The Physical and Mental Impacts on Athletes
The physical and mental demands of physical training and competing in sporting activities can be stressful and taxing to athletes of all levels. Sport participation has become a year-round activity, with young athletes involved in the same sport without having an off-season to allow the body to recover from the stresses and strains imposed. Repetitive stresses are abundant as athletes are continually training to improve strength, endurance, and agility. Athletic competition can also be taxing on the athlete as the stresses both generated and imposed can cause soft tissue injuries. Lastly, the mental stresses (both internal and external) in athletes can affect their ability to perform and recover.
Rehabilitation Technique for Athletes: Dry Needling
Athletes at all levels rely upon medical staff personnel to provide care and treatment for their injuries and to aid in recovery. Dry needling therapy is a relatively new rehabilitation technique for athletes. As the demands in athletes have increased, so have the demands for rehabilitation techniques for sports medicine and athletic training. Dry needling (DN) of injury for athletic trainers and physical therapists in athletics is performed to augment recovery, aid in injury prevention, and enhance performance.
Examples of Dry Needling Treatment for Sport Injuries
Trigger Points (TrPs) can develop in athletes as a result of muscle overload, overuse, repetitive activity, and excessive eccentric muscle activity (Gerwin, 2008). Dry needling has been shown to affect the biomechanical (Langevin et al., 2006), chemical (Shah et al., 2008), and vascular (Larsson et al., 1999) properties of soft tissue. Also, DN has been shown to be more effective in improving pressure pain thresholds compared to manual TrP therapy (Llamas-Ramos et al., 2014). Patients with unilateral ankle instability that received DN into the lateral fibularis muscle along with proprioception and strengthening exercises have been shown to have improved outcomes in both pain and outcome functional measurements as compared to those receiving exercise training alone (Salom-Moreno et al., 2015). Tendinopathy can be a debilitating condition in athletes, as a lack of blood flow and ensuing hypoxic tissue environment can lead to pain and disability. Dry needling has been advocated in the management of tendinopathy as it has been shown to increase both blood flow via local vasodilation (Kubo et al., 2010; James et al., 2007) and collagen proliferation (Langevin et al., 2007).
Osborne and Gatt (2010) revealed improved shoulder range of motion, function, and decreased pain in elite volleyball players receiving DN to the scapulohumeral musculature during the season. Dry needling in subjects with supraspinatus tendon lesions (tendinosis or partial tear) has been shown to have improved outcome measures and shoulder range of motion (Rha et al., 2013). Posterior shoulder tightness is a common finding in overhead athletes, for which stretching, massage, and joint mobilizations are often utilized in treatment. Passigli and coworkers (2016) demonstrated the use of DN to the infraspinatus, teres minor, and posterior deltoid muscles to improve shoulder horizontal adduction and internal rotation range of motion and decrease pain reproduction. Dry needling followed by active stretching has been shown to be more effective than stretching alone, which could lead to increased TrP sensitivity (Decoster et al., 2005).
Dry needling has been shown to increase maximal endurance and force in knee extensor muscles in elite soccer players (Haser et al., 2017). Another study showed that DN improved hamstrings flexibility (Alaei et al., 2021). Bandy et al. (2017) demonstrated a significant increase in vertical jump following one session of dry needling in a group of healthy subjects as compared to sham dry needling. TrPs have been shown to accelerate muscle fatigue and consequently tax neighboring motor units to the TrP (Ge et al., 2012). Elimination of the TrP can reduce the augmented muscle fatigue and thereby help reduce potential overload within the muscle (Ge et al., 2012). Ershad et al. (2019) showed that DN can be used as a novel recovery strategy for quadriceps muscle fatigue. Athletes can also suffer psychological stresses from both competition and non-competition sources (Noblet and Gifford, 2007). Psychological stressors have been shown to decrease the rate of strength recovery from strength workouts (Stults-Kolehmainen and Bartholomew, 2012). Dry needling can influence the anterior cingulate cortex and limbic system (Hui et al., 2000; Wu et al. 2002), which could affect emotional stresses that are frequent in athletics.
Dry Needling Is an Effective Option for Athletes
Athletes seek professional care in providing daily maintenance and rehabilitation following injury. Dry needling is a treatment technique that can be utilized in the care of athletes that provides a multitude of benefits. In addition to augmenting local tissue recovery, DN has been shown to release opioid peptides, reduce the nociceptive input from the TrP, and therefore decrease the overall pain and sensitivity that accompanies TrPs (Lavelle et al., 2007; Ge et al., 2009; Affaitati et al., 2011). While the use of opioids in athletics is well documented (Ekhtiari et al., 2020), it is important for practitioners to offer alternative options that effective care aimed at both restoring function and decrease the pain that often accompanies sports.
Dry needling is a treatment technique that can aid athletes in their pursuit of training and competing in their sporting activity. As both physical therapists and athletic trainers seek to expand their treatment skills through continuing education, DN can be an effective treatment modality to aid an athlete to return to play.
Todd Hooks, PT, ATC, OCS, SCS, FAAOMPT
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