Treatment Modalities

Treatment Modalities

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Dry Needling

What is Dry Needling? Dry needling is the use of a solid filament needle to target myofascial trigger points. A myofascial trigger point consists of multiple muscle contracture knots, which are related to the production and maintenance of the pain cycle.

How Does Dry Needling Work? Inserting a needle into trigger points can cause favorable biochemical changes, which assist in reducing pain. It is essential to elicit so-called "local twitch responses."

What Can Dry Needling Treat? Dry needling can be used for a variety of musculoskeletal conditions. These include (but are not limited to) neck, back, and shoulder pain, arm pain, headaches including migraines and tension-type headaches, jaw pain and leg pain.

Is the Procedure Painful? Most patients do not feel the insertion of the needle. The local twitch response elicits a very brief painful response. Some patients describe this as a little electrical shock; others feel more of a cramping sensation. Again, the therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.

What are the Side Effects? Most patients report soreness after the procedure, best described as muscle soreness over the area treated and into the areas of referred symptoms. Typically the soreness lasts between a few hours to a couple of days. Patients may also experience localized bruising.

What Should I Do After Having Dry Needling? Our recommendations vary depending on the amount of soreness you have and on the individual response to treatment. Recommendations may include applying heat, gentle stretches and modification of activities.

How Long Does it Take to Start Working? Typically it takes several visits for a positive reaction to take place. We are trying to cause mechanical and biochemical changes without any medications.

Joint Manipulation

Joint manipulation is the passive mobilization of synovial joints in an effort to achieve a therapeutic effect. Effects include temporary relaxation of surrounding muscle and intra-joint pressure. This consequently can increase passive range of motion of the targeted synovial joints. With a high-velocity low-amplitude force, the capsule of a joint (containing synovial fluid) can be deformed causing a change in pressure within the joint space. The effects are temporary though positive and can allow for freer less painful motion during therapeutic exercise.

Myofascial Release

Myofascial release is an effort to alter connective structures by stretching or mobilizing adhesive tissues. The therapist moves slowly through the layers of the fascia causing a change to the fibers within. This is done either by hand or with the use of special therapeutic tools.

Instrument Assisted Soft Tissue Mobilization (IASTM) has gained popularity of late due to its low impact and effort for the relief of myofascial pain. It is often performed during motion and may even be used during a painful but tolerable motion to cause an effect during active stretch and relaxation of tissue.

Neuromuscular Re-education

Muscle movement patterns can be affected when nerves or muscles experience injury or have a painful stimulus of any sort. Neuromuscular re-education is a technique used to restore movement patterns through the repetitive motion to retrain control centers of the brain and reflexive actions of the spinal cord to perform in accordance with what is intended.

The strength of a muscle is dependent on many factors:

  • anatomic and physiological status of the muscle fibers at the time of contraction
  • number and synchrony of the contracting fibers
  • number and frequency of nerve impulses reaching the muscle fibers
  • functional status of the neuromuscular junctions
  • structural and functional condition of the tissues surrounding the muscle fibers, such as blood vessels and connective tissue

O. Leonard Huddleston, M.D., Ph.D. 1954;156(15):1396-1398. doi:10.1001/jama.1954.02950150018005.

The effectiveness of a treatment may address any or all of the above elements to elicit a more powerful, safe muscle contraction.

Therapeutic Exercise

Directed guidance through exercises designed specifically to address patients' dysfunctions such as a movement disorder, muscle weakness, lack of balance or reduced endurance. Each patient will have their own set of exercises to challenge their neuromuscular system specifically.


Our therapists utilize three different types of tape:

  1. Dynamic,
  2. Kinesio Tape,
  3. Rigid types such as the Leuko brand.

The various tapes may be used to stabilize a joint, restrict excessive joint motion or increase proprioception of taped area. This technique can be surprisingly effective to increase pain-free ROM. Its effectiveness is reduced after 3-5 days of use but can be worn in the shower, during exercise or any other daily activities.

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