Dr. Ellison Melrose // #TechniqueThursday // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, Dry Needling lead faculty Ellison Melrose discusses using dry needling for recovery, including e-stim parameters using the ES-160 unit.

Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog

If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling.

EPISODE TRANSCRIPTION

ELLISON MELROSE Welcome to the PT on Ice daily show. My name is Dr. Ellison Melrose. I am lead faculty with the dry needling division of ICE. I am here to talk to you guys today about recovery, so dry needling for recovery. We are coming off of Ice Sampler Weekend, and we had two pretty intense workouts this weekend, and we're feeling it, I think. So we are pretty sore in the quads, so what I wanted to demonstrate today was a recovery method for primarily the quads. We're gonna go over recovery mechanisms, how to choose the muscles when you're thinking about setting up a recovery circuit, and the e-stim parameters that you want for dry kneeling for recovery. So there are three main mechanisms of action when we're thinking about recovery. The first is pumping, so hemodynamics. We're getting big muscles to pump. There are some muscles that are better pumps and better sponges, so they do a better job at the fluid dynamics. The second mechanism is washing out cellular debris from in that intracellular space. So thinking a little bit more microscopic than just vasohemodynamics or moving fluid. We're thinking cellularly. So we know that active recovery and facilitated recovery can do both of those things. What's nice about dry needling when we're thinking about recovery is that we're not putting any mechanical stress on the tissues, loading like we would with active recovery. Third, we have an autonomic nervous system response.

DRY NEEDLING FOR HEMODYNAMICS So one thing that they saw throughout the research is that dry, or e-stim, facilitated recovery with e-stim, there is a longer base of dilation effect after we removed the e-stem from the tissue. And so what they postulated from that is that we have an autonomic nervous system response, so we have increased vasodilation, which is just going to improve our body's natural ability to pump fluid. When we're thinking about choosing muscles, again, as I mentioned earlier, there are some muscles that have better capacity to pump, but also absorb fluid and that is based off what we call O2 flux capacity. We're not going to dive super deep into that today, but pretty much what it means is that there's increased capillary density in those tissues and so they act as better sponges and better pumps. When we look at the lower quarter, there are two main muscles that are going to be pretty good or have higher O2 flux capacity. One is the medial gastroc and the other is the quadriceps.

CHOOSING THE RIGHT MUSCLES FOR RECOVERY Another way to think about what muscles to choose are thinking about following the venous system. So again, we're trying to improve hemodynamics. So we want to follow the venous and lymphatic system to encourage that fluid to work its way back up towards the heart. And so thinking about a lot of the bigger venous structures, the lymphatic tissues run immediately. So when I'm thinking about setting up an entire lower quarter circuit. Sometimes, depending again on why I'm choosing these, we may be doing medial gastroc, medial quad, adductor magnus is a huge pump for the lower quarter. And then working into the glutes as well. And then, last but not least, is we have sport-specific muscle fatigue. So when thinking about, a great example I like to use is in CrossFit. After a really grip-heavy workout, we may be just specifically treating the forearm flexors, so the muscles that we're using to grip, right? In this case, we did a lot of thrusters on Sunday, so we are gonna be doing a quad recovery session for Sam today. We're just going to demonstrate bassus lateralis. When we look at e-stim parameters, so we want things to be a pump. So we need to have the intensity at a motor response. We also need it to be a non-fatiguing stimulus. So if our goal is recovery, we are thinking we want it to be non-fatiguing. So we're going to keep the frequency low. we are limiting pistoning. So we do not want to piston the tissue. Every single time we move a needle around in the muscle, we are creating a little bit more micro trauma to that tissue. And that is the opposite of what we want to do when we're thinking about facilitating recovery. So I'm going to get two needles set up in the vastus lateralis here, and we'll kind of go through the e-stim settings and, um, dive in a little bit deeper there. So for the, the needling technique, ready cleaned her skin here. We are going to be using a needle for the vastus lateralis that we feel like we have the most access to that tissue. So when thinking about choosing needle length for a larger muscle, we want to be using a longer needle where I'm going to be threading through the muscle here as I can have access to more muscle tissue. where I'd be going towards the femur. I am floating the needle in. I am not pistoning. If we get a twitch response, great. I'm not necessarily looking for a twitch response. Because we want a motor response with the e-stim parameters, we do want to be localizing our tip of the needle at a muscle spindle interaction, which is what elicits the twitch response. So what we're going to be doing instead of pistoning is a little bit of live redirecting of the needle under e-stem. We'll talk about that. So I'm just going to choose two big portions in the vastus lateralis here and thread across the tissue to have access to more. Oh, nice little twitch there. Because I did find a twitch, I'm going to leave my needle there as again, that is going to be the closest to that muscle spindle interaction where we can have better motor response. Then I'm going to choose a spot up a little bit more proximal, threading across the tissue. Perfect. Okay. So no twitch response there. Again, not necessary. We're not going to be pistoning to find that motor response.

E-STIM PARAMETERS FOR RECOVERY So, I'm just going to be setting up a circuit here. And we are looking for, I'm gonna just pull these cords out of the way so we don't have that blocking our visual here. We are using the ES-160 today. All right, so e-stim parameters.. Low frequency, so we're thinking below 5 hertz. We want a motor response. Duration. So the longer the duration, the better. So when we're thinking about this, the research looked at 10 minutes versus 20 minutes, and they had almost double the biochemical clearance with 20 minutes compared to 10 minutes. And so we are thinking we want to set these up for longer duration, so thinking greater than 20 minutes here. We're not gonna be doing that for the podcast this morning, but we will set up that circuit and look for that motor response. So I'm gonna be increasing the intensity. Sam, let me know if it's strong, but still tolerable. Okay, we're looking for that motor response. And if we're not getting that motor response, we are going to do a little bit of live redirecting. So I have switched the, and parameters to just constant, you can do alternating frequency, but it's not necessary in the recovery session. So really whatever's the most tolerable for the patient is what we're going to want to do. So I'm increasing my intensity until we get a nice, strong muscle pump.

DRY NEEDLING FOR RECOVERY So, this is what we're looking for when we're thinking about creating that muscle pump. Again, non-fatiguing, so we're thinking lower frequency, longer duration. Our muscles that we're choosing are either based off of following the venous system, looking at the O2 flux capacity in the muscle tissue, or sport-specific fatigue. Our mechanisms here, again, we're creating a pump. It's just a pump, it's really that simple, right? We're pumping fluid throughout the system. We're clear at a cellular level. We're clearing some of the, we're washing out the cellular debris. And then we are also facilitating vasodilation through the autonomic nervous system. If you have any more questions about this, feel free to check us out on the road. So we have a couple courses coming up on the third weekend in May. So the 17th and 18th is, you can check us out on the road. I'll be down in Virginia Beach. And then we hit, I'll be back in Florida, so maybe Florida first weekend in June and Longmont, Colorado on the 20th, the weekend of the 20th of June. So feel free to check us out on the road and have a great rest of your Thursday. See ya.

OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you’re interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you’re there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.