Dry Needling

joe2008

Has anyone any experience of dry needling?

I have a problem in my hamstring, it's not responding to rest, traditional stretching or strengthening and I fear it could be high hamstring tendinopathy.

I haven't suffered a sudden injury but rather the issue has been underlying for a few months, and it's not improving at all.

I have seen a physio a few times, he gave me some stretching routines, which haven't helped.

I have read that some have had a successful outcome with dry needling, and cross friction massage.

Matthewfalle

who has told you it is or could be h/t?

joe2008

Google

Just a stab really, I really hope it's not. I do know that HHT is much more common in runners and I don't run.

However, the physio I saw treated it as a pulled hamstring and had me stretching, then strengthening for 8 weeks, it's no better now then it was before I saw him, so I have done some googling and this is where I am.

Matthewfalle

may i humbly suggest you ignore google and internet forum and go and see another physio, your GP or a medical specialist.

they can then examine you, take history, moi, etc that i am sure you don't want on here, do whatever needs doing, monitor you moving forwards. gait analysis, flexion/reflexion tests etc can't be done on a forum or through a search engine.

problem is is that the body is quite complicated and one thing can look quite like another unless you know what you are doing and have the full picture.

joe2008

Yes, thanks, already booked.

I just wanted to know if anyone had any experience* of dry needling, because it's one of the treatments that they may suggest.

*Has it worked? How many sessions did they need? Does it hurt? General stuff like that.

Matthewfalle

one of the treatments with so many variables. and you may not even need it.

i wouldn't worry about it until it actually happens which it may not and even then i'd go with what the hcp says.

joe2008

Matthewfalle wrote:

one of the treatments with so many variables. and you may not even need it.

i wouldn't worry about it until it actually happens which it may not and even then i'd go with what the hcp says.

You're right, I just feel like I have wasted 2 months potential rehab time going with what the last hcp said.

maryka

I am battling HHT at the moment. Had it about a year now, it came on after I strained my right hamstring a year ago November in an XC running race. I think the tightness/weakness in my hamstring meant that the stress on that muscle migrated upwards to the tendon. I ignored/trained through it for the first 6 months, and even when I had some enforced rest time it was no better. So I decided to self-treat which was hit and miss, then finally started seeing the student physios at uni in October.

They have given me a load of deadlifts and other exercises to do in the gym which is improving it. Glute bridges every day at home and before any cycling or running. No direct pressure or massage on the area as it just irritates it more, but I'm foam and ball rolling the muscle further down.

It seems to be a very very slow injury to heal, some days it's like 2 steps forward and 1 back in terms of the nagging pain but I do think it's getting better rather than worse. It's not so debilitating that I am ready to start looking at more invasive options yet. There's a lot of research on eccentric exercises for tendon injuries which is basically what I'm doing. But it's helpful to have someone else look at it properly in the context of your whole body and any imbalances etc. In my case the chronic developed from an acute injury, but in your case if it came on gradually it may be something that you need a more holistic view to fixing.

whyamihere

I've had it for an issue with my shoulder/neck a few months ago. I'm generally massively skeptical of this kind of thing, but it did help for me. I walked in to the physio's room barely able to move my head and lift my arm, and left after the needling and a few other treatments with significantly improved mobility and less pain. A second session a few days later saw further improvement.

In terms of the actual experience, yes, it hurts, but it hurt a lot less than the actual problem. My physio told me that not everybody can put up with it, but the sessions only last about 10 minutes, and it's really not agonising. I had 2 sessions about 3 days apart. It and the rest of the treatments with the physio didn't completely resolve the pain and lack of mobility, but they allowed me to move sufficiently to perform the exercises he gave me which eventually got me the rest of the way. I didn't go in and ask for the needling as a treatment (I'd never heard of it in advance), it was on the suggestion of the physio.

joe2008

maryka wrote:

I am battling HHT at the moment. Had it about a year now, it came on after I strained my right hamstring a year ago November in an XC running race. I think the tightness/weakness in my hamstring meant that the stress on that muscle migrated upwards to the tendon. I ignored/trained through it for the first 6 months, and even when I had some enforced rest time it was no better. So I decided to self-treat which was hit and miss, then finally started seeing the student physios at uni in October.

They have given me a load of deadlifts and other exercises to do in the gym which is improving it. Glute bridges every day at home and before any cycling or running. No direct pressure or massage on the area as it just irritates it more, but I'm foam and ball rolling the muscle further down.

It seems to be a very very slow injury to heal, some days it's like 2 steps forward and 1 back in terms of the nagging pain but I do think it's getting better rather than worse. It's not so debilitating that I am ready to start looking at more invasive options yet. There's a lot of research on eccentric exercises for tendon injuries which is basically what I'm doing. But it's helpful to have someone else look at it properly in the context of your whole body and any imbalances etc. In my case the chronic developed from an acute injury, but in your case if it came on gradually it may be something that you need a more holistic view to fixing.

Thanks Maryka. I've found a great podcast here:

https://soundcloud.com/physioedge/pe-01 ... grimaldi-1

I hope it helps, good luck with your recovery.

Obviously, I'm hoping I haven't got HHT. It is never painful for me to sit, which seems to be a good indicator, so at least that's promising.

maryka

joe2008 wrote:

Obviously, I'm hoping I haven't got HHT. It is never painful for me to sit, which seems to be a good indicator, so at least that's promising.

The main test I use to judge how it's coming along is the foot raise. Sit with your legs out in front of you and hands behind. Lift your butt off the ground with heels on the ground. Lift your bad leg and see how it feels with your good leg. Then lift your good leg. If you get pain at the top of the hamstring, that's HHT.

Another easy test is removing your shoes by pulling the heel of your foot against the toe of the other. Again, if it hurts in that spot when you pull off the shoe on your bad leg, that's a good indication.

Mine mostly doesn't hurt to sit except when I've overdone it (like I did doing on and off the bike CX stuff yesterday, running with the bike up a hill etc.) Back around Easter when it was bothering me to sit, I got a kneeling chair, and then in the autumn I went for a standing desk too. All that sitting isn't that good for your back and hip flexors anyway, especially as cyclists where we're already hunched over with tight hips all the time on the bike.

Do update the thread if you end up being diagnosed with it and get any invasive therapy like dry needling, injections, etc. Be curious to hear how it goes.

joe2008

Tried both those tests and the pain is not right at the top of the hamstring where it joins the ischial tuberosity but more two thirds up.

What I didn't mention is that I have had a strange sharp pain in the back of my heel all year which I only get when I stretch my hamstring, or flex my foot, could this be a nerve problem?

I have just found, and done a slump test and this is positive, so it could be neural.

https://www.chronicconditions.co.uk/opi ... imary-care

Matthewfalle

please ignore all this self/forum diagnosis and go and see a hcp.

joe2008

Matthewfalle wrote:

please ignore all this self/forum diagnosis and go and see a hcp.

Will do, but not until Wednesday.

maryka

Yep get thee to a physio with this new knowledge!

joe2008

maryka wrote:

Yep get thee to a physio with this new knowledge!

Matthewfalle

maryka wrote:

Yep get thee to a physio!

ftfy

sungod

and make it a proper sports physio

Matthewfalle

and please don't tell him/her what you think it is because you read it on google/some bloke told you on a forum. you have not gained any new knowledge at all.

hdow

Yes to the original question. I've had what the physio called dry needling after a full assessment of pain in one of my glues. Turned out to be an overactive piriformis. A needle was inserted into the tight muscle which sent it into severe spasms after which it relaxed and the pain was gone and stayed gone. The procedure took a couple of minutes tops. Have also had intramuscular nerve stimulation (IMS) from a physio, again after a full assessment, and although he said it was different it seemed the same to me. Again it worked.
Please note that in both cases the problems were muscle over activation and had nothing to do with tendons. Alternative treatments were available if there were issues with needles.

apreading

In my experience, dry needling is used as a quicker and more effective alternative to treatment which otherwise can be done with trigger point massage. This is where a muscle is tight/in spasm and tender and by finding the appropriate trigger point (the most painful point) and pressing hard for 20-30 seconds, the muscle just suddenly relaxes and tension is relieved. You can actually do some of this yourself and pretty effectively with foam roller and/or trigger point massage balls, but physio can get to spots which are hard to do yourself and can sometimes dig in deeper and do it more effectively. Dry needling can do as much as you would do in a couple of physio sessions in about 10 minutes and can treat multiple areas simultaneously. Its fantastic if the resolution to your problem is trigger point release but if thats not the cause then I dont imagine it would be much use.

If you have already seen a decent physio and they havent done trigger point release because they dont think that is the right treatment for your condition then dry needling probably wont be appropriate. Some physios are pretty poor though and always just recommend stretches and/or kinesiology tape and/or stap you up to an infrared machine for half an hour and take their payment for going through the motions with little effort... If you had one of those then try another - a good physio is the answer rather that trying to diagnose yourself.

joe2008

Thanks for the replies and information.

Not sure what my problem is, but I do know that 2 months of hamstring stretches and strengthening prescribed by my physio did not sort it out.

The new physio I am seeing on Wednesday lists dry needling as one of her specialities, so I will wait and see what she thinks.

kingrollo

I had HHT and it took me 3 years to get over it. Sure google isn't ideal - but I seen a whole host of specialists, gp's, physio, orthopaedic surgeons - none of them knew about HHT. I got misdiagnosed at least twice:-

1.The One orthopaedic surgeon - ignored everything I said , over talked me and told me it was bulging discs in the spine referring pain down - He gave me 2 rounds of excruciating prolotherapty - which was making matters worse - I insisted on a scan - which showed no such bulging of discs

2.Then like the OP I got treated for tight or torn hamstrings - this ended up with me using a stick to walk for a couple of weeks - the more I stretched the hamstrings the worse it got.

3.Finally I got to see a consultant in sports exercise medicine - more scans, even had dye injected into my hip under MRI - Fair play to the consultant here - despite the scans not showing tendonathapy - He called the diagnosis of HHT - Got me some dry needling under MRI or ultrasound - this was where I had my big stroke of luck I got to see a guy who specialised in high hamstring pathology - He did 2 rounds of Dry needling , and recommended thrice weekly cross frictional massage - together with the sports excercise guy - they gave me a program of heavy one legged deadlifts, and prone hamstring curls - and do these with serious weights to the point of fatigue - it told me it would take year to get back on my bike - it took 18 months

Its flared up once since - I phoned a few private physio's and asked what they knew about HHT - and if they are prepared to do cross frictional massage & dry needling. a surprisingly high quota didn't inspire confidence. Then one lady physio seemed right on the money - I took her all my paper work - 2 dry needing sessions pain gone hasn't been back since.


So yes go and see a HCP - but if it is HHT don't be surprised if they miss it - its not common anyway - and is you say is more a runners injury than cyclists. Its often misdiagnosed , piriformis syndrone, pudendal nerve, bulging discs, traditional hamstring strain etc - also some physio's won't do cross frictional massage for fear of irritating the sciatic nerve. Even with a correct diagnosis it is notoriously difficult to treat.

Good luck.
If you want names of people I seen get in touch.

kingrollo

maryka wrote:

I am battling HHT at the moment. Had it about a year now, it came on after I strained my right hamstring a year ago November in an XC running race. I think the tightness/weakness in my hamstring meant that the stress on that muscle migrated upwards to the tendon. I ignored/trained through it for the first 6 months, and even when I had some enforced rest time it was no better. So I decided to self-treat which was hit and miss, then finally started seeing the student physios at uni in October.

They have given me a load of deadlifts and other exercises to do in the gym which is improving it. Glute bridges every day at home and before any cycling or running. No direct pressure or massage on the area as it just irritates it more, but I'm foam and ball rolling the muscle further down.

It seems to be a very very slow injury to heal, some days it's like 2 steps forward and 1 back in terms of the nagging pain but I do think it's getting better rather than worse. It's not so debilitating that I am ready to start looking at more invasive options yet. There's a lot of research on eccentric exercises for tendon injuries which is basically what I'm doing. But it's helpful to have someone else look at it properly in the context of your whole body and any imbalances etc. In my case the chronic developed from an acute injury, but in your case if it came on gradually it may be something that you need a more holistic view to fixing.

Sounds similar to my treatment. I would ask to be reviewed as a dry needling candidate. The NHS will be reluctant as they only do it under ultrasound or MRI which obviously costs. A decent private physio will do it for a £40 per session - If you are year in it might be worth considering.

joe2008

Saw the new physio today. Both hamstrings are strong; my right hamstring (where I have the issue) is more flexible, probably due to the 8 weeks of stretching I have done on it under the other physio.

She seems to think that there is a congestion of the sciatic nerve at the ischial tuberosity / top of the hamstring.

She stuck in two long needles (dry needling), one at the origin and one in my lower back, followed by some cross friction massage.

She told me to keep moving as much as possible (cycling ), and not sit around resting.

She also told me to stop focusing on my right hand side, and focus more on the left, good, side, and to stop sitting cross legged.

She gave me some hip flexor exercises to do, and some neuro dynamic hamstring movements.

I'm very happy with the consultation.

kingrollo

joe2008 wrote:

Saw the new physio today. Both hamstrings are strong; my right hamstring (where I have the issue) is more flexible, probably due to the 8 weeks of stretching I have done on it under the other physio.

She seems to think that there is a congestion of the sciatic nerve at the ischial tuberosity / top of the hamstring.

She stuck in two long needles (dry needling), one at the origin and one in my lower back, followed by some cross friction massage.

She told me to keep moving as much as possible (cycling ), and not sit around resting.

She also told me to stop focusing on my right hand side, and focus more on the left, good, side, and to stop sitting cross legged.

She gave me some hip flexor exercises to do, and some neuro dynamic hamstring movements.

I'm very happy with the consultation.

Would that be compression of the sciatic nerve ? rather than congestion ?

I realise it might not be for you - but I found chamios cream and a leather saddle really helped - advice seems sound, but I would try to avoid consecutive days cycling - If you get lazy with stretches I would recommend a yoga class

joe2008

I'm confident that the only issue I have with my hamstring is that it is tight due to anterior pelvic tilt caused by shortened hip flexors.

The hamstring stretches I was given by my previous physio were making matters noticeably worse by stretching an already stretched tendon.

I've already noticed an improvement after a few days of hip flexor stretches, so I believe I now have a good idea of what is going on and can hope for a successful resolution.

The dry needling I was given has 'relaxed' the area to the extent that I can now comfortably roll a hockey ball under my bum which was very painful before the treatment, this should help the sciatic nerve pass through the area better than it has been doing.

gingerflash1975

OP has asked how it felt and did it work?

I had dry needling and electric needling for a knot in my neck/shoulder.

It was slightly uncomfortable/painful, especially the electric needling, but what physio treatment isn't?

I had it done about 5 or 6 times.

It did not help me at all.

maryka

kingrollo wrote:

Sounds similar to my treatment. I would ask to be reviewed as a dry needling candidate. The NHS will be reluctant as they only do it under ultrasound or MRI which obviously costs. A decent private physio will do it for a £40 per session - If you are year in it might be worth considering.

Just caught up with this thread. My diet of single and double Romanian deadlifts and Nordic hamstring curls, along with more glute and general hamstring work (regular deadlifts, thrusts, etc.) seems to be improving it over these past few weeks. It was never bad enough to have to get off the bike or stop running, so I'm ok with the slower improvement especially now that I know it is improving. Will ask about the dry needling at my next visit though. I was told to avoid massage directly on the high hamstring area as it would just irritate the tendon, where were you getting your cross-friction massage -- lower down the hamstring or right at the tendon?

kingrollo

maryka wrote:

kingrollo wrote:

Sounds similar to my treatment. I would ask to be reviewed as a dry needling candidate. The NHS will be reluctant as they only do it under ultrasound or MRI which obviously costs. A decent private physio will do it for a £40 per session - If you are year in it might be worth considering.

Just caught up with this thread. My diet of single and double Romanian deadlifts and Nordic hamstring curls, along with more glute and general hamstring work (regular deadlifts, thrusts, etc.) seems to be improving it over these past few weeks. It was never bad enough to have to get off the bike or stop running, so I'm ok with the slower improvement especially now that I know it is improving. Will ask about the dry needling at my next visit though. I was told to avoid massage directly on the high hamstring area as it would just irritate the tendon, where were you getting your cross-friction massage -- lower down the hamstring or right at the tendon?

My CF was pretty close to the insertion point. 1 physio wouldnt do CF for fear of irratating the sciatic nerve. Think he was a rookie though.

joe2008

3 weeks post treatment, dry needling and cross friction massage, and my hamstring problem has improved greatly.

I have been stretching my hip flexors a lot and it has made a huge difference.

I rode 500km in Festive 500 week, about 20 hours of cycling with two 7 hour hilly rides. I can't say that they were pain free, but considering I hadn't ridden for more than an hour and a half at a time for 3 months, it went very well.

Yesterday I had what I would call my first pain free ride, a couple of hours with some hard efforts, so that was encouraging.

I'm now able to do a backwards, one-legged bridge without too much pain, that's a hell of an improvement. 3 weeks ago, before my consultation, I couldn't stand the pain of a couple of seconds. I think that could be pain free in a couple more weeks at the current rate of improvement.