Dry Needling Improves Homeostasis & Sarcomere Production Secondary to Exercise

The sarcomere is the smallest contractile unit of skeletal muscle. That we know of. To build muscles we must create new sarcomeres to add onto existing sarcomeres in series and in parallel. It takes about 8 weeks of sufficient exercise, 3 times a week, to begin building new sarcomeres. That’s 24 visits. The average number of PT visits health insurance approved in 2024 was about 20, for the entire year, not per condition. It is scientifically impossible to build new muscle in 20 workout sessions. This is why physical therapists should avoid spending time watching people exercise. Our time and knowledge are better spent helping the patient accomplish things they cannot accomplish on their own.

Did you know a third protein works along with actin and myosin in the sarcomere? Learn about the Titin protein here: https://intricateartseminars.com/titin-the-titan-of-proteins-and-why-almost-zero-doctors-know-it-exists/

As Physical Therapists, we should spend as much time as needed educating patients about exercise and how to do it, because it is 100% necessary if you want to be healthy. However, building muscle is something that can only be accomplished if the patient is willing to put in the effort on their own to consistently exercise. We should be spending the majority of our time eliminating tissue pathology and targeting the parasympathetic portion of the autonomic nervous system. This should be done with the express intent of inducing as much sympathetic depression and parasympathetic elevation as possible. The direction the autonomic nervous system needs to be pushed to reestablish homeostasis and health.

Muscle, Mitochondria, & ATP Production

Muscles do not grow or function well in hypoxic conditions. Their mitochondria produce about 18 times less ATP energy than they produce with sufficient oxygen. The more muscle we have, the more mitochondria we have, the more ATP energy we have, the more resistant to disease and impairment we become.

As we age we lose muscle mass, mitochondria, and the ATP energy those mitochondria produce. This can be almost completely mitigated if you consistently exercise throughout life and work to maintain healthy muscle mass. Aside from energy production, mitochondria in skeletal muscle cells are super important for a ton of other stuff, including glucose storage, immune function, metabolism, tissue healing, and more.

Think of mitochondria like your personal army of sword-wielding ninjas with superpowers. And the ninjas need lots of oxygen to access their superpowers. They do everything. Defend against outside attack, provide materials to rebuild stuff if it breaks, keep things clean and tidy, store extra materials until you need them, provide ninja power when you need energy, and a lot more. The more ninjas you have, the better off you are.

Mortality Following Hip Fracture

A recent systematic review reports a global downward trend in 1-year mortality rate post hip fracture in people over 60. But the number is still horrifying! The results of this study suggest that the previously reported 1-year mortality rate of 30% is outdated and a figure of 22% is a more accurate, up-to-date estimation of 1-year mortality rate post hip fracture. To be clear, this means 22% of people who break their hip are dead within a year!

• Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture – a systematic review. World J Orthop 2019; 10(3): 166-175 URL: https://www.wjgnet.com/2218-5836/full/v10/i3/166.htm DOI: https://dx.doi.org/10.5312/wjo.v10.i3.166

This is insane! Most hip fractures are not life-threatening injuries in and of themselves. The problem is a lack of resources you need to heal, while also maintaining function of everything else. This requires a lot of energy, which requires a lot of mitochondria. If you do not have sufficient muscle mass, you simply do not have a big enough army to do the work that needs to be done. And if you do have the muscle and mitochondria, but are living in a chronic state of sympathetic autonomic nervous system hyperactivity, the mitochondria lack the oxygen and other resources they need to do their job.

In either case, if you go through any sufficiently traumatic event, mental or physical, it can be enough to push the autonomic nervous system over its sympathetic threshold into a state of severe energy deficiency. When this happens, the ability to self-regulate is lost. The resulting cascade of dysfunction in various systems throughout the brain and body is what leads to further impairment or death. The hip is the spark that leads to a forest fire. If the people in these studies had significantly more healthy muscle at the time of injury, they would have had the energy resources in the form of mitochondria to properly heal and mitigate severe complications secondary to breaking their hip.

Mitochondria in Skeletal Muscle

Skeletal muscle cells contain numerous nuclei and have higher concentrations of mitochondria than many other cells. A single skeletal muscle cell has thousands of mitochondria. Red blood cells have no mitochondria at all. What a bunch of losers! Mitochondria produce the primary energy source human cells need to survive, adenosine triphosphate (ATP). We have trillions of mitochondria in our muscles, and skeletal muscle is the only tissue we have the ability make more of if we want to.

Athletes can have 5-times more mitochondria than your average American. Skeletal muscle comprises about 40% of total body mass and is the largest consumer of glucose and fatty acids, through mitochondrial oxidation. Mitochondrial function in skeletal muscle is a critical determinant of systemic metabolic homeostasis, the ability to heal, and overall health. (https://www.nature.com/articles/s41422-018-0078-7)

With sufficient oxygen, a single mitochondria produces about 36 ATP per molecule of glucose processed. In hypoxic conditions, only about 2 ATP are produced. Muscles need energy to build new sarcomeres and grow. Hypoxic mitochondria can’t produce enough energy to facilitate proper muscle growth secondary to exercise. Thoughtful dry needling is the most powerful tool Physical Therapists have at their disposal to regulate autonomic homeostasis and significantly increase blood flow and oxygen saturation to muscles, making it the most effective tool we have to 18X the ATP output from hypoxic mitochondria.

If we run short of mitochondria to meet energy demand, or if the mitochondria are dysfunctional and cannot produce the required energy to meet demand, bad stuff happens. The mitochondria are the primary energy source inside the cell and remove waste products. The more healthy mitochondria we have, the more energy our cells have, the better health we have.

Dry Needling Improves Cerebral Blood Perfusion, Neuronal Function, & Autonomic Homeostasis

This is an awesome article reviewing a bunch of studies looking at the effect head and face needling has on cerebral blood flow, neuronal function, and patient outcomes.

• Jin G-Y, Jin LL, Jin BX, Zheng J, He BJ and Li S-J (2023) Neural control of cerebral blood flow: scientific basis of scalp acupuncture in treating brain diseases. https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1210537/full

The results indicate the primary mechanism through which needling works is by improving brain homeostasis. Increased blood perfusion, decreased inflammation, and improved neuronal function were seen throughout numerous studies using fMRI. Improved brain function improves sarcomere production secondary to exercise by improving the cellular environment for growth and optimizing communication between the brain and the body. This is one of the reasons I always target the parasympathetic-dominant regions of the body with my first needles, then move on to treat whatever else.

These regions include the sacral plexus, pelvic floor, upper cervical, vagus nerve in the ear, Otic ganglion of the trigeminal nerve, suture lines of the skull. This immediately pushes the autonomic nervous system in the direction we want it to go, toward parasympathetic dominance, which is the overall result of needling almost regardless how you do it. Targeting the parasympathetics first limits the amplitude and duration of the initial sympathetic spike from being poked with sharp objects. This makes treatment more comfortable and more effective, as it allows patients to tolerate more needles, you can treat more pathologic tissue, and can induce more homeostasis to the autonomic nervous system.

I want to push my patient’s autonomic nervous system as far in the parasympathetic direction as possible, as fast as possible, then leave the needles for about an hour. The longer the needles are left in tissue, the more effective treatment is. The longer the brain has to respond to the homeostatic effects of thoughtful needling, the better. I think the point at which there is no improving return in leaving the needles longer is somewhere around an hour for most people, on average.

Having a proper amount of healthy skeletal muscle is key to improving healthspan and lifespan. If your goal is to build muscle to improve health, you are going to be seriously inhibited from doing so by a baseline lack of oxygen in your tissues secondary to chronic autonomic dysregulation, which per the CDC, affects about 90% of Americans. You will have to work harder than you should to achieve results, with a higher likelihood of pain and injury. This is a major barrier to consistent exercise for a lot of patients. Thoughtful dry needling dramatically improves autonomic nervous system homeostasis, reduces pain, and improves the likelihood people will consistently exercise.

 

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Learn more: Read about how dry needling works here: https://intricateartseminars.com/how-does-dry-needling-work/

 

Video: Dry Needling to Improve Autonomic Nervous System Homeostasis & Health https://www.youtube.com/watch?v=NjlFd5PLAaY&t=1s

 

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References

• Citation: Dong, H.; Tsai, S.-Y. Mitochondrial Properties in Skeletal Muscle Fiber. Cells 2023, 12, 2183. https://doi.org/10.3390/cells12172183
• Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture – a systematic review. World J Orthop 2019; 10(3): 166-175 URL: https://www.wjgnet.com/2218-5836/full/v10/i3/166.htm DOI: https://dx.doi.org/10.5312/wjo.v10.i3.166
• J Gerontol A Biol Sci Med Sci. Author manuscript; available in PMC: 2006 Sep 1. Published in final edited form as: J Gerontol A Biol Sci Med Sci. 2006 Jun;61(6):534–540. doi: 1093/gerona/61.6.534
• https://www.nature.com/articles/s41422-018-0078-7