Physiotherapies are often combined with chiropractic adjustments to help patients with acute pain, spasm, stubborn chronic tight muscles or scar tissue to heal faster. Healing time to damaged or torn muscles, or sprained ligaments and joints can be significantly improved with the addition of these types of modalities or procedures, and they add a level of comfort & relief to our patient’s care that enhance their overall experience.
Electrical Muscle Stimulation
Often referred to as “muscle stim,” this therapy involves low levels of electrical impulses delivered to the injured, painful tissues to help reduce pain and speed healing. Often described by patients as a pleasant, “tingling” sensation, or “electrical massage,” these impulses stimulate the body to release natural pain relievers, called endorphins. These endorphins reduce pain and inflammation, thereby promoting faster healing of the injured tissues. This therapy is often used to treat acute or chronic pain, as well as strains or sprains of the muscles, joints, and soft tissues of the spine and extremities.
This treatment should not be confused with diagnostic ultrasound, often used in prenatal screening, but is instead a therapeutic procedure that utilizes sound waves to treat injured muscles, joints, and soft tissues. The sound waves vibrate the tissues back and forth, creating a deep, micro-massage effect. In the case of a recent injury, this helps to decrease scar tissue and adhesion formation, which would otherwise interfere with the body’s healing process. The sound waves also decrease inflammation by destroying unwanted inflammatory cells. The sound waves also accelerate healing by stimulating the activity of the cells responsible for cellular and tissue repair. In chronic cases, special settings are used to create a deep-heating effect, heating the tissues far below the skin’s surface. This heat, along with the vibrations that are caused by the ultrasound, help to “melt away” the muscle spasms and “knots” felt in our muscles.
Trigger Point Therapy
The scientific term for a ‘knot’ is a myofascial “trigger point”. When left untreated these particular trigger points can often cause a domino effect on the body. Think of a muscle as being made up of thousands of muscle fibers the way a pony tail is make up us thousands of strands of hair. When the muscle is stressed or strained or becomes injured from overuse, individual muscle fibers can begin to contract. As they continue to contract, they produce lactic acid which is an irritant to the muscle and can cause more pain and contraction and can cause the muscle fibers to stick together. As this happens you can actually feel a bump or a knot in the muscle. This is the trigger point. The trigger point will be painful to the touch and it can be active or inactive; meaning that it may be painful only locally or it may cause referred pain in other locations of the body, such as down the leg when in the piriformis muscle.
The good news is that the myofascial trigger points can be treated:
Trigger Point Therapy is one of the best alternative treatments to target the ‘knots’. It assists in breaking down the lactic acid, separating the muscle fibers and allowing the blood to flow through and heal the area. Most knots are generally quite stubborn and need a few treatments to begin to breakdown and release. By keeping your treatments at close intervals you are preventing the excess lactic acid that is still within the muscle tissue to re-stick and cause the whole cycle to start over again. Trigger Point Therapy consists of alternating levels of concentrated pressure on the areas of muscle spasm. Pressure is applied with the fingers, knuckles, and/or elbow in ten to thirty second intervals to effectively alleviate the muscle spasm. This therapy works by relaxing the muscle in order to release stored lactic acid and encourage blood and oxygen circulation to the muscle to avoid the production of more lactic acid. The therapeutic pressure and massage typically produces initial soreness and “good pain” in muscle tissue. In my office I often follow trigger point therapy with ultrasound therapy or electric muscle stimulation to ensure increased circulation and to speed healing of the tissues.
Trigger Point Dry Needling is also an effective therapy to treat muscular tension and spasm which commonly accompanies conditions such as arthritis, nerve irritation, muscular strain, ligament strains and herniated discs. It is called “Dry” Needling because there is no solution injected as with a hypodermic needle during a flu shot. With Dry Needling, the needle itself and the effects it produces within the tissue is the treatment.
When an injury occurs from repetitive use or acute trauma, inflammation will be produced from the damaged tissues. The damaged tissues will also go into a protective tension state or contracture to guard against further damage from utilizing the injured tissue. This contracture and inflammation inhibit microcirculation which limits both the oxygen rich blood reaching the injury and the waste products leaving the injury. The injury site becomes hypoxic (decreased in oxygen) which stimulates the body to produce fibroblasts, a cell that produces fibrosis or scar tissue. This fibrosis and scarring builds up around the muscles and tissues limiting the tissues ability to fully function (lengthen/shorten) and can also cause compression and irritation of nerves (such as carpal tunnel syndrome) – all of which inevitably lead to biomechanical disturbances in gait and function.
Dry Needling uses a small, solid filament needle (acupuncture needle) which is inserted in a contracted painful knotted muscle to create a local twitch reflex which is both diagnostic and therapeutic as it is the first step in breaking the pain cycle as research shows will decrease muscle contraction, reduce chemical irritation, improve flexibility and decrease pain. When a needle is inserted into muscle it will also produce a controlled lesion and will cut between three to fifteen thousand individual muscle fibers. The body considers the needle as a foreign invader and will activate the immune system as a response. The cut muscle fibers also produce an inflammatory reaction that your body will respond to not just locally but all over the body to reduce inflammation systemically.
Whether applied manually or mechanically, the benefits of traction are similar. It is an excellent therapy choice to reduce pressure on cervical (neck) or lumbar (lower back) discs. Traction effectively reduces joint and nerve pain, pressure, and inflammation, caused by bulging or herniated discs. This procedure is quite comfortable, and lasts several minutes.
Ice therapy or cryotherapy is often thought of as the therapy of choice for acute injuries. Actually, the application of ice over any painful tissue is usually effective at any stage of an injury. It works by constricting blood flow to the tissue, thereby reducing swelling, pain, and muscular spasms. It is very important to use ice correctly. It should be used for a maximum of 20 minutes, but may be applied each hour. Also, it is important that you do not apply the ice directly to the skin. Instead, wrap the ice pack in a paper towel or thin damp cloth prior to applying to the injured area.
The use of heat is effective in treating conditions that are more chronic in nature. It is not recommended that heat be used within the First few days or weeks of a new injury, especially when any signs of swelling are present. The best forms of heat are in the form of a warm bath/shower or a moist heating pad. Avoid “dry” heating pads, as they can promote additional swelling and inflammation. As with ice therapy, apply the heat for a maximum of 20 minutes per hour. Never go to sleep with a heating pad, as this can result in increased pain and tissue damage.