Living in Alignment | Finding Balance in Life & Osteo S01E02 Bursitis

Ever wondered why what we do is called "Dry Needling"?

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Episode Transcript

(00:00):

Hi! Thanks for finding my podcast.
I'm Kerri Pearce, Principal Osteopath andSelf Directed Healing Practitioner at Lilydale
Osteopathy & Natural Health Care.
In this episode I want to talk briefly aboutbursitis and the origins of Dry Needle Therapy.

(00:24):
I have just returned from a women's consciousnessfestival called Bohemian Summer Festival which
was in Ballan near Ballarat, and I had anamazing weekend - I’m actually going to
talk about that next week in terms of someof the things that I learned, and some of
the things that I taught - but one of thereally interesting conversations I had while

(00:44):
I was away was with a lady who had her rightarm in a sling.
And when I queried her just out of curiosity;“what have you done to yourself?”
she told me that she had bursitis in her shoulder.
Now, bursitis is predominantly an overuseinjury - the old ‘RSI’ term; ‘repetitive

(01:04):
strain injury’ - and it is predominantlyinflammatory in nature, and it does respond
quite well pharmaceutically, to a corticosteroidinjection, but these days, most practitioners,
most general practitioners, most surgeonsaren’t really keen on doing corticosteroid

(01:25):
injections really quickly without having sentthe patient for some conservative treatment
first -and what surprised me about this particular
lady, was that she had only been sufferingfor about two and a half weeks when her doctor
had obviously sent her off to go and havethis corticosteroid injection, and she hadn't
had any conservative, manual therapy to startwith.

(01:46):
And I was surprised by that - the problemwith doing that is that corticosteroid is
chondroclastic - and, ‘chondro’ means‘cartilage’ and ‘clastic’ means it
breaks down.
So there's two main cells that live in yourcartilage - there's the chondroblasts and
the chondroclasts.

(02:07):
And the chondroblasts are the ones that buildcartilage, and the chondroclasts are the ones
that break it down.
And our body’s turning over those tissuesall the time so that needs to be in good balance
But corticosteroid can aggravate that destructionof cartilage and speed up the wear and tear

(02:28):
and result in those joints showing ageing,showing wear and tear, before we would normally
expect - so I was quite surprised that theyhad gone for that course of treatment quite
early on.
And I said to her; “Well if I was treatingyou - if you and my patient my approach is
some dry needling" - and I’m going to talkabout that in a minute, "some dry needling,

(02:49):
some therapeutic ultrasound - I like to tapeit up” - which is not dissimilar to the
way that she had it slinged in terms of rest,but gives the patient some mobility and that
keeps the tissues healthy - again I'll comeback to that in a moment
But what I want to start with before I gointo those details is just a little bit of

(03:12):
the history of Dry Needle Therapy.
Now Janet Travell, who's generally consideredthe mother of musculoskeletal medicine, she
actually started life as a cardiologist andshe would get sent patients who had chest
pain.
She’d check them out, make sure that itwasn't their heart, satisfied that it wasn't;

(03:32):
she thought ‘well, why have these patientsgot chest pain?’ and so she started to palpate
around the areas that they were complainingof having that chest pain, and she found these
little nodules of muscles that we now call‘Trigger Points’ - that's her terminology
- and she started to experiment with treatingthese sore bits of muscle by injecting local
anaesthetic and she got good results and soshe ended up with a bit of a reputation for

(03:56):
being able to treat these weird musculoskeletalconditions that didn't seem to have any particular
origin.
And one day she was injecting someone andhe said “oh!
That feels better already!”
- but she was like “but I haven’t injectedanything yet” - and all she’d done was
put the needle in, without actually doingthe injection of the local anaesthetic, and
so she started to wonder ‘well I wonderhow much of my patient's relief actually comes

(04:21):
from the anesthetic that she was injectingvs just the mechanical stimulation of the
muscle with the needle’ and so she startedto use a “dry” needle to inject trigger
points - to treat trigger points - and continuedto get really good results.
And in my experience - and I've been dry needlingnow for more than 20 years - it’s amazing

(04:44):
how many people who have had corticosteroidor other injections, and it wears off eventually
- and they come and see me - and the feedbackI get is that they got as much relief from
the dry needling as they did from their injectable.
And I wonder how many of these "miracle" treatments- you know, we’ve seen a few over the years

(05:04):
- there’s PRP - plasma replacement therapy,there’s prolotherapy, saline injections
and every time something new comes out it'sthe new best thing and everybody's gonna feel
better from it - but how much of the reliefthat these patients get is from the injectable
vs the mechanical stimulation of the musclefiber from the needle itself?
And I have continued over 20 years to seeamazing results on scar tissue, and inflammatory

(05:29):
conditions, RSIs, just by stimulating thearea with the dry needling.
So my approach for somebody with bursitisand they happen in all sorts of places - but
predominantly shoulders, elbows, hips andknees are the main places that we see those
bursitis - and I treat them with dry needling,with therapeutic ultrasound which sends high

(05:52):
frequency sound waves that travel quite deeplyinto the tissues and kind of give you a deep
tissue massage without the massage, and isshown to have anti-inflammatory properties
- along with the dry needling and so I findthat those two modalities work really well
together
I will tape the shoulder in the way that elevatesthe arm in the socket and takes the weight

(06:15):
of the arm off the tissues that would otherwisebe holding it, and that just gives those tissues
a chance to rest and a chance to recoverSome oral non-steroidal anti-inflammatory
drugs [NSAIDs] like Nurofen or Voltaren arealso optional, otherwise there might be some
natural alternatives that you might like totake, arnica,

(06:37):
I’m a big fan of green-lipped mussel extract,the omega-3s in that as an anti-inflammatory
can be really helpful for those inflammatoryconditions -
Ice, if it’s really problematicTopical anti-inflammatories - your Voltaren
gels and those sorts thingsor anything that if you wanted to rub it on,

(06:57):
the Inflameze, or the Medirubs, those typesof things that have got natural anti-inflammatories
again like Arnica in them can be helpfulbut I would expect to see some improvement
- especially in a patient who had a fairlyacute onset - a fairly recent onset of only
a couple of weeks - I would have expectedsome improvement with conservative manual

(07:22):
therapy within a week or two - not necessarilyresolved - but certainly improvement and so
I'm really disappointed that her Doctor - hergeneral practitioner encouraged her to go
down that corticosteroid route so quickly.
Now I’m not against it - steroids are afantastic drug, they’re a fantastic anti-inflammatory,
but they’re not without their risks, they’renot without their long-term problems.

(07:45):
Another adjunctive therapy that can be reallyhelpful is the Bexter’s Soda Crystals.
Now this is a slight variation on the goodold Lectric Soda or washing soda - we sell
it at the clinic you can get it from the supermarket;my advice to patients is to get an old pair
of pantyhose, or a new pair if you want, oran old tea-towel, something that’s quite
porous and throw a couple of handfuls of theBexter’s crystals in there, wrap it around

(08:10):
the area of swelling, and go to bed with it.
Put a towel down, your sheets are going toget messy otherwise, it is just washing soda
- so if it gets onto your clothes, on to yourjammies, on to your sheets, it's not a problem
just throw it in the wash, and it will actuallyhelp make the rest of your washing clean.
But Bexter’s crystals, lectric soda is hydrophilicso it loves water, it loves fluids and it

(08:32):
will pull the fluids out of those jointsThere’s really no harm in doing that on
a regular basis -Washing soda is highly basic, highly alkaline
so applying it directly to the skin for severaldays in a row, can result in irritation so
the advice is to only do it every second dayso that you don't create basically a burn

(08:55):
- not an acid burn, but an alkaline burn,so keep that in mind if you decide to give
the lectric soda a go - but that's reallyhelpful for sprains and strains and any joints
that have got fluid in them, get that Bexter’scrystals, get that lectric soda in there,
and you’ll be amazed at you how much ofthat fluid is pulled out,

(09:15):
and when you take it off the joint it willbe hard like plaster.
An example that I want to share with you isof a patient who came to me after a knee injury
and this knee was quite swollen, and of coursethe first thing I did was compare it to the
other knee - what should her knee, what SHOULDher knees look like? and the other knee was

(09:36):
almost just as bad, and she said “oh don’tworry about that - that's been like that for
20 years from a horse riding accident” and,okay that made my job a little bit harder,
but I treated her injured knee, and I didn'ttouch the other side, but I suggested that
she give the Bexter's crystals ago and shecame back to see me the following week and
she was like ‘oh my goodness that knee hasnot been that good for 20 years’.

(09:58):
So even old injuries that have swelled up,swollen up, and haven't really100% resolved,
you can always give the Bexter’s a go, andit's not going to do you any harm, just, as
I say, be aware that it is very alkaline andconstant contact with the skin it can cause
an irritation.

(10:19):
If you decide to put in the bath, it is veryslippery, so be careful when you get out,
but honestly using it as a 'pack' on the swollenjoint, is going to yield you the best results.
Now, if you Google bursitis, you're alwaysgoing to be met with the worst possible scenarios.

(10:40):
Generally speaking they show photos of whatbursitis looks like that has perhaps been
years in the making, completely untreated- you'll see these big, red, ballooned joints
and that's not usually the way we practitionerssee them.
Usually patients come to see us before itreaches that point
so if you have a suspicion that you've gota bursitis, don't necessarily rely on those

(11:06):
images from Google because they're the worstcase scenario.
Pretty much any hamstring strain is goingto result in some behind-the-knee, ‘Baker’s
Cyst’ type bursitis, and so making surethat you look after that hamstring strain
and that bursa behind the knee is a reallyimportant step to ensuring it doesn’t develop

(11:28):
into what you see on Google.
So if bursitis is one of those things thatyou've experienced or a loved one has, there's
a couple of ideas to throw at you - seek outan osteopath, or a practitioner that does
some dry needling, the therapeutic ultrasoundis a great adjunct to that, a lot of physios

(11:50):
do that as well, but give your bursitis achance to recover on a conservative level
before heading down that corticosteroid route,because the long term effects of injecting
corticosteroids into joints is premature ageing,premature wear and tear of that cartilage

(12:11):
So, look after your joints, take those omega-3s,seek out somebody who will guide you in that
conservative approach.
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(12:35):
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find me wherever you find podcasts, find mewherever you find videos, and stay tuned for

(12:57):
next week when I tell you about my littlefestival that I went to.
Have a good week!