 Hi, I’m Dr. Danny Matta DPT. I’m a Physical Therapist/Strength Coach and I’m the founder of Athletes’ Potential. Our company helps people just like you live higher quality, higher performance lives. That could be running your first 10K, competing in the CrossFit Games or getting rid of that lingering back pain so you can start getting back in shape! Dry needling is a technique we use frequently. I hope you have a better understanding of what it is after this article. Please email us if you have any other questions and we’d be glad to answer them for you. When I was in the Army as a Physical Therapist, I remember first hearing about dry needling and thinking how crazy it sounded. I remember thinking PTs that were doing dry needling were searching for some kind of voodoo treatment that only had placebo effects. I actively stayed away from learning it because at the time I was a new graduate that thought I knew everything and was going to set the world on fire by getting everyone better. Well, things changed one morning when I wrecked my back after a ruck march training session. I hurt my back so bad I could barely drive home and had to cancel all my patients that day. I threw everything at it that I knew and even enlisted the help of a few of my colleagues. Six months later, my back still hurt to pull weight from the ground, back squat or run (that was literally 80% of my training at the time!). About that same time, a new physical therapist named Dr. Emmanuel Easterling moved to where I was stationed. Dr. E, as we called him, was a certified dry needling ninja. I reluctantly let him perform his voodoo on my back and I'm so glad that I did! Within 2 days of Dr. E dry needling my back for the first time, I was running with no back pain. After the second time he did it, about a week later, I was squatting and deadlifting again. That was it- I was hooked and not only did I drink the Kool-Aid but I chugged it! I dove into dry needling head first and learned as much about it as possible.  So what does this technique do and why is it so effective? That’s a great question and the answer is we don’t fully know. Frankly, medicine is constantly evolving and we are always using our best evidence/knowledge at that time. Dry needling is the same way so as I answer this, understand there is probably way more to this than we even know. First, dry needling involves placing small needles into strategic spots in the muscles. These spots were recognized and mapped out by a physician named Dr. Janet Travell, MD. She was an incredibly smart lady and was even John F. Kennedy’s personal physician during his presidency. Did you know he had chronic back pain? Yep, and what did she use to alleviate the back pain? You got it- dry needling! The points Dr. Travell mapped were called trigger points. This trigger points in the muscle actually refer pain, not just where the “knots” in the muscle are, but to other areas of the body. Here’s an example of a trigger point in the upper trap. The X is where the trigger points are typically found. The dotted red areas are where the trigger points refer pain. Have pain on the inside of your shoulder blade? It could be just an irritated trigger point in your upper trap that dry needling would help fix really fast!  So how does a needle in a muscle cause pain to resolve quickly? There are a few theories on why this happens and I like to explain it in terms most of us understand: Think of a trigger point like a glitch in your computer. Something isn’t working right and it’s causing other things to have issues as well. What fixes most computer problems? You got it- the restart!
Dry needling is like the restart for the musculoskeletal system. If we have a irritated trigger point and we put a needle in it, it resets. This reset occurs at the muscle with what’s called the wash out effect. This basically means that a needle in a muscle causes increased blood flow to the area. Increased blood flow causes increased oxygen/healthy blood to shunt to the area. Local inflammation/stagnant fluid gets “washed out” by this effect. There has also been evidence to support the theory that dry needling has a strong effect on the nervous system. Basically, placing a needle in a trigger point causes local opioids (our bodies own natural painkillers) to be released. This also causes a positive pain relieving effect on the spinal cord. This means we can get a local and central pain relieving effect from this technique. Yes, most people are sore for a day. It feels like you worked out hard and the muscle is fatigued. In addition, you have to perform self-treatment work to really get the best benefit from dry needling. Picking the right home exercises and doing the right technique is where the magic is.
If you’ve been struggling with an injury or pain that’s stopping you from the activities you love, this might be a very effective treatment option for you. You have a choice. You don’t have to wake up every morning and hope that this is the day your shoulder/back/neck or whatever areas stops hurting. It’s sad how many people are in pain daily. It stops them from playing with their kids, walking 18 holes in golf, staying in shape and living overall happier lives. If you’re in the Atlanta area and you’d like to talk with one of our Doctors of Physical Therapy to find out if our approach is right for you, contact us. We’ll set up a free 10-minute phone consultation at your convenience. Thanks for reading. -Danny
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 Many active women wish to continue their lifestyle even through pregnancy. Aerobic activity and resistance training are fantastic for maintaining fitness while keeping the baby healthy. Of course, always consult your doctor after becoming pregnant to make sure that it is safe to exercise at various intensities. 
The general guidelines are to accumulate at least 20 minutes of moderate intensity almost every day of the week. For those of you who look for more intense activity, 3-5 days of vigorous activity is suggested for 20-60 minutes per bout.  Baby Bumps & Barbells guidelines:
Targeted Strengthening As the baby bump grows and the center of mass is moved forward, your posture will be affected. The lumbar lordosis, or curve of the low back, will increase drastically throughout the pregnancy. Often times, your thoracic spine will flatten. Although postural changes are expected and normal, it is important to continue to maintain the best posture possible. Continuing upper body strength training and focusing on proper posture are key. Another group of muscles that is greatly affected during pregnancy is the posterior chain. I’m talking specifically about the glutes and the hamstrings. Any barbell work to strengthen these areas should be continued throughout, keeping the baby bumps and barbells guidelines in mind. Lunges and squats remain some of the best and most simple workouts to target the posterior chain with little risk. Birddog- if achieving this position proves to be too difficult, you can keep your knees down and extended just one arm at a time. Then you can progress to extending just one leg at a time before combining for an arm and a leg simultaneously.  Safe Stretching As mentioned earlier, pregnant women are inherently more bendy than they were pre-pregnancy so stretching may seem unwarranted. However, most of these stretches are aimed at relieving areas of pain or tension from the growing bump and new posture. Child’s pose- as the baby bump grows, this can be modified by having your arms and hands out-stretched on a workout ball, chair, or any other elevated surface. A large ball will give you the option of small rotations right and left with your arms to feel the stretch intensified along your sides.  Seated Hamstring Stretch- as the bump grows it may be necessary to use a bed sheet wrapped across the bottom of the foot and held with the hands.  Hip flexor stretch- while standing at the bottom of a staircase, place the lead foot two or three steps up. Keeping the back leg on the bottom with a slight bend in the knee, shift the weight forward to the lead foot to the point that you feel a comfortable stretch in the front of you trailing hip. Cat Cow- a great way to stretch the lower back and get the thoracic spine moving throughout the entire pregnancy.  Pigeon- if you are unable to achieve or maintain this position, adding a firm pillow under the upper thigh of the back leg and buttock area of the front leg may be more comfortable.  Deep Squat- a great stretch for your hips and pelvic floor during the pregnancy. **Caution – in the third trimester, ask your doctor before trying this stretch as it may induce labor **   Remaining active will lead to a healthier and happier pregnancy. Keeping the posterior chain strong can ward off back pain for mom while exercise activity increases blood flow for the baby. Remember, it is important to always listen to your body and consult healthcare professionals when questions arise.
Thanks for reading! -Dr. Jackie References R Artal, M O’Toole. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Photos: FitPregnancy.com, tfwropestone.com, fusionwellness.com, themusicmommy.com, alimcwilliams.com, momjunction.com  Here’s a scenario I see all too often in my clinic: You’re a middle-aged, ex-athlete but you still like to workout and are a weekend warrior. You bang your knee up a little doing a CrossFit workout or a long trail run so you go to see a physical therapist. You have a good job and you have health insurance through your company. You pick a clinic that you find that takes your insurance that’s near your home or office and go in for your first visit. You get your diagnosis, they do some work on you and then you leave with some homework and a plan going forward. This plan is typically to come back 2-3x/week for 4 weeks. As you head to the front desk to check out, they present you with a bill. The bill is for $250 and is due today for the cost of your treatment session. You’re completely caught off guard. You are almost positive that you had read you have a $40 co-pay for physical therapy. The front desk staff explains to you that is correct but it’s only a $40 co-pay after you’ve met your deductible. Your deductible is $2000. She explains that once you’ve met that out of pocket expense which should be after the 8th visit, then you will have a $40 co-pay. You pay the bill and leave aggravated. You wonder why the hell you’re paying $400 a month for insurance. Why didn’t anyone tell you before that you had to meet the deductible first before your insurance started kicking in? My opinion on insurance is that you only win if you lose. What I mean by this is that you really only get a return on what you’ve been paying for if you get hurt badly or get very sick. We all need insurance for these catastrophic events but most people can expect their insurance to pay for very little if they are healthy. It used to be that deductibles were as low as $200 and maybe $1000 on the high side. I know individuals that have a $3000 deductible on a single person policy. I’ve seen family deductibles in the $10000 range. They are trending higher and the emphasis on the consumer (you) to pay more out of pocket is expected.  First, let’s clear up some confusion. In the scenario I laid out above, the $250 is an estimate. If the physical therapy practice that you go to is in network with your insurance, that means they have a contract and will charge set amounts. If you want that money to go toward your deductible, that clinic has to charge you the same amount they would bill your insurance company. Let’s do a little bit of math here and show the true cost to you assuming you want to use your insurance and apply your physical therapy towards your deductible. $250 a visit x 8 visits to meet the deductible= $2000 4 more visits to meet the 12 visits recommended by the physical therapist at the co-pay amount of $40= $160. Total cost for physical therapy= $2160 Last thing is to factor in the the cost of your time. You have now gone to the clinic 12 visits, each for 1 hour. Let’s assume that round trip you drive 30 minutes to each visit, that would come out to 6 hours of driving back and forth from the physical therapist. Add in 1 hour for each of the 12 visits you spend there and that equals 18 total hours. Total cost $2160 and 18 hours of your time. Let’s compare this to an out-of-network model like the one we use at Athletes’ Potential. Because we have no contracts with insurance companies we can charge whatever we want. Our office visit is $175 for an hour visit. This exclusion of being in network with an insurance company allows us to make decisions based on patient needs, instead of when you may or may not meet your deductible. Our clinic average is currently between 3 and 4 visits. Let’s say we see this patient once a week for 4 weeks for a total of 4 visits. $175 a visit x 4 visits= $700 We also need to factor in the time cost. Let’s say we have the same 30 minute round trip commute to our clinic. This patient makes a trip 4 times for a total of 2 hours driving. Total time commitment 4 hours of physical therapy plus 2 hours of driving= 6 hours. Total cost $700 and 6 hours of your time. So if it’s less expensive and costs less time to not use your insurance, why would you want to use it? That’s a tough question to answer. I think most people don’t actually know what their health plan covers or doesn’t cover. It’s also very confusing to look at your benefits sheet and try to figure out what it all means. You have a deductible, a copay, co-insurance, family vs individual and max out of pocket expenses. No wonder people show up at a clinic thinking they have a $40 copay and get slapped with a $250 bill. So should you just dump your insurance? Well, no, you legally need it and hopefully you never have a catastrophic event but if you do, that insurance will come in handy. I also think there are a few scenarios where you should use your insurance. The main physical therapy scenario in which you should use your insurance is if you need surgery. Surgery in most cases will be expensive enough to meet your deductible. Once that deductible is satisfied you owe that $40 co-pay for your insurance. Early on in the post surgery physical therapy plan it’s important that you get consistent treatment. It’s also not rocket science. They know why you’re there and for the first 6 weeks in many cases they are following a standard post surgery protocol laid out by the doctor. We actually turn people away almost every week that just had surgery. Not because we don’t think we can help them but because it will be more cost effective for them to go to a in network clinic since they’ve met their deductible. Once they get out of the early stages of rehab and can get more into return to sport/activities they will switch over to us for home based programming and advanced movement retraining.  Here’s the litmus test I usually give people to see if it’s worth it to use their insurance or seek out a provider outside of their insurance contract.
Have you met your deductible?
Do you value your time?
I hope this helps navigate some of the difficult to understand territory that is our current health system. Before you decide to go see someone for physical therapy, ask yourself the questions I posed in this article. If you’re in the Atlanta area and you want some help dealing with an injury or getting back to an activity you’ve been avoiding, give us a call. We can set up a 10 minute phone consultation with one of our Doctors of Physical Therapy to see if you’re a good fit for what we do. Thanks guys. Danny |
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