJ pain

• Sacroiliac Joint (SI) dysfunction

• Elbow pain

• Medial epicondylitis

• Lateral epicondylitis

• Pronator teres syndrome

• Carpal tunnel syndrome

• Thoracic outlet syndrome

• Knee pain

• IT band tension

• Hip flexor tension

• Sciatica

• Hip pain

• Calf pain and muscle spasms

• Plantar fasciitis

• and more...

 

How does Motor Point needling work? A great deal of pain is caused by muscle tension. I cannot count the number of times I have seen a patient come in with such severe low back pain that they’re sure they’ve herniated a disk - when the pain is all coming from a tight and spastic QL (Quadtratus Lumborum). In fact, one time I had such a painful QL spasm that even though I knew the pain was probably a muscle spasm, I still convinced myself that it could be a kidney stone. Fortunately I was able to get my acupuncturist spouse to release my QL on my lunch break, and set me straight. For some reason we have a hard time believing that muscle pain could be that bad - but it frequently is. Orthopedic Acupuncture is exceptionally effective for muscle tension, which is why it works so well for addressing many pain syndromes. Here’s a bit about how it works. 

 

Picture a number scale from 0% to 100%. Now think about your upper trapezius muscle - it’s the area between your neck and shoulder that you probably point to when you say “I carry my stress here.” Your muscle activity exists on this scale from 0 to 100, where 0 is completely relaxed and limp, and 100 is maximum contraction. Your muscles move back and forth across this scale, from contraction to relaxation. The contraction of your muscles is an electrical activity, mediated by sodium and potassium channels. Most skeletal muscles should be neither limp as noodles nor hard as rocks as we go about our day. Postural muscles, like the trap, should be at, say, 20% when we are sitting or standing with good posture. The problems arrive when that 20% constant contraction rises to 50% or 80%. Then you have that hard, painful, carrying-weight-of-the-world-on-your-shoulders trapezius problem. At this point, you probably also have a headache.

 

So how do we solve the problem? This is where muscle motor points come in. A motor point is the location in a specific muscle with the highest concentration of electrical activity, where the contraction begins and spreads through the rest of the muscle fibers. Most muscles have one, some have several. Your acupuncturist will locate the motor point in your tight, painful muscle and insert a needle into that motor point to a specific depth. And check this out - we, living humans, conduct electricity. Yes, it’s weak electricity, but it’s enough! The needle is metal, so the weak current that we conduct is transmitted through the needle and (with the proper technique) this stimulates a contraction to begin in the motor point. We are stimulating that muscle that’s stuck at 80% contracted, and we take it to 100%. By taking it to 100%, it can then go to 0, and this performs a kind of electrical reset on your muscle tension, like flipping the circuit breaker in your house up and down several times to fix a wonky outlet.

 

This resets the ability of the muscle to move between 0 and 100 as needed. What we’re ultimately after is the ability for that fiber to relax or contract, and exist in a “toned” resting state—that 20% contraction from earlier. We will usually try to elicit one or several good contractions, also called fasciculations, or muscle twitches. Sometimes we’ll use a specialized acupuncture TENS unit to get hundreds of gentle contractions to speed things up with stubborn muscle tension. 

 

And that’s basically motor point acupuncture in a nutshell - it’s an electrical reset to your muscle tension, and it feels awesome. 

​

Is Orthopedic Acupuncture more effective than chiropractic adjustment? 

For pain related to muscle tension patterns and muscle tone imbalance, yes absolutely. Chiropractic adjustments focus on the repositioning of the spine and bones. Chiropractic can be very valuable, especially with significant injuries like car accidents or falls. Repositioning the spine after an injury can be very important. However, it is your muscles that hold your bones and spinal structure in place. That's why a lot of chiropractic adjustments don't "hold" and you see many chiropractic clinics trying to get patients to come in weekly until the end of time. If muscle tension imbalances are not addressed, your muscles will continue to pull your spinal alignment out of place. Correcting muscle tension imbalance is what orthopedic acupuncture excels at, and it may be able to get you off the adjustment merry-go-round. Using both acupuncture and chiropractic adjustments in conjunction can be helpful in many cases. 

​

 

What is the difference between Orthopedic Acupuncture and Dry Needling? The difference is 3-4 years of postgraduate education, 3000 + hours of clinical education, passing national board exams, attaining licensure, and most importantly - being good at it. 

​

Dry Needling is Orthopedic Acupuncture done by practitioners that aren’t allowed to call what they are doing “acupuncture “because “acupuncture” isn’t in their legal scope of practice. Other fields like physical therapy and chiropractic recognized the value in Orthopedic Acupuncture and wanted to do it as well, so the term “dry needling” was coined so that they could use an acupuncture needle without violating their legal scope of practice. People recognizing the value in acupuncture techniques - well that’s a good thing. But rebranding it and then doing it poorly - not so good. 

 

Rebranding was easy due to the overall poor understanding in our country of what acupuncture is - and the pre-existing undercurrent of xenophobic skepticism of anything Asian. So now it’s common for PTs and chiropractors to tell patients that acupuncture is some “shamanistic energy magic” and what they do is “modern science.” Which is utter nonsense, to be clear. They can say “modern science” until they’re blue in the face, but these techniques were developed and recorded thousands of years ago. 

 

Why are acupuncturists better at orthopedic acupuncture aka dry needling? It's mostly about training and experience. On the subject of dry needling, acupuncturists are better educated, better trained, and more experienced. Our main job isn't doing PT or chiropractic adjustments all day and picking up an acupuncture needle for 10 minutes a couple times a week. With 4 years of clinical education, and 6 years in my own practice I have put hundreds of thousands of needles into tight trigger points. For us, it's not a side job. 

 

Many states require 0 hours of training for a PT or Chiropractor to practice dry needling, others require a few hundred hours. None require passing national board exams, none require specific licensure. And there’s just something about having a teacher’s voice in your ear telling you “don’t put the needle there, don’t give the patient a pneumothorax (lung puncture)” for four years, repeating it hundreds of times - that apparently really works. Because acupuncturists don’t lead the country in acupuncture needle-induced pneumothorax incidents - PTs and chiropractors doing dry needling do. When PTs and chiropractors learn anatomy in school, they learn it from the perspective of manipulation techniques they are training to apply - not from a perspective of all the places you can safely put a needle, and all the places and depths you cannot safely needle. Most dry needling is taught at weekend seminars, and some of the techniques being taught are specifically on our “what not to do” list if you’re trying to avoid causing pain and tissue damage. 

 

There is of course, some nuance to this. You can be a PT and put in the time to get really good at dry needling. That’s completely true and there are some PTs who are great at it. It’s just not the norm. And you also can be bad at dry needling and have it work - but it's usually more painful and takes longer.

​

​