Watch as the Nothing Stronger Team talks about the significance of dry needling in rehabilitation.
In this episode, Tim and Jakub engage with Jenn Concannon to explore the intricacies of musculoskeletal evaluations and the therapeutic modality of dry needling. They discuss the comprehensive evaluation process, the science behind dry needling, and the various patient experiences and responses to this treatment. The conversation highlights the importance of understanding individual patient needs and the effectiveness of dry needling in treating different types of injuries.
Tim Concannon (00:02.638)
Alright Episode One Nothing Stronger Show this show is just intended to help people Get better get out of pain and enjoy the gym So today we’re gonna bring you all things after your training Jakub and I are just gonna fire questions at Jenn To help better understand what she does to help people get pain free So Jenn let’s start with the first thing everybody does when they come to you the comprehensive musculoskeletal evaluation what does that look like what are you doing and
How does it range from person to person?
Jenn Concannon (00:33.506)
Yeah, so the Initial consult is really an opportunity for us to understand everything that’s been going on with that individual, not necessarily about that specific pathology or injury that they might be presenting with, but really trying to tie all of the pieces in together. Normally, injuries are not kind of siloed. And so we try to figure out kind of the whole comprehensive.
Tim Concannon (00:36.461)
This is what I’m trying to say.
Jakub Zalesky (00:39.4)
you.
Jenn Concannon (00:59.374)
what’s been happening even since you were 15, 20 years ago or three months ago or things like that. So it starts off with the subjective evaluation in kind of the patient talking to us about how they’ve been presenting their past medical history, whether that be orthopedic, general medical, psychological, social, kind of all trying to take the whole person into account.
And then we get into any sort of review of diagnostic imaging, if that has been done, x-rays, MRIs, CTs, ultrasound, things like that. Then we get into kind of the palpation in me looking at the segment and the functional lines that might be associated with that injury or pathology.
Then we get into kind of special tests and trying to figure out is there a specific pathology that we can test and try to see, could this be it and try to create this list of like what might be the differential diagnoses. And then we get into our functional assessment where we have the patient move and go through either range of motion or movement patterns like our hip hinge, rotational from the trunk, rotational from the hips.
squat techniques, single leg balance, things like that. And that can kind of feed us into a little bit better of what might be happening on the day to day. We also try to replicate motions that might be most provocative or symptomatic for people, because that might look different than based off of what our traditional kind of testing and functional tests might be. From there, we try to bring everything together. We do a lot of patient education, a lot of
you know, demonstrating and showing pictures and videos for people so that we’re all kind of on the same page. It’s a great opportunity for people to ask questions and just make sure that they understand what might be going on a little bit better. And then we kind of game plan from there. We talk a lot about what the patient goals are for either that session or sessions moving forward, how we can incorporate that into daily life.
Tim Concannon (03:00.089)
on the third.
Jenn Concannon (03:07.81)
styles, either workout programs or rehab programs or just maybe pain management. And then from there, we talk a lot about what the next steps are going to be. So whether that be, you know, coming in here or, you know, adding in whatever they need to and kind of their activities of daily living or, you know, PT settings or anything like that. And so it’s really just an opportunity for patients, I think, to be a little bit more feel
Tim Concannon (03:33.849)
Thank you.
Jenn Concannon (03:36.524)
more comfortable about what’s going on and feel more educated about that.
Tim Concannon (03:42.401)
So let’s dive into the therapeutic modalities of what you do. So you do dry kneeling a fair amount for different injuries and different people. What is dry kneeling?
Jenn Concannon (03:56.652)
Yeah, so dry needling can be used for a variety of different things. no, I would say no clinician probably dry needles the exact same. Everybody has a little bit different of a philosophy of it. But when you’re talking about dry needling, I like to compare it back to acupuncture because I think a lot of people are more familiar with the term acupuncture. So there are micro filament needles, which are the exact same type of needles that are used with acupuncture needles.
Tim Concannon (03:57.081)
Thanks.
Jenn Concannon (04:23.374)
Acupuncture is more rooted in Eastern medicine philosophy. The goals of acupuncture are much more about meridian balance, energy balance. So while you might have a pathology in the shoulder, you might be adding needles in the head or the hip or the foot or things like that. And so my brain does not function and work that way and I was not trained that way. So I come at it much more from a westernized kind of
Practical application of from an orthopedic perspective. So I look at it much more from an anatomy and a physiologic perspective So what structures tendons joints ligaments fascia muscles joint capsules? nerve nerve patterns like what structures am I adding those needles to How does that?
how does that have an implication of what is going on for that pathology? So for example, if I have Achilles tendonitis, right, it might actually be not the Achilles that’s the pain generator, but it might actually be coming from the hip or the foot. So I need to find that functional and that’s what the comprehensive evaluation does is try to figure out what the cause of the why, right? Just because you have pain here doesn’t mean that that’s actually where I care to treat. So I need to figure out the why behind the why behind the why.
And so we can add needles along that functional pattern. We can add needles at that source of injury. And then from a physiologic or cellular level, what is happening at the, how is this helping, right? And so.
There’s a few different kind of cellular processes that happen, but basically when you add in a needle, you’re creating an inflammatory response. And sometimes that’s just what the body needs to go through a complete inflammatory cycle. When you get people that have been in chronic pain patterns, whether that be from a physiologic pain patterning and pain processing center within the brain, or just a chronic inflammatory response from a peripheral perspective,
Jenn Concannon (06:26.796)
why can the body not hit that reset button and go through all of the steps to kind of clear that? And sometimes the needle is that perfect stimulus to be able to do that. So you create an inflammatory response to potentially help the body go through that inflammatory cycle, but it can also add in a different stimulus that will target the pain processing pathways without getting too nerdy on that from the brain back down to that local site of injury.
You can also use it, it is really helpful to help clear out some swelling. So you can use a flooding technique where you add in a whole bunch of needles to a really small area that is really helpful for like joint pathology. like osteoarthritis or meniscus type pathologies, you can use it for trigger points, which might be causing referred pain. So if you have an upper trap,
Kind of trigger point you might be getting, you know chronic tension headaches or what what may have been clinically diagnosed as a tension headache So you can always get that for those referral type patterns as well. So dry needling I love it because it’s one of the few modalities that you have that you know You’re at the site of injury and at the local that local level and you don’t get that with a lot of manual therapy techniques or modalities You just kind of hope you’re hitting that in and around that area
but you know truly that you’re at that site of injury or pathology with the needle.
Tim Concannon (07:50.697)
So I’ve seen your experience with dinoing for what maybe five, seven, ten years. I’ll be long even doing it. How would you describe how you first started dry needling and how you’re dry needle on now?
Jenn Concannon (08:06.698)
I think when you first start dry needling, you tend to be more localized, right? You have somebody coming in with a knee and you’re a little bit more, I think just cautious. I just add needles all the time now, right? because, and that’s probably terrifying for like the patient to hear, but I think that the needles are so,
provides such like this therapeutic benefit and some people get a complete psychological response from it and they’ll start crying when they’re in, right? Like it does so many things outside of just that localized area. And so we really use it, I would say I use it more to modulate the pain processing pathways versus just that localized tissue response. And I really learned that more in the advanced courses that I’ve taken.
because you learn more a lot more about the theory and kind of the complex theory, theories of dry needling and some of the really cool research versus like just learning how to dry needle and like your foundational courses and safety, know, safety considerations and precautions and contraindications, which is more kind of that foundational perspective. But I think as I’ve gotten more comfortable, I’m able to kind of open up that chain of knowing how that hip affects that foot.
and know, and adding needles in a very specific area. And a lot of clients or patients will often say like, my God, how did you know to put it there? Right? And you just learn it along the way and know how that, you know, behind the knee can impact the bottom of the foot and that type of stuff. So I would say I get a little bit more selective, but I’ve opened up my, the chain that I dry needle and like I said, more going towards like.
Tim Concannon (09:46.477)
and
Jenn Concannon (09:54.619)
processing pathways and thinking about it much more from a systemic response than just that localized and local response.
Tim Concannon (10:02.809)
Jakub, I know you’ve done therapy with Jenn. When you came in here, when you first started working here, what was your experience like working with Jenn? It was great.
Jakub Zalesky (10:13.16)
It was great. I’ve never tried, I never tried needling before that. Something I’ve always wanted to try. And I found it to be pretty, pretty groundbreaking in terms of like how long the, can kind of cause your muscles to of to relax and how long that lasts versus compared to like foam rolling or any sort of other manual therapy techniques. guess one question I do have is like, how deep into the muscle belly do you typically go?
Jenn Concannon (10:13.784)
Terrifying. Terrifying.
Jakub Zalesky (10:43.132)
with the needles. I know it varies a little bit between different muscles.
Jenn Concannon (10:48.002)
Yeah, and part of that comes back to the initial comprehensive evaluation when we’re doing the palpations. It’s not just palpating to see, is this where your pain is? Is this where your pain is? A lot of that comes back to, I’m feeling tissue quality. And so I wanna understand what is that tissue doing along that functional line? And if it’s super like adaptive in this area, could it be because of something happening up here?
And so a lot of times it’s the direction of the needle and where you’re putting that understanding the safety precautions are probably most important there. But you don’t always have to bottom out on bone. Like if you go from the quad, right? The goal isn’t always to get to the femur of it. And sometimes the patient will dictate that more than what I, know, sometimes you’ll get that twitch response and they’ll be like, please stop there type of thing. So.
I don’t think it’s always about the depth of as long as you’re targeting. One thing I’ll go back to, and you kind of said this at the beginning with your foam rolling experience, right? Why do you feel better after you foam roll, after you do mobility, ball work, massage, but then two hours, two days later, you’re like, okay, I just feel going back to the same?
And oftentimes it’s because we give up on the tissue before it’s ready to be given up on, right? You haven’t exhausted that tissue and what’s holding it. And one of the really cool things about dry needling is that you can keep the needles in safely for an extended period of time. So you could dry needle and have the needles in for, and this is where a lot of clinicians will vary and kind of differ.
But some of the best results you’ll get is when the needle is in longer than 20 to 30 minutes. And so as the patient, you tend to feel that kind of, you know, that roller coaster ride that you’re on with the dry needles in you, right? You put that needle in, sometimes it’s, it’s throbby and it’s aching as it goes in. And then you’re like, Oh yeah, I don’t really feel it. And then five, six minutes later, you’re checking in with the patient and they’re like, Oh, I feel all of the feels like it’s like super strong. It’s intense.
Jenn Concannon (13:04.238)
And so it kind of amplifies so you might start off that as you put the needle in a four it goes you know down to a two all of a sudden it hits an eight and then you start to kind of go on that descent back down and that is typically Where you you know, you want to make sure that that needle is in that area that is The needle is where the target site is but sometimes you can’t get there on that first time. So it’s really patient tolerance
and what that pain experience is, as well as that tissue. Sometimes you don’t get there on the first day or the first try, and that’s okay. So then you use other kind of modalities. But I think keeping it in, I always say, I let the needle, without sounding too weird, right? Like I let the needle and the patient tell me when that needle needs to come out. It’s not this timeline of it has to stay in for 20 minutes or 12 minutes or one minute, right? It’s really dependent on
what that patient response is, what the pain is, what the tissue is doing, and that kind of dictates how long that needle should be in for.
Jakub Zalesky (14:07.249)
Interesting.
Tim Concannon (14:07.321)
In your experience, are there certain injuries that respond better to driving, or is it more person to person?
Jenn Concannon (14:17.87)
I think it’s a little bit of both, right? Like one thing that, you know, a muscle strain, sure, responds wonderful to needles, right? You create that localized response. You can really kind of set that foundation to go through that inflammatory process. You can help with some of that trigger point and kind of that spastic, you know, hold of trying to do that muscle guarding after an injury. It helps really well with that. It helps really well with like OA and like
chronic knee pathologies, meniscus tears, it helps with lot of that inflammation. One of the best things that it helps for is getting blood flow to areas that don’t normally get great support for blood flow. And so things like dry needling and shockwave that are forcing that blood supply there. So like tendinopathies, Achilles tendinopathy, rotator cuff tendinopathies, epicondylasia type things in the elbow.
Planar fasciitis or fasciosis Things that don’t normally can’t heal because the blood has all of the nutrients to help heal it Once as you start to draw blood flow to that area It can usually help kind of expedite that healing process Oftentimes people have tried exercise before they’ve done that they’ve done the Advil the ice the rest
the exercises. And so sometimes it takes a little bit longer because it’s been, you know, such like a negated process for an extended period of time, that it does sometimes take a little bit longer to get there. But it is, it can be one of the more impactful modalities to use on tendinopathy type of things or things that don’t get a great source of blood supply.
Tim Concannon (16:03.811)
Awesome, awesome. Well, I’m glad how this is supposed to be all things athletic training, but of course I forgot how smart you were. So we did all things drowning link today apparently, but Jakub any closing thoughts on drowning link?
Jakub Zalesky (16:17.19)
Yeah, I was just, I think you mentioned before, kind of like suffocating the muscle and causing it to let go. Could you explain more about that? that like, I guess like something that, is that like a normal kind of response with the muscle to kind of let go when it’s, when it doesn’t have that, I guess that.
Jenn Concannon (16:37.228)
Yes. So, so when you have an injury, your body is going to say, so I’m going to say a phrase, I say it to everybody, and then I’ll break it down. Altered aphrine input leads to altered ephrine output. If your body experiences any type of pain, discomfort, increase of tissue temperature, anything that’s like outside of the normal,
And that a fair input or is going to the brain, the brain is going to say something’s not right here, right? And so it’s going to alter what comes out, whether that be shortening adaptive shortening, over activation of muscles, under activation of muscles, you know, and that is going to change positioning of of where that that joint or that body part is in space and time.
And so that adaptive process can or that efferent output that says, okay, I need to over activate here, under activate here, right? Oftentimes is what is the more painful part for the person versus the actual pathology, right? So when you put a needle in to something that is over activated is hypertonic has been kind of in this like choke held position for
how overlong this injury or pathology has been going on for. Sometimes when you put a needle in, the needle is the intruder. And that is that increase of pain that you’re often feeling. It’s that muscle being like, who are you? What are you doing here? Do I have to continue to provide this defense mechanism? And that’s why you get oftentimes that kind of roller coaster of symptoms because it’s saying, wait, you’re actually here to help. But it takes…
Jakub Zalesky (18:21.958)
interesting.
Jenn Concannon (18:23.082)
it takes different types of tissues and different responses of tissues, but also the patient’s response to that, right? from a psychological perspective, are you open to this treatment or are you kind of hyped up and amped up because you have a needle in your body or several needles in your body? Or are you recreating pain that you’ve experienced? Like people don’t always have a good association with their pain. So when you’re potentially causing more pain, it can be really
Jakub Zalesky (18:38.897)
Interesting.
Jakub Zalesky (18:43.496)
You’re free.
Jenn Concannon (18:49.998)
I’m a cyclical response for people. it really depends on like how they react. Yeah, how they’re reacting to it. And then how that body part is reacting to it is it’s it does it continue to hold that tension or can it just say, wait, you’re actually here to help. And so however long that process takes is usually there’s no like, you 10 minutes and then it usually resolves type of thing. Everybody’s response in that area responses is really going to dictate that more so.
Jakub Zalesky (18:53.212)
How’s it going?
Jakub Zalesky (19:19.994)
Awesome. That’s very interesting.
Tim Concannon (19:22.585)
Great, thanks guys, appreciate it today. Until the next one, thank you.
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