Dry needling and manipulation are two of the most powerful tools at our disposal, especially when it comes to hockey players. If you're working with hockey players (or athletes in general), getting certified in these areas is a great way to help your clients.

Hockey players might just be the toughest and most beat up players in any major sport. They constantly require quick and effective fixes for a variety of injuries in order to stay on the ice and perform at their maximum potential. Dry Needling (DN) and Manipulation are the two most powerful, quick, and effective treatments that we have at our disposal, especially when used together.

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Is dry needling good for athletes + hockey players?

The short answer is yes. Needling, when performed properly, regulates muscular physiology by returning our ANS and CNS toward homeostasis making dry needling good for athletes, especially hockey players.

There is evidence that needling can also positively affect the enteric nervous system, which plays a significant role in maintaining homeostasis along the with ANS and the endocannabinoid system. Although there are conditions that involve parasympathetic hyperactivity, the vast majority of patients we see as PTs, ATs, or DCs involve sympathetic hyperactivity with concomitant parasympathetic depression. The natural response of the human body to tissue damage and pain is to tighten everything up in the area to prevent further potential damage. This can be helpful acutely, but this process often persists to the point where it impedes healing, and the body cannot correct itself without outside intervention. If this occurs, the initial sympathetic elevation that occurs post-injury does not subside, which leads to significant detrimental effects on the body as a whole and harms players’ ability to perform on the ice.

On a muscular cellular level, excessive Ach is released, and instead of just the post-synaptic cleft being receptive to it, which is normal, the entire muscle epimysium becomes receptive to Ach. At the same time, less acetylcholinesterase (AchE) is produced. This leads to lots of Ach and not enough AchE. Over time, a chemically-induced muscle shortening occurs. There are a lot of processes that occur that we are starting to better understand with advancements in technology. The following is from a few of the best DN researchers out there. Remember, the combination of DN and manipulation is the best treatment available to us to reverse these abnormal physiologic processes and restore homeostasis for hockey players and athletes.

“The most accepted hypothesis for the development of myofascial TrPs is called the ‘integrated hypothesis’,30 which stipulates that dysfunctional motor endplates release an excessive amount of non-quantal acetylcholine (ACh), leading to localised contractures. The contractures may cause decreased blood flow within the tissue,31,32 which in turn can lead to local ischaemia, a lowered tissue pH and a subsequent release of pro-inflammatory substances and some chemical mediators including bradykinin, cytokines, substance P, calcitonin gene-related peptide (CGRP), glutamate, tumour necrosis factor-α (TNF-α), cyclo-oxygenase-2 (COX-2), hypoxia-inducible factor 1-alpha (HIF-1α), inducible nitric oxide synthase (iNOS), and vascular endothelial growth factor (VEGF) among others.33,34 These chemical mediators can activate and maintain muscle nociceptors, resulting in the experience of pain and muscle tenderness. The acidic pH contributes to the inhibition of acetylcholinesterase (AChE) at the motor endplate, thereby preventing the breakdown of ACh in the synaptic cleft, but also activates acid sensing ion channels (ASIC 1 and ASIC 3), vanilloid receptors, especially the transient receptor potential cation channel subfamily V member 1 (TRPV1), and short transient receptor potential channel 4 and 5 (TRPC-4 and TRPC-5).”34

“At the motor endplate, CGRP contributes to the up-regulation of ACh receptors, increases the release of ACh from the motor nerve terminal and inhibits AChE, which contributes to an increased quantity of ACh in the synaptic cleft, an increase in the frequency of end-plate potentials, sarcomere contraction, and taut band formation.30 At the dorsal horn lamina, CGRP can potentiate substance P, activate second messenger pathways protein kinase A and C (PKA and PKC), and enhance the release of brain derived neurotrophic factor (BDNF), which all contribute to the experience of pain.”
“Active and latent myofascial TrPs have altered chemical milieus as compared to normal muscle.33,35,36 As described, the local biochemical changes may activate muscle nociceptors and contribute to peripheral and central sensitisation mechanisms and also to functional changes within the dorsal horn.”37

Basically, all sorts of bad stuff happens when tissues become pathologic, and they all lead to hindered on-ice performance. The nice thing is that DN, in conjunction with manipulation, happen to be excellent tools to reverse these abnormal processes. The above is just a small percentage of all that we know about what happens in pathologic muscle, which is a small percentage of all that actually takes place. We have so much to learn, and it’s really exciting! One thing we do understand is that these processes facilitate sympathetic hyperactivity (or is it sympathetic hyperactivity that facilitates these processes?), which, in turn, inhibits our parasympathetic activity. When the ANS becomes stuck in this negative feedback loop, as it does in most chronic conditions we deal with, the body is unable to function properly. If DN and manipulation are used on a regular basis, or used acutely following injury, we can stop these processes from starting in the first place and keep the ANS and CNS in a more homeostatic condition. This facilitates the body’s own ability to heal itself. There is nothing more powerful than helping our body arrive at a state where maximum function and healing occur at homeostasis.

DN and manipulation both release endogenous opioids into the bloodstream, regulate the concentration of peptides such as calcitonin gene related peptide (CGRP), and have an overall effect of sympathetic depression and parasympathetic elevation. These techniques can be specifically targeted at regulating the autonomic nervous system (ANS) to lower sympathetic and increase parasympathetic tone. The two most accessible and safe areas of the body we have to specifically target the PANS with needles are the periosteum of the occiput / cervical spine and the sacral periosteum. Connecting these areas and adding 1-5 Hz of stim, which has been shown to be the most effective frequency we have found to stimulate endogenous opioid release, significantly helps with depressing sympathetic and increasing parasympathetic tone. This helps to quickly regulate the above-mentioned abnormal processes and allows the body to function at the highest level possible.

By regulating the ANS and other portions of the nervous system, along with restoring normal mechanical and physiological properties of muscle, we allow the body to heal and perform at its highest potential. Nerve conduction velocity and muscle firing patterns improve, shortened muscles are returned to their optimal length, and microvascular dilation and muscular blood perfusion improve, all of which facilitate increased power, strength, speed, and performance on the ice.

I used to pull my right adductors in college all the time when I was playing hockey. It was probably my adductor longus, but who knows. Let’s assume it was. To take a proper stride, the adductors need to be pliable enough to allow for a full stride length and they need to be powerful enough to pull the leg back into position to push off for another stride. With any type of groin pathology, the muscles are almost always going to be tight unless they are completely torn off, which is rare. With just 1 trigger point in the adductor longus, the muscle immediately loses length. This leads to a loss of power, strength, speed, and pliability, to name a few. This also leads to the negative feedback loop of events discussed above. This, in turn, significantly impedes a player’s ability to take a normal stride while playing, which harms their ability to perform. Needling, in combination with manipulation, is by far the quickest and most effective way to treat this condition along with a multitude of other common hockey-related impairments.

It is important to understand that there is very little “high quality” research out there on DN and manipulation. The research overlords—the people who determine what “works” and what doesn’t, require long-term, longitudinal randomized control trials (RCTs) to validate the efficacy of a treatment. Now listen, I love research. I read research about all sorts of things: DN, manipulation, quantum theory, neurology, salmon migration, physics, you name it. It is totally fascinating. However, people’s all out obsession with only believing something works if a longitudinal RCT says so is harmful to the evolution of efficacious science in our country. This leads people to think completely inside the box until the general public or scientific community accepts something new as effective.

To get a new drug or treatment approved by the FDA, it typically takes 3 levels of RCTs. Phase 1, 2, and 3. On average, phase 1 costs $4 million, phase 2 costs $13 million, and phase 3 costs $20 million. So, let’s say we wanted to get DN implemented as a mainstream treatment for nerve pain to reduce the number of opioids people are taking. Just the research necessary would cost about $37 million… Anyone? 37 million for DN research? Ha, ha, ha!! The pharmaceutical companies cannot make money off of DN or manipulation, so unless I win the lottery, I wouldn’t hold my breath waiting for any “high quality” research to come out on either subject any time soon.

So, when you see a research article on DN or manipulation that concludes with something like, “it may or may not be superior to control or placebo,” as they almost all do, look at how the study was conducted. A large percentage of the studies are conducted over 1-5 treatment sessions with a small sample size, and many do not even have a control. These types of studies do not lend much validity, specificity, or sensitivity to any of the outcomes. I can tell you from 10 years of experience needling and manipulating patients and from playing hockey in college that these are the two most valuable treatments we have at our disposal.

When used properly, DN and manipulation dramatically improve the performance of healthy athletes and facilitate the body’s ability to recover quicker, stronger, and more completely following activity or injury. DN and manipulation are, by far, the most powerfully effective tools hockey players should be aware of and seeking from their medical staff for the majority of their injuries. They are safe, quick, and effective. These techniques can be used not only to mechanically improve the body, but also to improve the function of the nervous systems, which includes the mind. Every single pro team should have multiple competent practitioners that combine Dry Needling and manipulation. I promise this will give your players a physical and mental edge over their opponents.

References

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