Biomedical Acupuncture for Sports and Trauma Rehabilitation: Dry Needling Techniques, 1e

384 Pages·2010·2.76 MB·English

by  Yun-tao Ma PhD

Yun-tao Ma, PhD, LAc
Director and Founder
Biomedical Acupuncture Institute and
American Dry N eedling Institute
Boulder, Colorado
Visiting Professor, Medical Faculty
Paris XI (Orsay) University
Paris, France
3251 Riverport Lane
St. Louis, Missouri 63043
Biomedical Acupuncture for Sports and Trauma Rehabilitation: ISBN: 978-1-4377-0927-8
Dry Needling Techniques
Copyright © 2011 by Churchill Livingstone, an imprint of Elsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are
advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the method and duration
of administration, and contraindications. It is the responsibility of the practitioner, relying on their own
experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for
each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither
the Publisher nor the Author assumes any liability for any injury and/or damage to persons or property arising
out of or related to any use of the material contained in this book.
The Publisher
Library of Congress Cataloging-in-Publication Data
Ma, Yun-tao.
Biomedical acupuncture for sports and trauma rehabilitation : dry needling techniques / Yun-tao Ma.
p. ; cm.
ISBN 978-1-4377-0927-8 (hardcover : alk. paper) 1. Sports injuries–Patients–Rehabilitation. 2. Acupuncture.
I. Title. [DNLM: 1. Athletic Injuries–therapy. 2. Acupuncture Therapy. 3. Sports Medicine–methods.
QT 261 M111b 2011]
RD97.M3 2011
617.1’027–dc22 2010000460
Vice President and Publisher: Linda Duncan
Senior Editor: Kellie White
Developmental Editor: Kelly Milford
Publishing Services Manager: Catherine Jackson
Associate Project Manager: Jennifer Boudreau
Book Designer: Margaret Reid
Printed in the United States of America.
Last digit is the print number: 9 8 7 6 5 4 3 2 1
In my field, athletes are always looking to gain a competitive edge. In the past, clinicians who worked with these athletes
relied on incomplete methodologies. Now, Dr. Yun-tao Ma provides the clinician with a detailed reference manual dem-
onstrating advanced dry needling techniques which enhance the neuromuscular, musculoskeletal and physiological sys-
tems of the elite, professional and recreational athlete.
Medical doctors, doctors of chiropractic, physical therapists, and acupuncturists aspiring to achieve optimal balance
and maximize athletic performance will find that Dr. Ma’s book provides a simple, detailed and proven process for detect-
ing and correcting soft tissue dysfunction, preventing chronic sports injuries and maintaining homeostasis by utilizing
advanced dry needling techniques to de-stress the musculoskeletal system.
It will teach you the science and provide the “how to” for you to increase microcirculation and reduce cellular aging
in the athlete. Not only does it provide valuable practical information and techniques, but the book gives the clinician the
effective tools to use for assessing, analyzing and evaluating the autonomic nervous system. It merges Eastern philosophy
and Western philosophy to create wholeness for the advancement of sports medicine.
After 10 years of working as a personal performance enhancement doctor, Dr. Ma’s course and book taught me one
new modality that may add years to the career and life of my athletes. What you will learn in this section alone makes the
book priceless. Dr. Ma gets the nervous system firing, the clinician excited and makes the athlete say “Wow!” after receiv-
ing his advanced dry needling therapy.
Dr. Clayton Gibson, III, MSA, DC, CCSP, CCEP, RTP, CSCS, CNT, FIAMA
Board Certified Chiropractic Sports Physician
Personal Physician to Numerous Elite, Olympic and Professional Athletes (NFL, NBA, MLB, USATF and NCAA)
Chief Functional Integrative Sports Performance Officer at Vitality Health Care, Inc.
Atlanta, Georgia
Presently we have a great confusion of various ideas regarding dry needling. Dr. Yun-tao Ma’s book is destined to play a
truly integrating role, explaining the mechanism of dry needling, offering a system for practical application and clarifying
misunderstandings. Current myofascial trigger point approach focuses on localized or regionalized symptoms. Integrative
systemic dry needling pays attention to both regionalized symptoms and their pathological influence over the entire
musculoskeletal system. This approach can be successfully used for both treating and preventing myofascial symptoms,
facilitating physical movement of both athletes and nonathlete patients.
Peter Lundgren, Physiotherapist
Director, AKNA Institute
Tyreso, Sweden
The concept of Dr. Ma’s book is fantastic for physicians and other medical professionals, providing detailed practical
procedures for treatment and prevention of sports and nonsports injuries using dry needling modality. Dr. Ma’s funda-
mental approach to applying dry needling for sports medicine can be successfully used for helping athletes to achieve a
peak performance, preventing soft tissue injuries, and facilitating rehabilitation after injuries or surgeries.
The de-stress treatment developed by Dr. Ma is a breakthrough in preventing and treating difficult conditions like
overtraining syndrome and delayed onset of muscle soreness. Dr. Ma’s concept of pain management for sports injuries
focusing on functional restoration is especially valuable to athletes and their team doctors. The clinical techniques
presented in this book are clear, simple and effective. I would recommend this book to all my colleagues and medical
professionals whose clinical practice involves sports medicine and pain management.
Randall L. Snook, MD
CEO and Founder
Advanced Integrative Medicine
Denver, Colorado
Pain management and trauma rehabilitation is especially challenging when treating veterans and active duty personnel given
the traumas experienced during combat. Dr. Yun-tao Ma’s textbook provides an excellent alternative and augmentation
to standard pain medicine approaches.
Jeffrey L. Hunter, DC, DO, FAAFP
Clinical Assistant Professor
Department of Family Medicine
College of Medicine
Ohio State University
Columbus, Ohio
The dry needling technique as described in Dr. Yun-tao Ma’s textbook has proven to be one of the most profoundly
beneficial treatments I have ever offered to my patients. This approach is unsurpassed for facilitating recovery from acute
injury. It is even more valuable in assisting an athlete in restoring high performance abilities after months or years of
experiencing subtle chronic injuries that have been masked by compensation. Dr. Ma’s assessment and dry needling
treatment protocols are pragmatic and designed to easily be incorporated into a modern clinic.
Mark A. Kestner, DC, FIAMA, CCSP, CSCS
Kestner Chiropractic & Acupuncture Center
Murfreesboro, Tennessee
What an exciting resource! This textbook will revolutionize our profession. Athletes are constantly looking for ways they can
get an edge and perform at their best, especially when rehabilitating from an injury. Dr. Yun-tao Ma blends his many years of
experience with his rich scientific background in bringing his unique system of integrative systemic dry needling to the sports
world. Whether treating an acute sprain or strain, joint edema, delayed onset muscle soreness, or overtraining syndrome, I am
thrilled to have this new tool to utilize in getting the elite and recreational athletes I treat back to competition quicker than ever.
Robert Ohashi PT, DPT, OCS, ATC, CSCS
Physical Therapist for elite athletes
Athletes’ Performance Company
Phoenix, Arizona
Integrative systemic dry needling has brought a whole new dimension to physical therapy. Dr. Yun-tao Ma’s virtually
painless dry needling techniques described in this book allow for dynamic treatment of the body as a whole. I am amazed
at the body’s reaction to Dr. Ma’s dry needling: the rapid reduction of pain, edema, and muscle spasm, which in turn
restores proper postural alignment, enhancing total body function.
Janine K. Rodriguez, PT
Physical therapist with 25 years of clinical experience
Colorado Springs, Colorado
Dr. Ma’s approach to dry needling is an integrative and systematic methodology specifically designed for medical/
healthcare professionals. He is a true master with an ability to convey his extensive knowledge in a clear, concise, and
enthusiastic manner. His latest book reveals an in-depth understanding into various sports-related injuries and treatment
for athletes, which has helped me to attain optimal results with my patients.
Laina Eskin, PT
10 years of experience in dry needling
Vail, Colorado
This is the most important book written to modernize acupuncture in the 21st century. Dr. Yun-tao Ma brings this field
to the next level by incorporating dry needling into acupuncture. I believe dry needling is a modality necessary for any
acupuncturist who wants to successfully practice in the modern world.
Jai H. Sue, LAc
Hackensack University Medical Center
Westwood, New Jersey
A brilliant insight into the world of biomedical dry needling. Conventional pain concepts focus on neurological
processes. Dr. Ma’s integrative systemic dry needling technique treats both neurological dysfunction and pathohistological
abnormalities of soft tissues, the main causes of soft tissue pain. His approach aims at tissue healing, providing pain relief
without any side-effects. His new concept and approach greatly improve quality of clinical pain management, especially
for athletes who suffer from overtraining and various injuries.
Lorenzo Gonzalez, PT, DPT, OSC, MS, LAT
Team Physical Therapist
2008 USA Olympic Silver Medal Women’s Foil and Men’s Sabre Fencing Teams
International Faculty Member
Hamilton, Ontario, Canada
Disease is a drama in two acts. The first one happens in the gloomy silence
of the tissues, with the stage lights off. The pain or other symptoms only
arrive in Act Two.
∼R. Leriche, MD, French surgeon and author of
La Phylosophie de la Chirurgie (1955)
For Mila, Katrine, and Anton.
With love,
Yun-tao Ma
Foreword
Finally! A definitive text on dry needling in the sports This book presents information that will aid in
environment has arrived. Until now I have found no the prevention of injury by detailing needling tech-
meaningful information in print or on the Internet niques to facilitate maximal recovery from train-
that deals exclusively with the use of dry needling in ing and competition, delayed onset muscle soreness
the treatment and management of athletes. and overtraining syndrome. Prevention is always far
The use of dry needling in sporting clubs is not better then cure, but traditionally we have looked to
new. However, it has been my experience and obser- our strength and conditioning and skills coaches to
vation that needling is used simply as an adjunct build “bullet proof” athletes.
to traditional treatment techniques and is therefore By providing regular de-stressing treatments as
restricted to the release of trigger points. detailed in this book you can substantially improve
Working with elite athletes on a daily basis I am physical performance and give your athletes the
constantly looking for techniques that will give us an edge over their competitors.
advantage in reducing recovery time and returning This is a truly exciting text and a must-have
the athlete to competition. We are under pressure to for anyone working with athletes and sporting
return athletes to competition as soon as possible. teams.
While I was achieving good results incorporating
dry needling with the management of injuries, it Tim Cooper
was not until I had contact with Dr. Ma, and started Physical therapist for the Australian Rules football
using the correct techniques, that I noted the recov- teams and other elite athletes
ery time for contusions, strains, and sprains was Queensland, Australia
nothing less than amazing.
vi
Foreword
Dr. Ma takes our understanding of dry needling to a and athletes, the use of needles as a treatment
new level by explaining the comprehensive biologi- modality can be studied with a solid scientific foun-
cal and physiological processes involved with using dation, enhancing our understanding of this valu-
needles. able intervention.
Dry needling research has traditionally focused In our physical therapy clinics, many athletes
on treating local pathology and the local effects. request a comprehensive dry needling interven-
Advancing the use of dry needling from a focus on tion as developed by Dr. Ma and presented in this
local responses allows the practitioner to apply this book, noting improvement in flexibility and faster
intervention with a better understanding of all of recovery. For the athlete, dry needling may be
the potential systemic effects including those on the considered a “total body” intervention to enhance
central nervous system. performance and maintain function after training
Biomedical acupuncture combines the research and competition.
on dry needling with the worldwide research that
explains the effects of this intervention from a mod- Herbert L. Silver, PT, ECS, OCS
ern scientific perspective, giving us a more compre- Senior Clinician and President
hensive understanding of its effects. Velocity Spine and
Using the research foundation compiled in this Sports Physical Therapy
book and the clinical insights in treating patients Atlanta, Georgia
vviiii
Foreword
Dr. Ma, after 40 years of clinical experience and exten- predictable prognosis in athletes, military personnel
sive research in the fields of neuroscience and pain and individuals involved in heavy labor work.
at National Institute of Health (NIH), University of Dr. Ma defines a new meaning for dry needling
Maryland, and the University of Iowa, has formu- and provides a simple but comprehensive and thor-
lated a unique approach that addresses both local ough rationale and explanation of the mechanism
and systemic effects of dry needling for normalizing of effects of integrative systemic dry needling on
myofascial and soft tissue function, regulating body psychological, behavioral and physical aspects
homeostasis, preventing injuries, treating move- of the athlete’s performance. He provides ample
ment dysfunctions, and enhancing athletic perfor- functional and practical implications for using ISDN
mance beyond conventional methods. in any clinical setting.
Integrative systemic dry needling (ISDN) is an
indispensible modality that is easy to learn and can M. Reza Nourbakhsh, PT, PhD, OCS
be effectively applied by many clinical practitioners Professor, Department of Physical Therapy
involved in preventing and treating sport injuries, North Georgia College and State University
chronic pain, and movement dysfunctions with Dahlonega, Georgia
viii
Preface
Background
shorten their sports career. It is my belief that dry
Dry needling acupuncture is a new medical modal- needling is the most effective therapy yet discov-
ity for treating patients with soft tissue pain and ered for helping athletes to recover completely from
sports injuries. those conditions, as long as the practitioners know
Sports are specialized, skilled activities requiring the underlying mechanisms of needling and under-
actions that are highly coordinated among different stand how to use the needles correctly. This espe-
body systems. The nerves, muscles, and skeletal sys- cially true in athletes who do not show any physical
tem must cooperate in elaborate patterns of activity signs of pathology, but are affected by deep physi-
according to a precise timing sequence. If a muscle ological stress which can lead to future injury or
cannot conform to the current timing and pattern, premature tissue degeneration.
the coordination is broken and the speed and preci- Finally, many practitioners only concentrate on
sion of the performance will be impaired, possibly needling trigger points, when research tells us there
resulting in injury. are at least three other types of myofascial condi-
In clinical terms, optimal performance is tions affecting athletes, each requiring a different
dynamic and needs continuous maintenance. Many needling technique.
factors, especially overtraining, can obstruct the This book provides a thorough and complete
achievement of optimal performance. Sports scien- explanation of how to treat soft tissue dysfunction
tists, doctors, coaches, and athletes are always seek- and prevent the development of chronic injuries in
ing more effective procedures for treating intrinsic sports training and exercise, and it includes specific
muscular fatigue and other problems, and now dry needling procedures for achieving maximal recov-
needling acupuncture offers a solution. ery from training and competition, DOMS, and
The use of needling to improve performance overtraining syndrome. Athletes can substantially
in sport and to treat related problems and injuries improve their physical performance through regu-
is not new. In ancient China, all Kung Fu masters lar use of the de-stressing therapy introduced in this
were also masters of acupuncture. Today, although book, and they can also achieve complete recovery
clinical successes in treating athletes with needling from intrinsic fatigue, overtraining, and musculo-
therapy are reported from time to time, the full skeletal stress, while increasing the integration of all
potential of dry needling in sports medicine has not their physiological systems.
been recognized for at least three reasons. It should be emphasized that the modern modal-
First, the majority of practitioners do not under- ity known as dry needling acupuncture does not share
stand the physiological mechanisms of dry needling, any common foundation with traditional Chinese acu-
and so their practice is mostly empirical, based on puncture, which is based on ancient Chinese philo-
their personal clinical experience. sophical and cultural concepts. The term acupuncture
Second, although empirical practice can pro- is used here in the sense of its original Latin roots:
duce good results—sometimes even apparent acus (needle) and punctura (puncture or piercing).
miracles—in most cases the results are not as good In recent years the unique efficacy of dry nee-
as they could be. For example delayed onset mus- dling therapy has been recognized by an increas-
cle soreness (DOMS) and insufficient recovery ing number of medical doctors, physical therapists,
between training sessions and competition are com- chiropractors, occupational therapists, and others,
mon problems in most active athletes, and many who have appreciated its value and incorporated
athletes never take the time for complete regenera- it into their clinical practices. “Dry” as opposed to
tion and repair. This makes them prone to injury, “wet” needling is defined by Drs. Janet G. Travell
impairs their performance, and may ultimately and David G. Simons as “needling the soft tissue
iixx
x Preface
without injection of any liquid substance to treat of traditional Chinese medicine (TCM), widely
human pathology” in their classic text, Myofascial acknowledged as one of the great inheritances of
Pain and Dysfunction: The Trigger Point Manual. Chinese civilization.
They also state: “In comparative studies, dry Modern dry needling started in the 1930s in
needling was found to be as effective as injecting England and developed to maturity in the United
an anesthetic solution such as procaine or lido- States (see Chapter 10). Travell and Simons did
caine in terms of immediate inactivation of the comprehensive clinical research that led them
trigger point”.1 Their ground-breaking work and to define and locate most of the important trig-
other innovative needling methods such as the ger points of skeletal muscles in the human body.
approach of Dr. C. Chan Gunn, which is known They also noticed the relationship between trig-
as Intramuscular Stimulation (IMS), have laid ger points and internal visceral pathology. 1 From
the foundation of what is now known as the new the beginning they noticed that trigger points
modality of dry needling acupuncture. affect the posture and biomechanical balance of
Clinically, soft tissue pain is an aspect of soft tis- the musculoskeletal system. Other clinicians con-
sue dysfunction and may include myofascial pain, tributed different dry needling techniques, such as
other musculoskeletal pain, fibromyalgia, and other the Intramuscular Stimulation technique devel-
soft tissue pathology. Soft tissue injury is present in oped by Dr. C. Chan Gunn.2 These researchers
most types of sports injury. Dry needling acupunc- created the foundation of the analytical approach
ture is a very effective modality for treating acute in dry needling therapy. Then came the synthetic
and chronic soft tissue damage. An additional clini- approach.
cal benefit of dry needling is that it is effective in Dr. Ronald Melzack found that more than 70%
preventing the chronic injuries which result from of the classic meridian acupoints corresponded to
repetitive overuse of muscles as is commonly seen commonly used trigger points.3 Then the discov-
in sports and physical exercise. ery of homeostatic trigger points by Dr. H.C. Dung,
Dry needling acupuncture is a unified system Professor of Anatomy at the University of Texas
which successfully combines both systemic and Health Science Center at San Antonio, advanced our
analytical approaches. Practitioners should not understanding of the connection between homeo-
treat local symptoms only, but also need to restore static trigger points and the principle of the central
the systemic homeostasis of their patients. innervation of trigger points (see Chapters 7 and 8).
In contrast to wet needling, the clinical procedure Travell herself paid attention to Dung’s work (per-
of dry needling acupuncture emphasizes more tissue sonal communications between Travell and Dung
healing than pain relief, a more systemic approach in 1984 and between Dr. Dung and myself).
than treatment of local pathology, and both post- With 40 years of clinical experience and medi-
injury treatment and pre-injury prevention. cal training, I found that both the analytical and
synthetic approaches could be organically inte-
a brief history of dry needling
grated into a new modality—modern dry-needling
acupuncture
therapy. Working in the neuroscience program of
Like any medical procedure, dry needling acupunc- the National Institutes of Health and in the physi-
ture has gone through a period of development and cal therapy department of the University of Iowa,
may now be considered to be reaching its matu- I did research on pain relief and the neurophar-
rity. Dry needling as a medical technique has been macology of the central nervous system, kinesiol-
observed in various human civilizations for over ogy, cognitive neural science, and neurology. I was
two millennia. From historical literature, we know able to incorporate all these fields into dry needling
that it appeared in Egypt, Greece, India, Japan, and therapy.
China. The Chinese, as we know, systematically For the last 10 years, my colleagues in the U.S.,
preserved this technique, developed its medical China, Germany, Brazil and other countries and I have
value, and formulated the well-known acupuncture used dry needling acupuncture to treat thousands of