Pelvic health impairments are some of the most improperly treated impairments humans struggle with. Oh, don’t get me wrong, there sure are a lot of ineffective treatments out there for incontinence, pain with sex, etc., that do nothing but treat symptoms, rather than addressing the cause of the problem. You all have heard the commercials for night catheters, adult diapers and pills that make pharmaceutical companies money by keeping people impaired for life. Money, not effectiveness, is the number one driver of medical treatments in today’s age. It is a sad, petty, and pathetic state of affairs, to put it lightly.

Without significant underlying pathology, such as vaginal prolapse, prostate enlargement, or spinal cord injury, for example, no human should suffer from incontinence, pain with sex or other pelvic health impairments. This is true for both men and women. Unfortunately, the vast majority of medical practitioners, and I really mean almost all of them, tell their patients things like incontinence are just normal things you must deal with, that happen with age, trauma, child birth, etc. This is complete and utter nonsense. It leads to massive psychosocial impairments that are easily avoidable and completely treatable with the proper medical understanding.

Let me tell you a little story to exemplify my point. This example is just one of hundreds that I have experienced over the years regarding pelvic health impairments, and is, unfortunately, commonplace. I was teaching a needling class a few months ago and we were discussing treatments for urinary incontinence. A PT in her 30’s mentioned that she had had urinary incontinence for the past 11 years, ever since she gave birth to her youngest child. She had attempted treatment with numerous pelvic health specialists for multiple years, with no significant improvement.

Two needling treatments in back-to-back days during the class resulted in 100% resolution of 11 years of incontinence!

I didn’t even need to expose the genitalia. This is not an uncommon response to needling, if thoughtfully performed. Why is this so? Needling and manipulation address the underlying cause of pelvic health impairments, CNS / ANS dysregulation, along with the symptoms.

The Insufficiency of Non-Needling & Non-Manipulative Pelvic Health Treatments

Most pelvic health treatments, whatever the specific issue, involve a lot of exercise. Most of the time, this is detrimental to patient outcomes. Pelvic health-specific impairments rarely require pelvic exercise, barring atrophy for some reason or other. Just like with any other skeletal muscle in the body, normalizing muscle length and physiology leads to adequate muscle function (unless you are a high-level athlete, fireman, etc.). How many Americans exercise on a regular basis? Well, the average number of pullups an American can perform is… Wait for it…. Zero. So, I ask again, what is the average number of Americans that exercise on a consistent basis? Yep, basically zero. Furthermore, how many patients actually do their home exercise program? You guessed it, almost none. These are indisputable scientific facts backed by loads of high-quality research.

Note: Ideally, everyone should exercise consistently. This would make everyone far healthier and happier. I give all my patients some simple exercises to perform at home. However, this is simply not the reality of the situation. People, especially most Americans, are sedentary, overweight and will never exercise, no matter what you tell them, especially if you are not right there with them. The way I look at it is this: Why waste my time doing something with a patient that may only benefit them for the time they are actually going to PT? You know they will never exercise again. So, why not perform treatment that will have more effective and lasting effects, like needling and manipulation?

How long does it take to start adding sarcomeres to muscle in series and in parallel, to actually make your muscles bigger and mechanically stronger? About 8 weeks, 3x per week, of strenuous exercise to muscle failure. That is 24 PT visits. How many patients get 24 visits to anyone? Again, basically zero. So, no PT is going to have enough time to mechanically make patients’ muscles stronger. I know, I know, patients get stronger during PT. Yes, true. However, this is not a mechanical strength increase caused by muscle growth and it will dissipate as soon as PT is finished. It is a neurologic strength and functional improvement secondary to normalization of CNS / ANS homeostasis and improved neurologic function. Needling combined with manipulation is the most powerful way to accomplish this and will have a lasting effect.

As almost all PT patients present with sympathetic hyperactivity, and strenuous exercise causes sympathetic hyperactivity, exercise is one of the last things PT patients need. Normalizing muscle length and CNS / ANS homeostasis (depressing sympathetics and elevating parasympathetics) is the primary thing people need. This holds true for just about all PT-related impairments, including pelvic health impairments.

I have many success stories similar to the example above, with men and women of all ages and health conditions, that have already tried all of the typical pelvic health treatments. Why is this so?

Because typical treatments do not hold a candle to the powerful homeostatic effect of needling combined with manipulation on the nervous systems.

For one, many of the pelvic floor muscles are basically impossible to properly treat without needles and manipulation. Think about the coccygeal muscles, the levator ani complex. These muscles are buried under other big muscles, like the glute max, making direct treatment impossible. The only manual treatment possible to these muscles, without needles, is extremely indirect and oftentimes ineffective. These muscles are also seriously difficult to stretch properly, which includes removing trigger points to restore muscle length. Trigger points, especially when chronic, simply do not respond to indirect treatment much of the time. However, trigger points always reduce and disappear secondary to direct needle treatment. Removing trigger points, improving blood perfusion, restoring muscle length, firing patterns, and therefore strength, and regulating the CNS / ANS towards homeostasis are all easily achievable in the pelvic floor musculature, when using needles and manipulation. Otherwise, it is a challenge.

Related: Check out another blog of mine discussing the importance of treating the true pelvic floor muscles

Let’s think about the coccygeal muscles for another sec. These muscles connect the coccyx to various other aspects of the pelvis. If these muscles shorten in any way, pelvic, lumbar, and basically any other joint in the body can be detrimentally affected. The multifidus is another prime example of a deep, hard-to-treat muscle, unless you have needles, that directly affects the entire spine and indirectly affects all of your other joints. If muscles are addressed, but not the joints, or vice versa, the remaining muscular or joint pathology is going to lead to recurring muscular, joint, and nervous system impairment. This is why it is so important to needle and manipulate together. Restoring normal muscle length and physiology, followed by joint reduction to neutral, strengthens the nervous systems, immune systems, and muscles to functional levels, without the addition of exercise, for the majority of people.

Remember, exercise makes chronic trigger points worse. You are asking a muscle to contract that is already contracted and shortened secondary to sympathetic hyperactivity and trigger points. Trigger points are hypercontracted groups of sarcomeres that can shut off over 90% of blood flowing through them, reduce muscle strength, inhibit normal firing patterns, increase pain, dysregulate the nervous systems, and reduce function. In PT-Land, needling is, without question, the fastest and most effective method to restore normal neuromusculoskeletal function and patients’ abilities to perform activities of daily living in regards to pelvic health, and most other impairments, for that matter.

If you are a person dealing with pelvic health impairments, or a practitioner who treats any type of neuromusculoskeletal impairments, including pelvic impairments, if you are not utilizing dry needling in your treatment, you are not achieving your maximum potential.

Let me know if anyone has any questions about anything. Talk to you soon.

Jason

Check out some of my other articles on pelvic health:
– Pelvic Floor Dry Needling: How to treat Incontinence
– Pelvic Floor Dry Needling: What is it + Who can do it?
– Dry Needling to Improve Pelvic Health: Postpartum Incontinence, Urge Incontinence, and Pain
– Pelvic Floor Dry Needling to Reduce Stress, Anxiety & Pain Associated with Any Impairment, Including Low Back Pain

Let me know if anyone has any questions about anything. Talk to you soon.

DISCLAIMER: The content on the blog for Intricate Art Spine & Body Solutions, LLC is for educational and informational purposes only, and is not intended as medical advice. The information contained in this blog should not be used to diagnose, treat or prevent any disease or health illness. Any reliance you place on such information is therefore strictly at your own risk. Please consult with your physician or other qualified healthcare professional before acting on any information presented here.

References

Muscle Contraction

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Pelvic Floor References

• Liu, B., Liu, Y., Qin, Z., Zhou, K., Xu, H., He, L., Li, N., Su, T., Sun, J., Yue, Z. and Zang, Z., 2019, January. Electroacupuncture versus pelvic floor muscle training plus solifenacin for women with mixed urinary incontinence: a randomized noninferiority trial. In Mayo Clinic Proceedings (Vol. 94, No. 1, pp. 54-65). Elsevier.
• Wang, Y., Zhishun, L., Peng, W., Zhao, J. and Liu, B., 2013. Acupuncture for stress urinary incontinence in adults. Cochrane Database of Systematic Reviews, (7).
• Itza, F., Zarza, D., Serra, L., Gomez-Sancha, F., Salinas, J. and Allona-Almagro, A., 2010. Myofascial pain syndrome in the pelvic floor: a common urological condition. Actas Urológicas Españolas (English Edition), 34(4), pp.318-326.
• Kalichman, L. and Vulfsons, S., 2010. Dry needling in the management of musculoskeletal pain. The Journal of the American Board of Family Medicine, 23(5), pp.640-646.
• Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S. and Perreault, T., 2014. Dry needling: a literature review with implications for clinical practice guidelines. Physical therapy reviews, 19(4), pp.252-265.
• Montenegro, M.L., Braz, C.A., Rosa-e-Silva, J.C., Candido-dos-Reis, F.J., Nogueira, A.A. and Poli-Neto, O.B., 2015. Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain. BMC anesthesiology, 15(1), p.175.
• Halle, J.S. and Halle, R.J., 2016. Pertinent dry needling considerations for minimizing adverse effects–part two. International journal of sports physical therapy, 11(5), p.810.
• Zhong, D., Tang, W., Geng, D. and He, C., 2019. Efficacy and safety of acupuncture therapy for urinary incontinence in women: A systematic review and meta-analysis. Medicine, 98(40).
• Zhang, Z., Wang, W., Song, Y., Zhai, T., Zhu, Y., Jiang, L., Li, Q., Jin, L., Li, K. and Feng, W., 2021. Immediate Effect of Dry Needling at Myofascial Trigger Point on Hand Spasticity in Chronic Post-stroke Patients: A Multicenter Randomized Controlled Trial. Frontiers in neurology, 12.
• Sheikhhoseini, R. and Arab, A.M., 2018. Dry needling in myofascial tracks in non-relaxing pelvic floor dysfunction: A case study. Journal of Bodywork and Movement Therapies, 22(2), pp.337-340.
• George, A., VanEtten, L. and Briggs, M., 2018. Dry Needling for Female Chronic Pelvic Pain: A Case Series. Journal of Women’s Health Physical Therapy, 42(1), pp.8-16.
• Lin, A., Abbas, H., Sultan, M. and Tzeng, T., 2022. A critical review of interventional treatments for myofascial pelvic pain.
• Bubnov, R. and Kalika, L., Dry needling of trigger points under ultrasound guidance effective to treat chronic pelvic pain and pelvic prolapse.
• Frederice, C.P., Brito, L.G.O., Pereira, G.M.V., Lunardi, A.L.B. and Juliato, C.R.T., 2021. Interventional treatment for myofascial pelvic floor pain in women: systematic review with meta-analysis. International Urogynecology Journal, 32(5), pp.1087-1096.
• Rajkannan, P. and Vijayaraghavan, R., 2019. Dry needling in chronic abdominal wall pain of uncertain origin. Journal of Bodywork and Movement Therapies, 23(1), pp.94-98.
• Alappattu, M., Hilton, S. and Bishop, M., 2019. An international survey of commonly used interventions for management of pelvic pain. Journal of women’s health physical therapy, 43(2), p.82.
• Bartley, J., Han, E., Gupta, P., Gaines, N., Killinger, K.A., Boura, J.A., Farrah, M., Gilleran, J., Sirls, L.T. and Peters, K.M., 2019. Transvaginal trigger point injections improve pain scores in women with pelvic floor hypertonicity and pelvic pain conditions. Female pelvic medicine & reconstructive surgery, 25(5), pp.392-396.
• Hastings, J. and Machek, M., 2020. Pelvic Floor Dysfunction in Women. Current Physical Medicine and Rehabilitation Reports, 8(2), pp.64-75.
• Bazzaz-Yamchi, M., Naghdi, S., Nakhostin-Ansari, A., Hadizadeh, M., Ansari, N.N., Moghimi, E. and Hasson, S., 2021. Acute and Short-Term Effects of Dry Needling in Patients with Chronic Nonspecific Low Back Pain and Hamstring Tightness: A Pilot Study. The Scientific World Journal, 2021.
  Vagus Nerve Stimulation
• Sprouse-Blum, A.S., Smith, G., Sugai, D. and Parsa, F.D., 2010. Understanding endorphins and their importance in pain management. Hawaii medical journal, 69(3), p.70.
• Usichenko, T.I., Dinse, M., Hermsen, M., Witstruck, T., Pavlovic, D. and Lehmann, C., 2005. Auricular acupuncture for pain relief after total hip arthroplasty–a randomized controlled study. Pain, 114(3), pp.320-327.
• Usichenko, T.I., Kuchling, S., Witstruck, T., Pavlovic, D., Zach, M., Hofer, A., Merk, H., Lehmann, C. and Wendt, M., 2007. Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial. Cmaj, 176(2), pp.179-183.
• Jaić, K.K., Turković, T.M., Pešić, M., Djaković, I., Košec, V. and Košec, A., 2019. Auricular acupuncture as effective pain relief after episiotomy: a randomized controlled pilot study. Archives of gynecology and obstetrics, 300(5), pp.1295-1301
• Taylor, S.L., Giannitrapani, K.F., Ackland, P.E., Thomas, E.R., Federman, D.G., Holliday, J.R., Olson, J., Kligler, B. and Zeliadt, S.B., 2021. The Implementation and Effectiveness of Battlefield Auricular Acupuncture for Pain. Pain Medicine.
• Shah, A.N., Moore, C.B. and Brigger, M.T., 2020. Auricular acupuncture for adult tonsillectomy. The Laryngoscope, 130(8), pp.1907-1912.
• Garner, B.K., Hopkinson, S.G., Ketz, A.K., Landis, C.A. and Trego, L.L., 2018. Auricular acupuncture for chronic pain and insomnia: a randomized clinical trial. Medical acupuncture, 30(5), pp.262-272.
• Kang, H.R., Lee, Y.S., Kim, H.R., Kim, E.J., Kim, K.H., Kim, K.S., Jung, C.Y. and Lee, J.K., 2017. A clinical study of electroacupuncture and auricular acupuncture for abdominal pain relief in patients with pancreatitis: A pilot study. Korean Journal of Acupuncture, 34(1), pp.47-55.
• Moura, C.D.C., Chaves, E.D.C.L., Cardoso, A.C.L.R., Nogueira, D.A., Azevedo, C. and Chianca, T.C.M., 2019. Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis. Revista da Escola de Enfermagem da USP, 53.
• Tsai, S.L., Fox, L.M., Murakami, M. and Tsung, J.W., 2016. Auricular acupuncture in emergency department treatment of acute pain. Annals of emergency medicine, 68(5), pp.583-585.
• Yeh, C.H., Chiang, Y.C., Hoffman, S.L., Liang, Z., Klem, M.L., Tam, W.W., Chien, L.C. and Suen, L.K.P., 2014. Efficacy of auricular therapy for pain management: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2014.
• Sator-Katzenschlager, S.M., Szeles, J.C., Scharbert, G., Michalek-Sauberer, A., Kober, A., Heinze, G. and Kozek-Langenecker, S.A., 2003. Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study. Anesthesia & Analgesia, 97(5), pp.1469-1473.
• Usichenko, T.I., Lehmann, C. and Ernst, E., 2008. Auricular acupuncture for postoperative pain control: a systematic review of randomised clinical trials. Anaesthesia, 63(12), pp.1343-1348.
• Johnson, R.L. and Wilson, C.G., 2018. A review of vagus nerve stimulation as a therapeutic intervention. Journal of inflammation research, 11, p.203.

Neurologic Conditions, Including TBI & CVA

• Ghayour Najafabadi, M., Shariat, A., Dommerholt, J., Hakakzadeh, A., Nakhostin-Ansari, A., Selk-Ghaffari, M., Ingle, L. and Cleland, J.A., 2021. Aquatic Therapy for improving Lower Limbs Function in Post-stroke Survivors: A Systematic Review with Meta-Analysis. Topics in Stroke Rehabilitation, pp.1-17.
• Pourahmadi, M., Dommerholt, J., Fernández-de-Las-Peñas, C., Koes, B.W., Mohseni-Bandpei, M.A., Mansournia, M.A., Delavari, S., Keshtkar, A. and Bahramian, M., 2021. Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: A systematic review and meta-analysis. Physical Therapy, 101(5), p.pzab068.
• Fernández-de-Las-Peñas, C., Pérez-Bellmunt, A., Llurda-Almuzara, L., Plaza-Manzano, G., De-la-Llave-Rincón, A.I. and Navarro-Santana, M.J., 2021. Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis. Pain Medicine, 22(1), pp.131-141.
• Sánchez-Mila, Z., Salom-Moreno, J. and Fernández-de-Las-Peñas, C., 2018. Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial. Acupuncture in Medicine, 36(6), pp.358-366.
• Mendigutia-Gómez, A., Martín-Hernández, C., Salom-Moreno, J. and Fernández-de-Las-Peñas, C., 2016. Effect of dry needling on spasticity, shoulder range of motion, and pressure pain sensitivity in patients with stroke: A crossover study. Journal of manipulative and physiological therapeutics, 39(5), pp.348-358.
• Mendigutía-Gómez, A., Quintana-García, M.T., Martín-Sevilla, M., de Lorenzo-Barrientos, D., Rodríguez-Jiménez, J., Fernández-de-Las-Peñas, C. and Arias-Buría, J.L., 2020. Post-needling soreness and trigger point dry needling for hemiplegic shoulder pain following stroke. Acupuncture in Medicine, 38(3), pp.150-157.
• Valencia-Chulián, R., Heredia-Rizo, A.M., Moral-Munoz, J.A., Lucena-Anton, D. and Luque-Moreno, C., 2020. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review. Complementary Therapies in Medicine, 52, p.102515.
• Calvo, S., Navarro, J., Herrero, P., Del Moral, R., De Diego, C. and Marijuán, P.C., 2015. Electroencephalographic changes after application of dry needling [DNHS© technique] in two patients with chronic stroke. Myopain, 23(3-4), pp.112-117.
• Cuenca Zaldívar, J.N., Calvo, S., Bravo-Esteban, E., Oliva Ruiz, P., Santi-Cano, M.J. and Herrero, P., 2020. Effectiveness of dry needling for upper extremity spasticity, quality of life and function in subacute phase stroke patients. Acupuncture in Medicine, p.0964528420947426.
• Hernández-Ortíz, A.R., Ponce-Luceño, R., Sáez-Sánchez, C., García-Sánchez, O., Fernández-de-Las-Peñas, C. and de-la-Llave-Rincón, A.I., 2020. Changes in muscle tone, function, and pain in the chronic hemiparetic shoulder after dry needling within or outside trigger points in stroke patients: A crossover randomized clinical trial. Pain Medicine, 21(11), pp.2939-2947.
• Tavakol, Z., Shariat, A., Ansari, N.N., Ghannadi, S., Honarpishe, R., Dommerholt, J., Noormohammadpour, P. and Ingle, L., 2021. A Double-blind Randomized Controlled Trial for the Effects of Dry Needling on Upper Limb Dysfunction in Patients with Stroke. Acupuncture & Electro-Therapeutics Research, 45(2-3), pp.115-124.
• Ghaffari, M.S., Shariat, A., Honarpishe, R., Hakakzadeh, A., Cleland, J.A., Haghighi, S. and Barghi, T.S., 2019. Concurrent effects of dry needling and electrical stimulation in the management of upper extremity hemiparesis. Journal of acupuncture and meridian studies, 12(3), pp.90-94.
• Ghannadi, S., Shariat, A., Ansari, N.N., Tavakol, Z., Honarpishe, R., Dommerholt, J., Noormohammadpour, P. and Ingle, L., 2020. The effect of dry needling on lower limb dysfunction in poststroke survivors. Journal of Stroke and Cerebrovascular Diseases, 29(6), p.104814.
• Bynum, R., Garcia, O., Herbst, E., Kossa, M., Liou, K., Cowan, A. and Hilton, C., 2021. Effects of dry needling on spasticity and range of motion: a systematic review. American Journal of Occupational Therapy, 75(1), pp.7501205030p1-7501205030p13.
• DiLorenzo, L., Traballesi, M., Morelli, D., Pompa, A., Brunelli, S., Buzzi, M.G. and Formisano, R., 2004. Hemiparetic shoulder pain syndrome treated with deep dry needling during early rehabilitation: a prospective, open-label, randomized investigation. Journal of Musculoskeletal Pain, 12(2), pp.25-34.
• Carusotto, A.F., Hakim, R.M., Oliveira, R.G., Piranio, A., Coughlan, C.P. and MacDonald, T.J., 2021. Effects of dry needling on muscle spasticity in adults with neurological disorders: a systematic review. Physical Therapy Reviews, pp.1-6.
• Sánchez-Mila, Z., Salom-Moreno, J. and Fernández-de-Las-Peñas, C., 2018. Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial. Acupuncture in Medicine, 36(6), pp.358-366.
• Salom-Moreno, J., Sánchez-Mila, Z., Ortega-Santiago, R., Palacios-Ceña, M., Truyol-Domínguez, S. and Fernández-de-las-Peñas, C., 2014. Changes in spasticity, widespread pressure pain sensitivity, and baropodometry after the application of dry needling in patients who have had a stroke: A randomized controlled trial. Journal of manipulative and physiological therapeutics, 37(8), pp.569-579.
• Valencia-Chulián, R., Heredia-Rizo, A.M., Moral-Munoz, J.A., Lucena-Anton, D. and Luque-Moreno, C., 2020. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review. Complementary Therapies in Medicine, 52, p.102515.
• Núñez-Cortés, R., Cruz-Montecinos, C., Latorre-García, R., Pérez-Alenda, S. and Torres-Castro, R., 2020. Effectiveness of Dry Needling in the Management of Spasticity in Patients Post Stroke. Journal of Stroke and Cerebrovascular Diseases, 29(11), p.105236.
• Bynum, R., Garcia, O., Herbst, E., Kossa, M., Liou, K., Cowan, A. and Hilton, C., 2021. Effects of dry needling on spasticity and range of motion: a systematic review. American Journal of Occupational Therapy, 75(1), pp.7501205030p1-7501205030p13.

Electrical Needling

• Dunning, J., Butts, R., Henry, N., Mourad, F., Brannon, A., Rodriguez, H., Young, I., Arias-Buría, J.L. and Fernández-de-Las-Peñas, C., 2018. Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial. PloS one, 13(10), p.e0205405.
• Dunning, J., Butts, R., Zacharko, N., Fandry, K., Young, I., Wheeler, K., Day, J. and Fernández-de-Las-Peñas, C., 2021. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. The Spine Journal, 21(2), pp.284-295.
• Ghaffari, M.S., Shariat, A., Honarpishe, R., Hakakzadeh, A., Cleland, J.A., Haghighi, S. and Barghi, T.S., 2019. Concurrent effects of dry needling and electrical stimulation in the management of upper extremity hemiparesis. Journal of acupuncture and meridian studies, 12(3), pp.90-94.
• Brennan, K., Elifritz, K.M., Comire, M.M. and Jupiter, D.C., 2021. Rate and maintenance of improvement of myofascial pain with dry needling alone vs. dry needling with intramuscular electrical stimulation: a randomized controlled trial. Journal of Manual & Manipulative Therapy, 29(4), pp.216-226.
• Fernández-Carnero, J., 2021. Effectiveness of Dry Needling with Percutaneous Electrical Nerve Stimulation of High Frequency Versus Low Frequency in Patients with Myofascial Neck Pain. Pain physician, 24, pp.135-143.
• WALSH, S., GOULT, C. and GILLETT, B., 2021. Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. journal of orthopaedic & sports physical therapy, 51(2), p.73.
• Dunning, J., 2019. Effectiveness of Electrical Dry Needling for Lower Extremity Pain Disorders.
• Hadizadeh, M., Tajali, S.B., Moghadam, B.A., Jalaei, S. and Bazzaz, M., 2022. Effects of Intramuscular Electrical Stimulation through Dry Needling on Pain and Dysfunction Following Trigger Points in Upper Trapezius Muscle: A Double-blind Randomized Controlled Trial. Journal of Modern Rehabilitation.
• Ahmed, A.F., Elgayed, S.S. and Ibrahim, I.M., 2012. Polarity effect of microcurrent electrical stimulation on tendon healing: biomechanical and histopathological studies. Journal of Advanced Research, 3(2), pp.109-117.
• Yazdan-Shahmorad, A., Kipke, D.R. and Lehmkuhle, M.J., 2011. Polarity of cortical electrical stimulation differentially affects neuronal activity of deep and superficial layers of rat motor cortex. Brain stimulation, 4(4), pp.228-241.
• Gentzkow, G.D., 1993. Electrical stimulation to heal dermal wounds. The Journal of dermatologic surgery and oncology, 19(8), pp.753-758.
• Hayashi, K. and Ninjouji, T., 2004, September. Two-point discrimination threshold as a function of frequency and polarity at fingertip by electrical stimulation. In The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (Vol. 2, pp. 4256-4259). IEEE.
• Demir, H., Balay, H. and Kirnap, M., 2004. A comparative study of the effects of electrical stimulation and laser treatment on experimental wound healing in rats. Journal of rehabilitation Research & development, 41(2).
• Balakatounis, K.C. and Angoules, A.G., 2008. Low-intensity electrical stimulation in wound healing: review of the efficacy of externally applied currents resembling the current of injury. Eplasty, 8.
• Ashrafi, M., Alonso‐Rasgado, T., Baguneid, M. and Bayat, A., 2016. The efficacy of electrical stimulation in experimentally induced cutaneous wounds in animals. Veterinary dermatology, 27(4), pp.235-e57.
• Krause, B. and Cohen Kadosh, R., 2014. Not all brains are created equal: the relevance of individual differences in responsiveness to transcranial electrical stimulation. Frontiers in systems neuroscience, 8, p.25.
• Asadi, M.R., Torkaman, G. and Hedayati, M., 2011. Effect of sensory and motor electrical stimulation in vascular endothelial growth factor expression of muscle and skin in full-thickness wound. J Rehabil Res Dev, 48(3), pp.195-201.
• Deriu, F., Tolu, E. and Rothwell, C., 2003. A short latency vestibulomasseteric reflex evoked by electrical stimulation over the mastoid in healthy humans. The Journal of physiology, 553(1), pp.267-279.
• Wang, J., Wang, H., Thakor, N.V. and Lee, C., 2019. Self-powered direct muscle stimulation using a triboelectric nanogenerator (TENG) integrated with a flexible multiple-channel intramuscular electrode. ACS nano, 13(3), pp.3589-3599.
• Nussbaum, E.L., Houghton, P., Anthony, J., Rennie, S., Shay, B.L. and Hoens, A.M., 2017. Neuromuscular electrical stimulation for treatment of muscle impairment: critical review and recommendations for clinical practice. Physiotherapy Canada, 69(5), pp.1-76.
• Asadi, M.R. and Torkaman, G., 2014. Bacterial inhibition by electrical stimulation. Advances in wound care, 3(2), pp.91-97.
• Snyder, A.R., Perotti, A.L., Lam, K.C. and Bay, R.C., 2010. The influence of high-voltage electrical stimulation on edema formation after acute injury: a systematic review. Journal of sport rehabilitation, 19(4), pp.436-451.
• Feger, M.A., Goetschius, J., Love, H., Saliba, S.A. and Hertel, J., 2015. Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review. Physical Therapy in Sport, 16(4), pp.361-369.
• Hamid, S. and Hayek, R., 2008. Role of electrical stimulation for rehabilitation and regeneration after spinal cord injury: an overview. European Spine Journal, 17(9), pp.1256-1269.
• Reilly, J.P., 2012. Applied bioelectricity: from electrical stimulation to electropathology. Springer Science & Business Media.
• Gordon, T., Amirjani, N., Edwards, D.C. and Chan, K.M., 2010. Brief post-surgical electrical stimulation accelerates axon regeneration and muscle reinnervation without affecting the functional measures in carpal tunnel syndrome patients. Experimental neurology, 223(1), pp.192-202.
• Hwang, I.H. and Thompson, J.M., 2001. The effect of time and type of electrical stimulation on the calpain system and meat tenderness in beef longissimus dorsi muscle. Meat science, 58(2), pp.135-144.

Autonomic Nervous System

• Li, Q.Q., Shi, G.X., Xu, Q., Wang, J., Liu, C.Z. and Wang, L.P., 2013. Acupuncture effect and central autonomic regulation. Evidence-Based Complementary and Alternative Medicine, 2013.
• Park, S.U., Jung, W.S., Moon, S.K., Park, J.M., Ko, C.N., Cho, K.H., Kim, Y.S. and Bae, H.S., 2008. Effects of acupuncture on autonomic nervous system in normal subjects under mental stress. The Journal of Korean Medicine, 29(2), pp.107-115.
• Haker, E., Egekvist, H. and Bjerring, P., 2000. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. Journal of the autonomic nervous system, 79(1), pp.52-59.
• Bäcker, M., Grossman, P., Schneider, J., Michalsen, A., Knoblauch, N., Tan, L., Niggemeyer, C., Linde, K., Melchart, D. and Dobos, G.J., 2008. Acupuncture in migraine: investigation of autonomic effects. The Clinical journal of pain, 24(2), pp.106-115.
• Uchida, C., Waki, H., Minakawa, Y., Tamai, H., Miyazaki, S., Hisajima, T. and Imai, K., 2019. Effects of acupuncture sensations on transient heart rate reduction and autonomic nervous system function during acupuncture stimulation. Medical acupuncture, 31(3), pp.176-184.
• Uchida, C., Waki, H., Minakawa, Y., Tamai, H., Miyazaki, S., Hisajima, T. and Imai, K., 2019. Effects of acupuncture sensations on transient heart rate reduction and autonomic nervous system function during acupuncture stimulation. Medical acupuncture, 31(3), pp.176-184.
• Butts, r., dunning, j. And serafino, c., 2020. Dry needling strategies for musculoskeletal conditions: do the number of needles and needle retention time matter? A narrative review of the literature. Journal of bodywork and movement therapies.
• Castro-Sánchez, A.M., Garcia-López, H., Fernández-Sánchez, M., Perez-Marmol, J.M., Leonard, G., Gaudreault, N., Aguilar-Ferrándiz, M.E. and Matarán-Peñarrocha, G.A., 2020. Benefits of dry needling of myofascial trigger points on autonomic function and photoelectric plethysmography in patients with fibromyalgia syndrome. Acupuncture in Medicine, 38(3), pp.140-149.
• Loaiza, L. A., Yamaguchi, S., Ito, M., & Ohshima, N. (2002). Electro-acupuncture stimulation to muscle afferents in anesthetized rats modulates the blood flow to the knee joint through autonomic reflexes and nitric oxide. Autonomic Neuroscience : Basic & Clinical, 97(2), 103–109. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12132642.
• Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., … Nishijo, H. (2017). Compression at myofascial trigger point on chronic neck pain provides pain relief through the prefrontal cortex and autonomic nervous system: A pilot study. Frontiers in Neuroscience, 11(APR). https://doi.org/10.3389/fnins.2017.00186.
• Sillevis, R., Van Duijn, J., Shamus, E. and Hard, M., 2021. Time effect for in-situ dry needling on the autonomic nervous system, a pilot study. Physiotherapy theory and practice, 37(7), pp.826-834.
• Lázaro-Navas, I., Lorenzo-Sánchez-Aguilera, C., Pecos-Martín, D., Jiménez-Rejano, J.J., Navarro-Santana, M.J., Fernández-Carnero, J. and Gallego-Izquierdo, T., 2021. Immediate Effects of Dry Needling on the Autonomic Nervous System and Mechanical Hyperalgesia: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 18(11), p.6018.
• Abbaszadeh-Amirdehi, M., Ansari, N.N., Naghdi, S., Olyaei, G. and Nourbakhsh, M.R., 2017. Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points. Acupuncture in Medicine, 35(2), pp.85-92.
• Castro-Sánchez, A.M., Garcia-López, H., Fernández-Sánchez, M., Perez-Marmol, J.M., Leonard, G., Gaudreault, N., Aguilar-Ferrándiz, M.E. and Matarán-Peñarrocha, G.A., 2020. Benefits of dry needling of myofascial trigger points on autonomic function and photoelectric plethysmography in patients with fibromyalgia syndrome. Acupuncture in Medicine, 38(3), pp.140-149.
• Skorupska, E., Rychlik, M. and Samborski, W., 2015. Intensive vasodilatation in the sciatic pain area after dry needling. BMC complementary and alternative medicine, 15(1), pp.1-9.
• Clark, N.G., Hill, C.J., Koppenhaver, S.L., Massie, T. and Cleland, J.A., 2021. The effects of dry needling to the thoracolumbar junction multifidi on measures of regional and remote flexibility and pain sensitivity: A randomized controlled trial. Musculoskeletal Science and Practice, 53, p.102366.
• Sánchez-Infante, J., Navarro-Santana, M.J., Bravo-Sánchez, A., Jiménez-Diaz, F. and Abián-Vicén, J., 2021. Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis. Physical Therapy, 101(3), p.pzab070.
• Eftekharsadat, B., Babaei-Ghazani, A. and Zeinolabedinzadeh, V., 2016. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Medical journal of the Islamic Republic of Iran, 30, p.401.
• Li, Q.Q., Shi, G.X., Xu, Q., Wang, J., Liu, C.Z. and Wang, L.P., 2013. Acupuncture effect and central autonomic regulation. Evidence-Based Complementary and Alternative Medicine, 2013.
• Mori, H., Nishijo, K., Kawamura, H. and Abo, T., 2002. Unique immunomodulation by electro-acupuncture in humans possibly via stimulation of the autonomic nervous system. Neuroscience Letters, 320(1-2), pp.21-24.
• Sakatani, K., Kitagawa, T., Aoyama, N. and Sasaki, M., 2010. Effects of acupuncture on autonomic nervous function and prefrontal cortex activity. In Oxygen Transport to Tissue XXXI (pp. 455-460). Springer, Boston, MA
• Haker, E., Egekvist, H. and Bjerring, P., 2000. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. Journal of the autonomic nervous system, 79(1), pp.52-59.
• Shu, Q., Wang, H., Litscher, D., Wu, S., Chen, L., Gaischek, I., Wang, L., He, W., Zhou, H., Litscher, G. and Liang, F., 2016. Acupuncture and moxibustion have different effects on fatigue by regulating the autonomic nervous system: a pilot controlled clinical trial. Scientific reports, 6(1), pp.1-11.
• Matić, Z. and Bojić, T., 2020. Acupuncture, autonomic nervous system and biophysical origin of acupuncture system. Vojnosanitetski pregled, 77(1), pp.79-86.
• Uchida, C., Waki, H., Minakawa, Y., Tamai, H., Hisajima, T. and Imai, K., 2018. Evaluation of autonomic nervous system function using heart rate variability analysis during transient heart rate reduction caused by acupuncture. Medical acupuncture, 30(2), pp.89-95.
• Napadow, V., Beissner, F., Lin, Y., Chae, Y. and Harris, R.E., 2020. Neural Substrates of Acupuncture: From Peripheral to Central Nervous System Mechanisms. Frontiers in neuroscience, 13, p.1419.
• An, S. and Keum, D., 2021. Effect of Acupuncture at the Field of the Auricular Branch of the Vagus Nerve on Autonomic Nervous System Change. Journal of Korean Medicine Rehabilitation, 31(2), pp.81-97.
• Kupari, J. and Ernfors, P., 2020. Pricking into Autonomic Reflex Pathways by Electrical Acupuncture. Neuron, 108(3), pp.395-397.
• Kurita, K., Kiyomitsu, K., Ogasawara, C., Mishima, R., Ogawa-Ochiai, K. and Tsumura, N., 2019. Effect of acupuncture on the autonomic nervous system as evaluated by non-contact heart rate variability measurement. Artificial Life and Robotics, 24(1), pp.19-23.
• Dommerholt, J., Hooks, T., Chou, L.W. and Finnegan, M., 2019. A critical overview of the current myofascial pain literature–November 2018. Journal of bodywork and movement therapies, 23(1), pp.65-73.
• Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., Ono, T. and Nishijo, H., 2017. Compression at myofascial trigger point on chronic neck pain provides pain relief through the prefrontal cortex and autonomic nervous system: a pilot study. Frontiers in neuroscience, 11, p.186.
• Dommerholt, J., Mayoral, O. and Thorp, J.N., 2021. A critical overview of the current myofascial pain literature–January 2021.