Note: For the purpose of this article, Manipulation and HVLA will be used synonymously. It is absolutely necessary to be competent with all grades or amplitudes of manipulative therapy, but this article will focus on HVLA only.

Muscles need to function in a highly specific, specialized, and coordinated manner to achieve maximum performance. If just one of a multitude of factors is dysfunctional, maximal output will be diminished and performance will be compromised. I have taught numerous PTs, ATs and DCs associated with sports teams, but not nearly enough. All serious sports teams should have multiple practitioners, from whatever profession (a medical profession, preferably, haha), that are highly competent with the implementation of DN and Manipulation. A lot of them do, but a lot of them do not. I played division 1 ice hockey in college, and we never had anyone with either of these skills readily available to us, and holy crap, it would have helped.

Here’s a little background about me: My only bad joints are my shoulders. I always had problems with them playing any sport, especially hockey. To this day, if I am in a boat and it is bumpy, or on a dirt road in a car, if I don’t tighten up my shoulders, they sublux. Yes, it’s wonderful. If I don’t keep my shoulders in good shape, it gets worse. If I had been manipulated and needled in college, I am sure my shoulders would have done a whole lot better. I bring that up because I find it extremely helpful to have been through many of the issues we deal with when treating athletes. I had two shoulder surgeries throughout college, 4 broken clavicles, and a bunch of other injuries. Pretty common for hockey, I guess. I also shattered my right hip, not playing hockey, and that was the worst. I don’t recommend damaging yourself—it is really not fun. At all. But it does help you be a better clinician by providing first-hand experience. Probably not the experience a sane person hopes for though.

Why athletes benefit from DN + Manipulation

When I treat athletes or teach people who will be treating them, I always talk about how incredibly powerful dry needling and manipulation are for all patients, but athletes are in a league of their own.

Athletes, especially high-level athletes, typically have specifically trained muscles to perform certain tasks at high intensity for certain durations of time. This type of activity requires the sympathetic portion of both the CNS and ANS to turn up. This is truer in contact sports, but it is also true for most sports that come to mind. 

If the sympathetics are allowed to remain in an elevated state for too long, without allowing for intermittent periods of relative nervous system homeostasis, by depressing the sympathetics and elevating the parasympathetics, bad stuff happens. Muscles and organs do not recover fully. In skeletal muscle, Excessive Ach gets released into the synaptic cleft, too little AchE is produced, Ach builds up, and other neuropeptides become concentrated in the pathologic tissue. Many of these substances amplify pain and inhibit normal muscle physiology, and therefore, function. There need not be any significant and obvious injury to begin this negative feedback loop, it typically just needs to be around for a bit. You can find something like this in any athlete, whether they are aware it is bothering them or not.

It allows quick recovery for athletes

Dry Needling, in combination with manipulation, is by far the fastest and most effective way I know how to help athletes recover quickly from a plethora of injuries. Athletes respond dramatically to needles with results that are more pronounced and longer lasting than your typical patient. This just makes sense as we are already working with a body that is hopefully in prime condition, and they are typically young. These are good indicators for success in any circumstance. This is especially true with DN and manipulation. There is typically a more profound nervous system response in people in really good shape. It has to be a combination of improved body awareness, increased sensitivity to physical stimuli, etc. Whatever the reason, this seems to be true. It was certainly true for me when I first started getting needled. I was such a wimp! I would start sweating everywhere—you know how it goes. I am much better now, and I needle myself all the time. Needling yourself really is the best way to learn.

Related: Introducing needling to hypersensitive patients

I bring this up because it may not be a bad idea to focus your treatment more on reducing sympathetic hyperactivity first before specifically addressing any mechanical issues.

How soon after an injury should you needle?

One question I get asked a lot in class is how soon after an injury should you needle? The answer for me is ASAP. I had a good conversation with an AT one time about this concept for inversion ankle sprains. Her thought was, wouldn’t it be better to let the peroneals tighten up at first to provide support for the ankle? This is a good thought, but it’s not conducive to proper healing and function.

Related: Dry needling for athletic trainers

I like to stop the negative feedback loop, as discussed above, before it starts. If the muscles are allowed to contract and tighten, which is the natural response to prevent further injury, this slows down blood flow, especially venous return, and allows for abnormal concentrations of a variety of substances that inhibit healing.

Needling the musculature surrounding the ankle will:

• speed up healing
• reduce pain
• return the athlete to full function faster.

In this instance, I would also manipulate the spine and needle the multifidus at the levels of the spine corresponding to wherever I was working in the ankle. And I would connect the two areas with stim, 1-5 Hz. I have another blog on using stim if you want more info on that.

DN + Manip work together for conducive healing

My basic thought process for treating this way is to reduce soft tissue restriction and improve blood flow from the injury site to the spinal levels and nerve roots responsible for innervating the damaged structures and surrounding tissues along with reducing sympathetic hyperactivity and returning the nervous systems to a more homeostatic level. All of this is conducive to healing.

Both DN and manipulation accomplish these goals swiftly. This is a powerful method to employ, and it totally makes sense to me scientifically. Most importantly, it works. I have seen this general concept produce incredible results that I never would have achieved otherwise. This goes along with the concept of treat the whole body, which is great, but applies it in a slightly more specific way.