RecoverRx Performance and Recovery Blog
This blog is dedicated to all things from recovery to performance. Our industry expert Physical Therapists provide evidence based information and opinions educating our readers on how to optimize their health in order to be able to overcome injuries and live the life they were meant to live!
By Dr. Luke Greenwell, PT, DPT, CSMT, CSCS
Can dry needling help my shoulder injury? Dry Needling can be a very effective treatment strategy for men and women with musculoskeletal pain including rotator cuff injuries with or without tears.
What is Dry Needling??
Dry needling treatment involves insertion of solid (non-hypodermic) needles into the muscle or fascia below the skin. “Dry” refers to the fact that there is no medication in the needle. There has been plenty of research to support dry needling (also known as trigger point dry needling, intramuscular dry needling, and needling) as an effective way for Licensed Practitioners (Physical Therapists, Chiropractors, Physicians, and Acupuncturists) to:
There has been a historical misconception that dry needling is used only for patients with myofascial trigger points as a way to “release the trigger point.” However, recent evidence is out there to support other neurophysiological mechanisms for pain relief and muscle tension reduction.
In fact, we use Dry Needling in many of our patients as a way to increase muscle activation and biomechanical feedback when attempting to retrain normal movement patterns and increase strength in the injured extremity.
What is the Rotator Cuff and How can it get Injured?
Rotator cuff injuries including tears are some of the most common causes of disability across the globe. The rotator cuff is a group of 4 muscles (infraspinatus, teres minor, supraspinatus, and subscapularis) that in isolation can perform different movements of the shoulder but in conjunction have the main function of stabilizing the head of the humerus (ball) in the glenoid (socket) to avoid asymmetrical loading on different tissues that help stabilize the shoulder.
Rotator cuff injuries can either be traumatic (falls, weightlifting, or throwing) or chronic degeneration (small tears that add up over time). Once the rotator cuff is compromised, the normal biomechanical movement properties of the shoulder are affected and can lead to pain, weakness, and compensatory movement strategies. In many cases, strains and small to medium tears can heal with the right treatment strategies but in some cases, with large tears surgery is warranted. I won’t be covering surgical recovery cases in this article, but will mostly focus on how we utilize Dry Needling in our Rehab for our patients with rotator cuff strains or small to medium tears.
How Do We Utilize Dry Needling to Treat Rotator Cuff Injuries?
Let’s talk about how we address these injuries in the clinic while utilizing Dry Needling as a therapy. The most important start to our process is to develop an accurate working diagnosis of rotator cuff injury via a comprehensive shoulder evaluation. From there we are able to identify
Typically after 1 session of dry needling (this can involve multiple needle insertions to multiple muscles) we do see a very immediate change. With that being said, we typically need multiple sessions over the course of a couple weeks. We like to educate that there will be some soreness in the areas where we see a significant response (known as a muscle twitch response).
What do I need after I receive Needling treatment?
After the dry needling is performed to the identified areas, we can use the rest of the session to focus on:
This Strategy Works!
It’s a tried and true strategy that has worked for thousands of patients we have seen for shoulder pain and although every patient is different, we find this system to be very effective in helping patients recover from rotator cuff injuries. Our 3 step process of Recover (from painful limitations), Rebuild (functional movement patterns) and Redefine (future strength and performance) could never be more true for our patients with rotator cuff injuries.
Check out this videos of a Dry Needling Technique: www.youtube.com/shorts/cfXC0UI6xGY. To see even more, subscribe to our YouTube Channel and Follow us on social media @recoverrxpt.
If you would like more information on our approach to treating shoulder pain in addition to rotator cuff injuries, please feel free to reach out to us via email at email@example.com.
Thanks again for checking in and be on the lookout for our next Badass Blog!
Use Every Setback As A Comeback!
Do I need an MRI for shoulder pain?
In order to effectively treat so many people with shoulder pain, we need to be able to diagnose the problem, create a clear path for treatment, and establish steps for the resolution of pain. We do this on a daily basis without the use of X-rays or MRIs. Although we don't utilize medical imaging in creating our clinical diagnosis, I will explain to you why 2 other aspects of the evaluation are more important than an expensive image. Those 2 aspects are the subjective history and physical examination.
When a patient presents to the clinic, the first thing we do is listen and let the patient explain their story- we are looking for key features which help to explain common causes of pain. Subjective history includes:
Physical examination includes:
The information gathered from the subjective history and physical examination will create a clear picture if an MRI is warranted or if treatment can begin in the clinic.
Let's break down 2 patient examples of how a physical therapist would use their skills to determine if an MRI would be necessary.
Patient 2: Shoulder pain began 3 months ago without a known cause, but started to hurt when bench pressing and military press. He denies any history of trauma. Pain is not present at rest but only hurts during reaching in the backseat of his car or at the gym. His pain is the same but not constant. If he avoids bench press and military press his shoulder does not bother him in the gym. Physically he has limited active motion overhead and in rotational motions. His strength is appropriate in all motions but has pain and a little weakness when resisting motion with arm away from body. His joint mobility is limited in rotation in 1 direction and has tenderness along his rotator cuff muscle. He occasionally has numbness in the outside of his arm after sleeping on his side.
Hopefully reading through the subjective history and physical examination of 2 different patients, you can see that these patients' recommendations may be a little different.
I would recommend an MRI for patient 1, but I would not recommend an MRI for patient 2.
For patient 1- his injury was traumatic- there is a known cause for a potential significant tissue injury due to the force from a fall. His functioning is very poor with inability to lift arm, his strength indicates a potential significant injury to his muscle system, and his pain is not improving whatsoever even after 7 days.
For patient 2- there was no injury that caused the pain so the likelihood of significant tissue injury is very low, his biggest limitation is weakness caused by pain which is typically related to mechanical issues versus structural issues. His functioning is appropriate, his pain is not constant, and it does not limit him outside of the gym.
As you can see, there is a lot of information needed to determine if an MRI is appropriate and warranted for each individual case. Seeing a skilled physical therapist for your shoulder pain is the Best First Step to set you on a path to recovery. We will use your subjective reports and physical exam to create a clear diagnosis for you, as well as a treatment plan to resolve the pain and get back to the things that matter most.
Learn more about our unique approach to resolving shoulder pain: https://www.recoverrxpt.com/shoulder-pain.html
For more on this topic, check out our YouTube Curiosity Corner. Or give us a call to set up a visit: 331-253-2426
Dr. Luke Greenwell, Dr. David Bokermann, Dr. Sarah Greenwell, & Dr. Ariel Sernek are Performance Based Physical Therapists with extensive backgrounds in treating the injured athlete. At RecoverRx, they are passionate about returning people to the sports & activities they love. Check out more about them by visiting our About Us page.