Needle in the butt

Last week one of my one o'clock patients cancelled, so I had an hour to spend tidying all the loose ends in my paperwork.  Half way through I realized one of my office mates was doing the same.  Casually I offered to let him practice dry needing on me if he ever needed, as he was recently certified in level 1 and needs to accrue practice hours before getting certified in level 2.  I figured he was finishing an evaluation from later, which takes a good amount of time on our computer program.  He jumped up.  "Sure!  Want to do it now?" 

I paused as the reality of my offer set in.  For me, that would mean needles in my butt - gluteus medius, glut minimus, piriformis, maybe even glut maximus.  I have a tailbone that has been fractured twice and is now tilted to the left, rotated to the right, and the tip is bent and re-fused at a 90 degree angle; the larger muscles of my hips often develop the mysterious "trigger points" that are something of a controversy within therapy. 

What are trigger points?  They feel like knots in the muscle upon palpation with thready or stringy muscle fibers above and below that are supposedly held on tension from the knot.  And yet when you press onto an area you are simultaneously pressing on hundreds of nerve endings, small blood vessels, and a significant amount of subcutaneous tissues and multiple fascial layers.  Trigger points cannot be found during cadaver dissections.  Who is to say you are palpating just muscle?  Further, muscles do not sense pressure or pain - nerves send signals to the brain, which then decides what it is feeling and to what intensity.  Pain and discomfort are interpretations. 

This was my first time being needled.  Not every state allows it - New York State does not so it never came up, but Colorado does.  I've had my colleagues needle certain patients who had areas of chronic problems that didn't respond completely to other treatments.  But this was my first time. 

When the needle goes in you barely feel it.  They are small needles, "dry" because there is no syringe attached.  It looks more like acupuncture for those familiar (though the technique is not acupuncture as it is not eastern medicine, does not use meridians, etc).  The size of the needle is determined by the tissues of the area being needled.  Sometimes they place needles and attach a small electrical stimulation unit that the patient can control.  Sometimes, like with me, they go for muscle twitching by pistoning or twisting the needle. 

The sensation definitely increases to an intensity just beyond that of getting a tattoo.  I had to tap my hand continuously on the therapy mat, since somehow this would prevent me from moving the area under treatment.  There were also some mild verbalizations on my part amid laughing at myself.  Laugh too hard and you'll move everything, so I had to stifle myself as well. 

Then WHAMO.  Your muscle twitches.  That stringy line of taught muscle fiber is in repeated spasm and the sensation of a cramp feels like it takes up half your body.  It isn't painful per say, but it is very peculiar and can be rather uncomfortable.  I yelped more than a few times.  The pistoning continues until the adequate muscle twitch is achieved, so the cramping goes on for what feels like five minutes but is probably about 10-15 seconds.  I also started mild sweating all over, a tiny sympathetic response (as in sympathetic nervous system, or what many know as "fight or flight" physiological response) that luckily did not go any further than that.  By now I was smacking the table with my eyes squeezed shut, probably sounding ridiculous to whoever was in the treatment room next door.  "Whoa whoa whoa whoa...."  My opposite knee was kicking, also feigning as help to hold still.  My colleague had to use his elbow on my back to make sure I didn't buck.  He needled three spots on my right hip/glut and two spots on the left.  A mere twenty minutes. 

At one point my colleague said "This is your ilium [hip bone].  Can you feel the tapping on your ilium?"

"Twitching!  All I feel is TWITCHING!"  Still smacking and kicking the table.  But as awful the process probably sounds, we were both also laughing.

One of my colleague's patients previously said he was "screaming like a little girl" when his pectoralis muscles were needled.  Those are super sensitive.  I cannot even imagine.  I planned to tell that patient that I was yelping most of the time, though I didn't go so far as to scream.

Afterward, the homunculus of my ass was gigantic.  Every step felt like little rockets were pushing their way out through the skin.  Flushing out the area with activity is recommended, so I hopped on a stationary bike and had the office staff send my next patient back to bike next to me once he arrived.  I explained to my patient why I'd be dancing the wiggle worm and rubbing my bum throughout the session so he wouldn't think I was crazy.  Supposedly the after effects wear off faster in those who are active.  Since I'm more active that just about all our patients (aside from an occasional Adams State U athlete) they were very curious how it would go for me. 

By the end of my second patient I stood up to walk her out of the clinic and realized I only felt the slightest, teeniest little pull on the lateral left hip.  The right hip had been more pronounced before treatment, hence it receiving three needles.  These spots have been there for years in fluctuating intensities that I try to keep under control by laying on a tennis ball or foam roller.  It was weird to suddenly not feel them.

So what exactly does the twitching achieve?  If nothing else, it gives a huge shot of sensation to the brain so that afterward the pesky little pulls probably don't even register anymore.  Does the "knot" go away?  It appears to.  If the brain no longer interprets danger in an area then it won't tell that muscle to contract.  Whatever the mechanism, I have not felt those areas on my two runs since. 

Just after the treatment my colleague said, "If people didn't improve afterward then no one would come back."

Damn straight they wouldn't.