By Guest Blogger Michael Yang
If you haven’t tried acupuncture/dry needling for your pain, you may be missing out on a safe and often effective treatment.
In this blog post, guest blogger, acupuncturist Michael Yang, answers some common questions about this alternative treatment approach to pelvic pain. Take it away Michael!
Where’d this whole needling thing start anyhow?
Well, we thought it was China. Thousands of years ago. And then archeologists got some new evidence that threw that theory up in the air. In 1991 they discovered Otzi the Copper Age frozen man in Austria, who is dated back to 5,300 years ago. Some scientists believed tattoos found on Otzi’s body marked acupuncture points, suggesting that the practice was around about 2,000 years earlier than was originally thought.
Nevertheless, the needle therapy that eventually became acupuncture was certainly best codified in China.
Let’s take a whirlwind tour through 3,000 years of medical history for a snapshot of how acupuncture as we know it today came to be:
Before needles existed, sharp rocks may have been the first tools used to treat patients back when evil spirits were likely considered the root cause of disease. It was around 200 BC that we see metal replace stone and bone needles, likely very much to the satisfaction of sore patients. Acupuncture caught the eye of Westerners in the 1600s and made it to the United States in the early 1800s, and has been around ever since.
What does research tell us about how acupuncture works?
As modern science matured, so did the research on acupuncture. As we started to understand pain better, we started to see where acupuncture fit into the picture. The body produces natural opioids and endorphins. For its part, acupuncture seems to affect endorphin response. According to the National Institutes of Health, evidence shows that acupuncture releases opioid peptides, and that the analgesic effects of acupuncture are at least partially explained by their actions. The finding that opioid antagonists, such as naloxone, actually reverse the analgesic effects of acupuncture has further strengthened this hypothesis.
In addition, stimulation by acupuncture may also activate the hypothalamus and the pituitary gland, resulting in a range of positive systemic effects. There is also evidence that there are alterations in immune functions produced by acupuncture.
What about safety?
The answer to this question is simple, and one of the great selling points of acupuncture. It won’t cause damage and make symptoms worse. When we look at the risks associated with medications and more so, surgery, conservative therapy starts to look like a good option. This is why patients are generally encouraged to go through conservative care first before looking to more invasive and potentially side effect ridden options.
Acupuncture is like pizza. There’s great pizza and there’s decent pizza, but rarely is it terrible. In fact, the big warning I give patients regarding side effects is “don’t be surprised if you sleep very deeply tonight.”
Which brings us to efficacy, does it work?
This is the question I always wish I had a more clear cut answer for, but like all interventions, it’s a question of percentages. That said, I have seen some remarkable improvements in patients that I honestly thought were real long shots. That is always a very happy day. Especially after all other options have been exhausted.
Some of the big benefits stem from the chance to treat multiple areas and issues simultaneously. For instance, I have yet to see a pelvic pain patient that was not also suffering from at least one of the following: neck pain, back pain, insomnia, anxiety, depression, headaches, digestive issues. Usually it’s a couple of these and then some. Being able to address multiple concerns during the same visit is a boon to patients, and as the saying goes, a rising tide raises all ships. If we can make progress in an area that may not even be the chief complaint, we can see a general improvement in other seemingly unrelated areas.
How much does it cost?
Of course there is a range of pricing based on region and experience, but the good news is that many more insurance plans are covering some or all of the treatment.
How about some pelvic floor specifics?
This is where a specialty level of understanding is helpful. Because of the precision needed to target the relatively thin muscles of the pelvic floor, finding a practitioner who is familiar with this are of the body is important. That way, targeting the trigger points in the muscles involved in a patient’s symptoms can be achieved with pinpoint accuracy (pun intended).
In addition, in my experience treating pelvic pain patients, I have found that using points that are not just at the point of discomfort, but in other parts of the body, adds to the efficacy of the treatment.
This amalgam style of therapy, which blends classic point selection with contemporary biomechanical understanding, is a strategy that yields the most bang for the buck and can be the difference in success or failure. Part of this stems from being able to tap into some of the more central effects that acupuncture has on the nervous system. In the realm of chronic pain, more and more attention is being given to what happens in the brain, as opposed to just what is happening at the site of pain.
So should you give acupuncture a try? Patients and doctors familiar with the benefits of well-performed acupuncture as part of interdisciplinary treatment plan will certainly tell you: “It’s worth a shot.” (Terrible almost pun intended).
If you have any further questions after reading this post, feel free to leave them in the comments section below!
All my best,
Michael
About the Author: Michael Yang DOM, L.Ac., has been practicing Integrative and Chinese Medicine since 2000. He studied at the University of California as Santa Cruz, Emperor’s College, and the PanAmerican School in Nevis.
He has been featured in various publications and on national television. He is the director of the Pacific Medical Group and past vice president of Vitality Healthcare. He is the author of The Lean Gene, due to published in 2015 and is the editor in chief for HealthInspiring.com.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Can you recommend an acupuncturist in New York City or Long Island, NY who deals with pelvic pain?
Thanks,
RIcki Mitchell MD
Hi Ricki,
Beyond Basics IN NYC has an acupuncturist with pelvic pain experience.
I see her and she’s great! Definitely recommend her.
what is the difference between acupunture and dry needling? I live in new jersey and have been doing dry needling. So far I am having success with it for chronic pelvic pain. thanks !
would you mind sharing who you see who does dry needling in new jersey for pelvic pain? I am looking for a practitioner there. Thanks!
Can you recommend a acupuncture doctor in Kentucky.
Thank you
Hi Kathy,
Unfortunately I don’t have a personal contact in Kentucky. Come visit California, the weather is great!
I would check with your licensing board or Acupuncturetoday.com for a starting point.
Good luck,
Michael Yang
Hi Dr. Mitchell,
I treat clients who have chronic pelvic pain and I’m an acupuncturist, located in Chelsea. I’m happy to discuss my approach.
Colleen Canyon, MS, L.Ac.
acupunctureforathletes.com
Can you recommend an acupuncturist in or near Grand Rapids, MI who deals with pelvic pain? I had pudendal nerve ablation yesterday, but I know that this will take care of only a part of the pelvic pain I live with. I also have Crohns, IC and PFD. I’ve tried everything available to me and would like to explore that option as well. Thank you! Brenda
Hi Megan,
The difference between the terms acupuncture and dry needling comes up a lot. Wikipedia actually does a good job of diving into it.
http://en.wikipedia.org/wiki/Dry_needling
Dry needling many years ago referred to using empty wide bore hypodermic needles. Today everyone uses the same thin type of needles that the FDA has cleared for acupuncture. So the tools are the same.
Today most people use the term Dry Needling to mean trigger point needling. Historically these points were called “ah shi” points in Chinese.
The bigger picture is one of competency and experience. There are good Porsche mechanics and poor Porsche mechanics. They both work on cars.
Likewise, pelvic pain is something like a Porsche- it is a bit more unusual and a bit more delicate, and not something you want just anybody without a lot of experience fooling around with.
It can be tricky to find a good mechanic, but once you do, it can be a game changer.
Glad you’re doing well,
Michael Yang
Dear Brenda,
A good place to start is with your state acupuncture licensing board and AcupunctureToday.com.
I wish I had a 50 state wide list of great docs, but sadly not yet.
IC and PFD I have seen improve with treatment, so going after multiple birds at the same time will be possible.
Good luck,
Michael Yang
I am more familiar with acupuncture and meridian theory than acupuncture that goes along with ‘contemporary biomechanical understanding.’ Does that refer to the opioid/endorphin/etc responses you discussed, or does the needle act directly on the muscle in some other way? Is that what people are referring to when they say ‘dry needling?’ If that isn’t what they mean by ‘dry needling,’ what is that?
And, same request as everyone else: recommendations for pelvic acupuncturists in the SF Bay Area?
Hi Faith,
Have a peek above where I responded to a dry needling question. The mechanisms of putting a needle into the body is going to have both local (in the muscle) and central (in the brain) effects. Both are important in resolving muscle tightness and pain.
If you want to get really nerdy, meridian theory is one of many treatment models. Muscle channel theory is another that was developed centuries ago and looks the same as the myofascial chain model.
Long story short, the knee bone’s connected to the hip bone, as the song goes, and looking beyond the local spot of pain is very helpful to a successful treatment plan.
Regards,
Michael Yang
Can you explain the significance of the various immediate sensations from insertion of dry needles: sharp pain, dull pain, etc, or no sensation at all? Is the immediate sensation indicative of muscle tension or proximity to trigger points, and is it significant in terms of outcome from the treatment? When you insert needles do you look for a particular immediate sensation? How is the time before removal of needles determined? Thanks.
Hello David,
Treatment plans need to be catered to the individual both in terms of time and intensity. There is no ideal standard as there is no standard patient.
As far as sensation goes, sharp pain often is the result of a very tight muscle and/or less than great practitioner technique.
There are different nerve receptor sites at different tissue depths which explains the difference in techniques. Classically Chinese techniques penetrated deeper, while Japanese techniques were very shallow (these are generalizations to illustrate my point).
Having someone that can change up their techniques to figure out what is working best is important. Some of my patients respond well to a heavy needle sensation- that dull achy sensation; others need a much lighter touch.
Regards,
Michael Yang
Is this the same thing as dry needling? Also, can you recommend a therapist for pelvic pain near Athens, AL (close to Huntsville, Decatur , or maybe even Birmingham, AL)?
Hello Janet,
Please see the other replies about dry needle above, and unfortunately I don’t have a resource for you in AL. I would start with the State Board, or take a look at AcupunctureToday.com
Regards,
Michael Yang
Wonderful post. Thank you. Very encouraging and i’ll share with my other PFPT colleagues.
Any trusted, experienced practitioner’s in Bellevue, or Seattle area?
thanks,
Hello Kathy,
I do not have a recommendation for Bellevue or Seattle. A good place to start is with your state acupuncture licensing board and AcupunctureToday.com.
Regards,
Michael Yang
Can you recommend an acupuncturist in Phoenix/ Scottsdale,Az. who treats pelvic floor pain?
Hello Herb,
I do not have a recommendation at this time. Please refer to your state acupuncture licensing board and AcupunctureToday.com for a recommendation.
Regards,
Michael Yang
I just began acupuncture treatments for possible pudendal nerve irritation/entrapment (constant rectal/vaginal burning), pain in tailbone area, hip, sacrum and general pelvic discomfort. This is in addition to ongoing work with a women’s health PT. In addition to needles, the acupuncturist uses an electrical stimulation device on various pain sites to “open up the nerve pathways” (quite painful when applied). After two treatments, I am finding no relief. Are there any pros/cons to the electrical stimulation? I don’t want to make matters worse but am desperate for some relief after months of unrelenting pain. Thanks for any input.
Hello Kathy,
We find that alternative treatments such as acupuncture can be beneficial as a supplement to pelvic floor PT. However, all treatment does take time, and 2 treatments may be to soon to see significant improvements. Is your therapist providing internal and external manual therapy? Are you seeing him/her once per week for hour long apts? Please read our blog about what to look for in therapy. It may help you decide whether or not you’ll need a second opinion.
https://pelvicpainrehab.com/pelvic-floor-physical-therapy/1964/what-is-a-good-pelvic-pain-pt-session-like-2/
Best,
Stephanie
Hi,
Can you recommend someone in the Bay Area in Northern California?
Thanks,
Garrett
Hi Garret,
Please call our San Francisco, Berkeley, or Los Gatos office to setup an appointment.
Regards,
Admin
Hi all,
Does anyone know of a practitioner in the UK?
Thanks 🙂
Hi Lester,
Please use the link below to find a pelvic floor physical therapist in your area.
https://pelvicguru.com/2016/02/13/find-a-pelvic-health-professional/
Regards,
Admin
Do you know of any in the philadelphia area?
Hi Joseph,
Please use the link below to find a provider in your area:
https://pelvicguru.com/2016/02/13/find-a-pelvic-health-professional/
Regards,
Admin