What Dry Needling Looks Like for the Shoulder
There is a certain degree of uncertainty around anything new and dry needling is no exception. At Resilience RX, we use dry needling a lot (although it’s certainly not the only hands-on treatment we do). A good chunk of the time, clients have never had dry needling before. Because of that, we wanted to show you what to expect if you do have dry needling done.
This post specifically discusses what dry needling looks like in the shoulder. The video below walks you through what we’re doing, why we’re doing it, and how we’re doing it. Below the video, we’ve discussed the key points and information we cover in the video. Feel free to watch, read, or both to get a better understanding!
Dry Needling for Rotator Cuff Pain
Rotator Cuff Pain Overview
Lindsey has rotator cuff pain and volunteered to be a demo person for us. She previously played volleyball and presents with pain in the front of her shoulder. Rotator cuff pain is often experienced in this location and it typically occurs mid-way through raising your arm. This is called an ‘arc sign’ because pain is present in the middle of the motion.
The rotator cuff has four muscles. Two of these muscles usually cause the majority of rotator cuff problems. One of these is called the infraspinatus. It is located on the bottom part on the back of the shoulder blade.
When the infraspinatus has trigger points, it responds well to dry needling. Trigger points are simply painful or tender areas in a muscle. Sometimes pain is only present where the trigger point is and sometimes it refers to other areas. The infraspinatus commonly refers pain to the front and side of the shoulder as well as down the front of the biceps. If you want to know more about trigger points and how they relate to dry needling, we have a whole blog post on that topic here.
Dry Needling Includes Looking at Surrounding Areas
When we treat the infraspinatus, we sometimes include the cervical spine. We do this because an area of the neck, specifically the C5 area, supplies the infraspinatus with signals from nerves. These signals are what allows the muscles to work.
Sometimes when there is dysfunction in the rotator cuff there are culprits further up the chain that are partially responsible. Because of that, we may include the spine when treating muscles on the arms and legs.
Checking In With Clients
In the video, we start with needling the neck muscles. While we are needling, we frequently check in with clients. We want to make sure that what we are seeing matches what you are feeling. Dry needling isn’t always comfortable, so we want to know how you’re doing and ensure that we treat to maximize results while staying within appropriate levels of discomfort. Quick side note – dry needling isn’t necessarily uncomfortable. Some clients love the way that it feels – during and after!
We also check in while needling muscles to make sure we are on trigger points. Sometimes what we feel isn’t what you feel and clients get the best results when we are as specific as possible to what they are experiencing. Because of that, you’ll hear Dr. Sarah check in with Lindsey as she’s finding trigger points in her shoulder.
Twitch Responses During Dry Needling
While Dr. Sarah is needling Lindsay, you’ll see a couple of twitches in the muscles around the shoulder. This is very normal and occurs frequently with dry needling. It is called a ‘twitch response’. A twitch response is when a partially contracted muscle fully contracts and then lengthens. When muscles are fully lengthened, they are less painful, able to produce more force, and function better.
Dry Needling with Electrical Stimulation
After we do the dry needling, we may or may not use a TENS unit. Drs. Emily and Sarah were trained through two different continuing education companies. The one Dr. Sarah took courses through uses electrical stimulation and Dr. Emily’s does not. One way isn’t better than the other. Different people respond differently so it’s more important to match the individual with the treatment than it is to prioritize one treatment over another.
If electrical stimulation is applied, we will check in with you throughout the process. The goal is that you feel the stimulation (it feels very gentle, like a thumping or a heartbeat). It will run at a moderate level.
We let individuals pick what moderate intensity feels like to them. If your injury is more painful, the intensity is typically lower. If you have less pain, the intensity is often higher. More or less intensity isn’t better or worse. Again, it’s about matching the correct intensity for the person in front of us.
What Electrical Stimulation Does
With electrical stimulation, you will feel your muscle contracting and the muscle itself will be moving. While electrical stimulation may sound scary, it’s really just forcing your muscle to contract. Without getting too technical, muscles run off electrical stimulation from nerves. A TENS unit shortcuts that and simply works directly in the muscle.
Sometimes the intensity of the electrical stimulation will increase, sometimes it will decrease, and sometimes it will stay the same. Any changes that do or do not occur in the amplitude of the muscle contraction give us cues as to how the muscle is doing and how irritated it is.
After Dry Needling
After we take the needles out, we do a little bit of soft tissue massage or sustained pressure on the area. That can help with soreness that sometimes – but not always – occurs with dry needling. If soreness does occur, it’s localized to the muscles treated, typically mild or moderate, and feels like you did a hard workout. Once the soreness goes away, clients feel better and move better.
And there you have it, that’s what dry needling for rotator cuff pain looks like! If you have questions, you may find our blog post on the basics of dry needling useful. Otherwise, you are always welcome to reach out through the contact us page on our website.