In the practice of integrative systemic dry needling (ISDN), nothing is more important than understanding the biologic mechanisms of needling.
ISDN is a unique therapy because it entails the use of fine needles to inoculate minute intrusive "traumas," or lesions, into soft tissues to activate self-healing processes. When a needle is inserted into the human body, it breaks the skin—the first defense line of the immune system—and then inoculates lesions into all the soft tissues it encounters, including muscle fibers, nerve endings, blood vessels, fascias, tendons, ligaments, and even periosteum. Lesions remain when the needle is removed. The human biologic system activates all possible physiologic mechanisms to repair the lesions inoculated by needling.
The repair starts with an inflammatory reaction to destroy and eliminate the tissue that is lesioned and dead as a result of needling, and then genetic machinery is activated to synthesize new tissue to replace what is damaged. These processes require coordination of all physiologic systems, particularly the nervous, immune, endocrine, and cardiovascular systems, involving both central and peripheral mechanisms. These are built-in biologic survival mechanisms. No matter where the needles are inserted—in the face, neck, arm or leg—the local biologic mechanisms are the same (Fig. 6-1). Local symptoms, such as soft tissue pain in the shoulder, or nonlocal symptoms, such as headache, may respond to needling in the arms or in the legs. Because of this, ISDN therapy is nonspecific. Symptoms of different pathologic processes are improved or cured by the same "lesion" mechanism. However, different locations of the needling may result in somewhat different levels of therapeutic efficacy. For example, in the treatment of frozen shoulder, needling the painful shoulder area is more effective than needling the legs in most cases, although it has been observed clinically that needling the legs, the scalp, the ears, or other part of the body can provide relief in the shoulder in some cases as a result of systemic reflex mechanisms.
These mechanisms used to be puzzling to medical practitioners and are still so today to those who compare ISDN therapy with pharmaceutical therapy. A sound physiologic basis has already been established by distinguished scientists and clinicians for why and how ISDN works. Pomeranz,1 a prominent researcher in the field of acupuncture analgesia, said, "We know more about acupuncture analgesia than about many chemical drugs in routine use."
Nevertheless, knowledge of the complex biologic processes that underlie the apparently simple procedure of needling is still inadequate. To guide clinical practice, this chapter focuses on peripheral mechanisms. These mechanisms can be observed, predicted, and proved by any clinician who practices ISDN.
The fact that central mechanisms are not discussed in this book does not mean they are unimportant. On the contrary: They are critical in ISDN because the central regulations control and coordinate peripheral mechanisms. Needling signals are brought to the central nervous system (CNS) by sensory nerve fibers, first to the spinal cord and then to different spinal levels; to the brainstem, the thalamus, and the hypothalamus; and up to the cortex (Fig. 6-2).
Needling first stimulates the somatosensory system, when a needle punctures the skin and penetrates to the deep tissues and leaves lesions there. This system has many tasks ranging from the input for motor reflex to the higher orders of perception such as cognitive comprehension, perception of nociception and pain, and emotion.
Needling induces the coordination of all physiologic systems. Today with functional magnetic resonance imaging (fMRI) (Fig. 6-3), it is possible to
Dorsal root ganglion
^ ^/Bradykinin \N Serotonin
Substance P Û
^ ^/Bradykinin \N Serotonin
Substance P Û
Figure 6-1 Lesion mechanisms of needling therapy. Needling introduces lesion into soft tissues, stimulates peptide-containing C fiber, and elicits axon reflex response. The damaged tissues release chemical signaling factors, as shown.
Lesion precisely locate the part of the brain that is activated by the needling. However, knowledge of how to interpret these images is still developing. A detailed discussion of central mechanisms is beyond the scope of this book, and for this reason, readers may refer to up-to-date research publications for more information.
In conclusion, ISDN is soft tissue therapy. In fact many different diseases, especially chronic diseases, either involve or are caused by soft tissue dysfunction. It is very important for clinical practice that the nature of soft tissue dysfunction be well understood.
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