#85 - The Intersection of Dry Needling and Acupuncture in Clinical Practice with Dr. Gary Estadt, Part 1

Hi guys, welcome to another episode of The Factor Podcast. I'm your host, Jessica Riddle. Today we kick off a new 2-part training on the intersection of dry needling and acupuncture in clinical practice. With Dr. Gary Estott. Needling techniques can be some of the most effective treatments in a healthcare provider's arsenal. And while both use solid filiform needles and target specific points in the body, acupuncture and dry needling could not differ more in their historical background, philosophy, and terminology. And while both acupuncture and dry needling use solid filiform needles and target specific points in the body, they differ in their historical background, philosophy, and terminology. In Part 1 of this 2-episode series, we'll learn about the fascinating history of needling that goes back over 5,000 years, with insights into the incredible case of Ötzi the Iceman. We'll also discuss the critical differences and surprising similarities Among dry needling, Western medical acupuncture, and traditional Chinese acupuncture. So cue the intro music, grab something to take notes with. Let's dive in.

Okay. Thank you, Jessica. As Jessica said, my name's Gary Eastat. I practice up in the Cleveland area. I've been in practice 43 years and I started doing acupuncture and dry needling back in about 2007 when myself and another doctor wrote the law for Ohio to get acupuncture as an add-on service for chiropractors. And then became board certified in acupuncture with the American Board of Chiropractic Acupuncture. I've been fortunate to serve as the president of both the board and the council that oversees it. And I'm certified in dry needling and I've been teaching dry needling now for about 7 years. And I've also been asked by the ACA to serve as an expert witness with— together with the AMA, we wrote and got a dry needling code. And I just represented the ACA at the AMA conference on getting an increase for acupuncture services. So It's a great modality to use in your office, but I get asked questions all the time. Should I be using dry needling? Should I be using acupuncture? What should I do? What are the differences? What are the similarities? So we put this presentation on to kind of answer some of those questions for you so that you could choose what, what seems to be best for you. So first question I'd ask you is, have you considered adding a new modality like dry needling or acupuncture to your practice? I can tell you that in 43 years of practice, both dry needling and acupuncture to my practice is probably the best thing I've ever done for my patients. Not just from a perspective of I'm adding an additional service into my clinic, but it gave me the ability to start treating things I never would have considered treating with just chiropractic manipulative services and rehabilitation and modalities and things like that. It kind of opened up my eyes to what the possibilities of services I could give to my patients. Some of the things that I'd been reluctant to treat that now all of a sudden were very easy to treat. So I would ask the question is, what option do you think is right for you? Is it dry needling? Is it acupuncture? How— think about how would it benefit you in your practice based upon what type of services you offer? And if acupuncture, dry needling is actually right for the type of practice that you have. So we'll kind of talk a little bit about that all, but we'll talk primarily about the differences and the similarities of them all. So if you look at dry needling, Western medical acupuncture, and traditional Chinese acupuncture, the one thing they all have in common is the needle. They all use a solid filiform needle. And all 3 types of treatment treat specific points in the body. So let's go back in history a little bit and have you meet Ötzi the Iceman. Ötzi was discovered in 1991 frozen in the ice in the Alps by 2 German tourists who were hiking. He lived in the Ötztal Alps somewhere between Austria and Italy. anywhere from 3350 to 3105 BC. He was discovered with over 60 tattoos running along the longitudinal axis of his body, across his lower back, in his right knee and ankle, and on the left wrist. And they were thought to represent either acupoints or acupuncture meridians within his body. Up to this point, everybody thought acupuncture was started by the Chinese and was about 2,000 years old. But here we're looking at a body that preserved in the ice over 5,000 years old. And the x-rays of his bones, when they evaluated him, showed degenerative changes corresponding to the tattooed areas. He had degenerative disc disease in his lower back. He had degenerative joint disease in his knee and ankle joints. So the speculation was these tattoos were part of pain relief treatments that were similar to acupuncture or acupressure, even though he lived 2,000 years before its earliest use in China. 9 of the 19 tattoo groups were located next to or on acupuncture points that are used today, and most of the others were on meridians over arthritic joints. He also had some abdominal tattoos that may have been used to treat intestinal pain from whipworm. So needling was being done even 5,000 years ago. So when we needle, what is it that we are exactly needling? So let's get to the point on that. In dry needling, you primarily treat myofascial trigger points. Chinese have specific points that they call Ah Shi points, Ah Shi being the Chinese word for, oh yes, or that's it. So when you push on a point and it's tender on a patient, that's an Ah Shi point. That is often needled in acupuncture. Kori points are a little different. So in the Ah Shi points, they— the Chinese feel that the Ah Shi point is tender because Qi does not, which is the energy of the body, does not flow through the body, gets stuck, and becomes painful. Kori points are used by the Japanese, and they describe areas of body stiffness or discomfort. And they're described as tight myofascial points. They may or may not be painful, but they can be palpated by the physician. So if you're pushing on it, it might feel like a pencil eraser in there. And these Cory points are felt to block the 4 circulatory systems, your lymphatic, your venous, your arterial, and your nervous systems. And they're felt that they also may compromise your internal regulatory and immune systems. So trigger points, as we talked about, are more— and we'll talk about them in a minute— they're hyperirritability in the tissue that when we compress it, it's locally tender, but it may also refer pain. It may create autonomic nervous system phenomena as well as proprioceptive disturbances. They can occur in the myofascia. They can occur in cutaneous tissues. Fascial tissues, ligamentous tissues, and periosteal tissues. I just blew out my Achilles tendon last week playing pickleball. Yes, I'm that old. And I've been needling my myofascial tendinous junctions on the Achilles, as well as the osteotendinous junction at the calcaneal region to try to increase blood flow in that area and speed up healing. The next type of point are acupuncture meridian points. These are traditional acupuncture points that follow within the pathways of acupuncture meridians, which we'll talk about briefly in acupuncture. And then there are also points in Chinese acupuncture called extra points, which are points that don't follow on a meridian. They're not a painful Ah Shi point, but they have a very specific profound effect. So they are named as extra points in the body. And then lastly, we have neuromotor reflex points, which are points that are used both in Western medical acupuncture as well as in dry needling. And they are points where typically where nerves surface on the body or enter into a muscle or wrap around a muscle. And they also have very profound effects when we use them for treatment. So what differs between the forms of treatment really is the intent, because the intent is what influences your action, and action is what influences the results you wish to achieve. It's similar to the old debate we used to hear in chiropractic about the chiropractic manipulation is different than the osteopathic manipulation, or different than manip— by a physical therapist, and it all really wrapped around intent. What is it you were trying to do with that manual service? Well, it's the same thing with needling. You have a certain belief system, and these belief systems often overlap, but they may be distinct. And from that belief system that you have, it's what do you want to accomplish with the needling? That's the potential. And then the action is how are we going to do it? How are we going to needle the person? And then the result would be, did we accomplish what we set out to do through the action? So there are a lot of similarities between the styles of needling, but there are some major differences. So let's look at them separately. So dry needling, which you often see abbreviated as DN, involves the needling of a myofascial trigger point, and it uses skilled and varied traditional needle techniques. The effect of which we can explain anatomically and physiologically. So we apply the needling techniques to stimulate changes in movement and tissue physiology based on pain patterns, postures, faulty movement patterns, palpation, neurological, and orthopedic testing. Sounds a lot like what we do in chiropractic. So dry needling, we're usually needling tissues that are either altered or dysfunctional to either restore order or improve or restore function. Dry needling is used by medical doctors, osteopaths, chiropractors, physical therapists, athletic trainers, nurse practitioners where allowed by state law, and it may include needling myofascial trigger points, periosteum, and other soft tissues. Dry needling is used in conjunction with rehab procedures to stretch the muscle following needling. So an important component of needling is once you loosen the tissue up with the needling, you wanna stretch it. So dry needling works very well hand in hand with rehab. And I recommend anybody doing rehab and doing soft tissue techniques, dry needling is an excellent technique. to add into a rehab-style practice. It's also great for any, any type of musculoskeletal practice in general. So we look at these myofascial trigger points, and the myofascial trigger point is a taut band of skeletal muscle, and it's located within a larger muscle group. So these trigger points, they can be tender to the touch, and they can refer pain to distant parts of the body. So the goal of treating the myofascial trigger point is to release or inactivate the trigger point, thereby relieving pain. Dry needling improves pain control. It reduces muscle tension. It normalizes biochemical and electrical dysfunction of motor end plates, and it facilitates an accelerated return to active rehab. Trigger point— it's called trigger point dry needling. It's called trigger point manual therapy. It's called intramuscular manual therapy. We— I call the program that I do dynamic neuromuscular dry needling, which we'll explain why later on. But it's using the term manual therapies does— is not an endorsement of the CPT code 97140 manual therapy when doing needling. You have to check with your insurance companies regarding payment policies for dry needling. PTs define it as an intramuscular manual therapy. As a technique used to treat myofascial pain that uses a dry needle without medication inserted into a trigger point with the goal of releasing or inactivating the trigger points, as we just talked about. Difference between trigger point injections and dry needling is the fact in dry needling, the needle is much thinner and smaller, so the patient really doesn't feel it much. They feel a little bit of Pinch sometimes when you needle them, but there's no substance being injected, no wet substance being injected into the body, hence the term dry needling. So these myofascial trigger points constitute one of the most common musculoskeletal pain conditions. It's now being found that muscle pain is commonly, commonly a primary dysfunction and not necessarily secondary to other diagnoses. And as a result of that, they're often overlooked or ignored as causes of both acute and chronic pain. Very commonly, we see these in whiplash-associated disorders where the head's whipped around and then the muscles overreact. So the muscles have many types of pain fibers or nociceptors, which can be activated by various means. What we often see in these trigger points, there's There's usually local tenderness when you palpate the band. And often when you cross friction across the band, you get what's called a local twitch response, which is a little jump of the muscle. And when you palpate them a little deeper, often the pain becomes recognized by the patient as their pain, because when you go deeper, you often are hitting the trigger point that's referring the pain. So the pain is usually based upon myofascial referral maps. And then you can also have autonomic phenomenon occur when you have these trigger points, like sweating, goosebumps, vasomotor changes, things like that. Trigger points can be caused by trauma, contusions, sprains, strains, things like that. Repetitive movements or low muscle, low-level muscle contractions. So like eccentric contractions in a muscle that's not used to holding that position for a period of time, or delayed onset muscle soreness after like working out. Microtraumas like repetitive overload, things like that can cause a trigger point. Emotional stress can cause the muscle to tighten and form a trigger point. So could things like poor posture and postural stress, things like scoliosis, degenerative changes, things like that. We often see with osteoarthritis a loss of myofascial flexibility. Dry needling will help improve that. And then we also see with dehydration and nutritional changes, people who have vitamin D deficiency have much higher incidences of trigger points and myofascial pain syndromes than the general population. So as I said, dry needling involves multiple advances of a solid filament needle into the muscle in the region of the trigger point. And when we stick the trigger point with a needle, our goal is to get a local twitch response, which will release the muscle tension and the pain. And the patient may feel, when you needle them, a reproduction of what they call their pain, the referral pain pattern that they had. And that's a very good helpful diagnostic indicator for the doctor when you're diagnosing the cause of the patient's symptoms. And then it's used also to desensitize hypersensitive musculoskeletal structures while restoring motion and function. So dry needling is not just effective for the trigger point, but it's also a very effective treatment for chronic pain that has a neuropathic origin. It has few side effects, very few side effects. It's unequaled in finding and eliminating neuromuscular skeletal dysfunctions that lead to pain and functional deficit. And as I stated earlier, the needle used, it's very thin. Most people don't even feel it penetrate the skin. When you needle the patient, if the muscle's healthy, they'll really feel very little discomfort with insertion of a needle. But if the muscle is shortened or sensitized with active trigger points, They may get a little cramping sensation, and that's the twitch response that the patient gets. Immediately after that response, though, the muscle relaxes and lengthens. So here we see 2 types of dry needling, and we see superficial penetration on the left and deep penetration on the right. Superficial penetration, we see the needle goes through the epidermis and the dermis into the subcutaneous tissue. But does not go into the trigger point or down near the nerve. In a deeper penetration, we go through the subcutaneous tissue into the muscle to disrupt the trigger point and take it down near the area of where the nerve is. So dry needling differs a lot from acupuncture in both its history, its philosophy, its indications, and how it's used in practice. But in both dry needling and acupuncture, you can use both superficial and deep penetrations. Dry needling doesn't use any traditional acupuncture theories, any acupuncture terminology. As I stated earlier, it's based on neuroanatomy and modern and scientific study of the musculoskeletal and nervous systems. The similarity does exist in the terms of we're penetrating the skin with a solid filament needle. Which is a tool, and we're going to various depths within the body for therapeutic indications. Ready to transform your practice with groundbreaking technology? Join us for our next Faktor webinar on Wednesday, July 31st to discover the latest advancements in whole-body electrical stimulation and its incredible impact on autonomic Autonomic nervous system dysfunction. Learn from an expert clinician about the science, applications, and proven protocols that are enhancing patient outcomes, especially for conditions like Long COVID. Don't miss out on this opportunity to elevate your expertise and improve your patients' lives. Click the link in the show notes to register for free. So the 5 mechanisms that happen when we dry needle is it will release a shortened muscle. It will remove irritation of spinal nerve roots by relieving the short paraspinal muscle. It promotes healing through a local inflammatory response. Which we'll talk about in a few minutes. It decreases spontaneous electrical activity and biomechanicals in the myofascial trigger points. And then it decreases the pain associated with the myofascial trigger point. It does this by 3 effects. There's a mechanical effect, which was described in 2004 by Domerholt, which stated that it disrupts the integrity of the dysfunctional motor endplate. Causes a local twitch response, and that local twitch response then alters the muscle fiber length. There's a neurophysiological effect that occurs. It was described by Baldry in 2001. Baldry is also the guy that does a lot of superficial needling, and he noted that dry needling stimulates A-delta nerve fibers for 72 hours post-needling. When you needle somebody, whether it's dry needling or acupuncture, because the The physiological effect is still gonna be the same. You get an effect for up to 3 days post-needling, a neurophysiological effect, which is why in most of the protocols for needling, you see needling at twice a week rather than like 3 times a week, because you have that 72-hour ramp-up before it starts to degrade again. And then the last effect is a chemical effect, and there's a decrease in chemicals at the active trigger point immediately after we get that local twitch response. Some of the noxious chemicals that are in the area are immediately decreased through the needling. So the benefits that we derive from needling is we're going to improve blood flow. We're going to get healthy blood flow back into the area where the trigger point or the injury is. We're going to improve oxygen circulation in that local area. We're gonna ease joint and muscle pain. We're gonna loosen stiff muscles, allowing for, allowing for quicker recovery, as well as increased range of motion and flexibility. And some of the things that we commonly see and commonly treat through dry needling, and this is not an all-inclusive list, we treat joint problems like any joint in the body, shoulder problems, elbow problems, wrist problems, problems in the hands. Hips, knees, ankles, feet, TMJ. I mean, a lot of different joint disorders in the body are commonly treated by dry needling. We treat it for disc issues of the spine very effectively, by the way, tendinopathies in the body, migraine and tension headaches, temporomandibular joint dysfunctions and mouth disorders, repetitive motion disorders like carpal tunnel syndrome, Peripheral nerve root entrapments. Spinal issues like disc problems, joint and muscle problems, degenerative changes, spinal stenosis, radiculopathy. As I stated earlier, whiplash-associated disorders. Pelvic pain, night cramps, phantom limb pain. So we can, we can use that dry needling to treat somebody who's got phantom limb pain. We can use dry needling treat the opposite limb as well as some other points and actually alleviate the phantom limb pain. Very effective. And it works very well for complex regional pain syndrome, CRPS, which has a similar phenomenon as phantom limb pain. We use it to treat postherpetic neuralgia from shingles. And it's very effective in the treatment of scar pain. Again, this is not an all-inclusive list. But some things that are commonly treated by dry needling. So next, let's take a look at traditional Chinese medicine. So Chinese medicine, traditional Chinese medicine, is a healing method. It's based on crude and sometimes inaccurate empirical science that's been developed over centuries from clinical experiences. For example, Chinese medicine is a useful source of Western drug discussions. Discovery and new interventions. Probably one of the most common is when we started using Valium, which was derived from an herb, valerian root. In 1949, Mao Zedong integrated Chinese medicine with Western medicine, and this modern form of Chinese medicine became known as TCM or Traditional Chinese Medicine. So in TCM, in addition to acupuncture, which is used extensively for back, neck, and shoulder pain. Herbs are an important part of traditional Chinese medicine. Things like Ma Huang, which is ephedra, which is a source of ephedrine, which is used for colds and allergies, and Huang Gui, which is astragalus, which is a supplementary source of telomerase, which is used to promote cell regeneration. But TCM theory has a number of problems associated. Words like Qi and phlegm are complex concepts that have obscure meanings. The anatomy becomes a set of organs that are functional systems, not somatic functions as we understand them in the West. And then the meridians have been mapped out in the medical manuals that have been— the medical manuals in China have never been isolated in human dissection. So it reduces human physiology to simplified models of relationships among organs, meridians, and body fluids. So Traditional Chinese Acupuncture is a form of TCM that's been performed for centuries. So we're going to take needles, we stick them into various acupoints in the body, and by doing that, we're going to relieve physical and mental ailments and help promote Better energy through the flow of Qi, uninterrupted flow of Qi. And needles can be inserted in different places over the body that can seem to be unrelated to the problem. So for instance, a patient with facial pain, we can stick needles in the face, but we also may be putting them in the arms and the legs for a specific therapeutic effect according to TCM, which also has a therapeutic effect, as we'll see later, based on Western medical concepts also. So traditional acupuncture, in its theory, traditional acupuncture looks at changes of the tissues through the meridians as well as the status of Qi, blood, and fluids, which they call fundamental substances. They then apply acupuncture either to the meridians using specific points or non-specific areas where tissue changes are evident, like trigger points, Or Rashi points. And then the clinical reasoning process includes the theories that have been found in traditional Chinese medicine on why we treat these points. So in the traditional basis of acupuncture, man is considered a microcosm of the universe. We're like the buffer, we're a microcosm of the entire universe. And what's interesting is all the meridians on the second picture, these are the acupuncture meridians of heart, Pericardium, lung, large intestine, triple warmer, small intestine, kidney, liver, spleen, stomach, gallbladder, and urinary bladder. All of the meridians either come from the heavens to the face and then from the face to the earth, grounding heaven with earth, or they go from the foot into the chest and from the chest through the hand to the heavens, communicating earth with heaven. Man is the conduit between heaven and earth, in other words. And then we have yin and yang. And yin and yang is the common symbol, what we call the Tai Chi symbol, which represents the cosmos in perpetual motion and endless circulation. So if we look at the symbol of yin and yang, it's divided into 2 equal tadpole-shaped opposing halves. that are equal in proportion. The white is the yang, the black is the yin. So we have yin and yang. They dovetail into one another, which symbolizes they're not absolute, but they're relative to one another. And if you notice, within the yin, we have this area of white yang, and within the yang, we have this area of black yin. So there is always yin inside of yang, there's always yang inside of yin. When yin is approaching its maximum, yang is at its minimum, and vice versa down here. So they always coexist, and they complement and supplement one another. So when there's balance between yin and yang, there's harmony in the universe, harmony in nature, harmony in man. When they're in turmoil, we have sickness. If we look at the macrocosm and microcosm of yin and yang, Earth is yin, heaven is yang. Moon is yin, sun is yang. Night is yin, which makes sense because yin is black. Day is yang. Darkness is yin, brightness is yang. If we go down through these and look at all these, and then as we look at yin and yang, ventral is yin, dorsal is yang. Abdomen is yin, the back is yang. Interior or internal is yin, exterior is yang. Moisture is yin, dryness is yang. Blood, which is a nourishing factor, is yin. And Qi, which is a functional or movement factor, which also helps with deep body's defenses, is yang. Deficiency is yin, excess is yang. Coldness is yin, heat and warmth is yang. So if we take these And we look at these same thing structures and concepts, and we look at it scientifically. Semiconductors, when they have an extra electron, are yin. They have an extra negative electron. Semiconductors that are lacking an electron, which means they're more positive than negative, they're yang. So you always have a little yin and yang. Even in endocrinology, when we look at electrolytes, we have negative and positive ions, yin and yang. And if we look at neurology, the sympathetic nervous system, your fight-or-flight system, is yang. Your parasympathetic nervous system is yin. And it was this concept when I took traditional acupuncture that really kind of brought it back full circle to me in that we're really talking about neurology here. And we're talking about what we do in chiropractic every day. And once I started looking at things from those concepts, a lot of the traditional concepts of acupuncture started to make sense, but they made sense from a scientific basis. So when you look at your autonomic nervous system and your sympathetic system, which is this little white dot here and this white section here. It's your fight or flight system. Your heart rate increases, your airways dilate so that you can get oxygen so that you're ready to either fight or flee. You get an energy mobilization, you get that function going, and it's an inflammatory process. Whereas the parasympathetic is a decreased heart rate, it's rest and recovery. Heart slows down. The body goes through regeneration and repair and energy is being stored rather than mobilized. And it's an anti-inflammatory process. So in the autonomic nervous system, sympathetic and parasympathetic work in a harmony and a balance. And when they're out of balance is when we get both skeletal as well as visceral changes in the body. And they're technically yin and yang. Or should I say yin and yang technically is autonomic nervous system. And what we found with needling is we can influence function of the autonomic nervous system by needling specific areas. And then the organs are either solid, which would be a yin organ, or hollow, which would be a yang organ. The solid organs kind of store everything and hold it together, and the yin organs Or Yang organs move it, like your intestines, your stomach, your bladder, all your elimination organs. And then we have this concept you sometimes see in acupuncture called the 5 elements, which was an alchemy concept developed by Taoist scholars and physicians. In its time, it was quite advanced, but it's really hard to integrate it in terms of anatomy and physiology. They often use it in traditional acupuncture when treating pathologies. That's traditional acupuncture in a nutshell. And then we have Western medical. So let's look at Western medical versus traditional. So acupuncture has been a process that's been around for years. It's been thousands of years. It's continued to grow. And the acupoints that we treat, as we saw on Ötzi the Iceman, Predated the meridian theory of acupuncture. So the points came first before the meridians did. Ancient doctors developed the meridian theory to explain the discovery of the interrelationship between different parts of the body. Now science, we look at that differently. So we have what's in our scientific theories or our hypotheses. We have 2 components. We find facts and then we explain the facts. So that's like a string of pearls. The advances in science is the ongoing process of changing the string on that string of pearls while preserving the pearls. Traditional acupuncture, traditional Chinese medicine, the pearls and the string is really tangled together. And hard to differentiate. And the channels serve as a temporary explanation of these relationships, but it's also become the narrow neck in a bottle that impedes us further developing acupuncture. So what scientific medical acupuncture does is it looks at these pearls and it connects them with a new biomedical string. Which leads to an increase in scientific understanding of acupuncture. So Western medical acupuncture is a therapeutic modality, also involves the insertion of needles. But Western medical acupuncture, it's an adaptation of Chinese acupuncture where we use current knowledge of anatomy, physiology, and pathology, and the principles of evidence-based medicine. That's why you're seeing such an upsurge in the use of acupuncture in hospitals now, and as well as in the VA, which— where I worked for a while. Acupuncture's modes of action, particularly those related to pain control, involve stimulation of the nervous system, the muscular system, and the connective tissue. Also what we do in chiropractic on pretty much a daily basis. So scientific medicine traditional Chinese acupuncture, they would just absorb these new theories into their old theories of the macrocosm and the microcosm and yin and yang and the tai chi and qi and blood flow and all that. But as knowledge and understanding of the body developed, whereas in Chinese acupuncture they didn't replace them, they just absorbed them, but in current scientific tradition. It's being— we're replacing outdated concepts when new evidence arises. So when we teach acupuncture, we teach it both from a Western medical as well as a traditional aspect. So through the approaches, even though they're different, the actual practice of acupuncture is pretty similar. And even though most acupuncturists around the world still use traditional Chinese acupuncture, we're now understanding the effects from well-known scientific physiological mechanisms, which is one of the things that's leading to the explosion of acupuncture right now. So when you combine Western and Eastern, we use acupuncture to treat musculoskeletal disorders that should follow a clinical reasoning process that we want to identify primary tissue and pain mechanisms that the patient presents with. And we use that to identify what is it that we're going to do. And one of the things we do in Western medicine is called layering, the layering method, where we treat musculoskeletal conditions with acupuncture using a mechanism-based approach and physiological processes within the central nervous system to provide the best effect for the patient. So it's a Western approach, but it allows us to integrate traditional Chinese point selection into our clinical reasoning. So it kind of takes the best of Western medicine and Eastern medicine and melds them together into a process that seems to work very well clinically. But to do layering, the clinician must have an understanding of how acupuncture affects the central nervous system, what the presentations of the pain mechanism are, how long is it gonna take to heal, what are the timeframes? How does the tissue heal? And then when implementing it, we need to know acupuncture points. We need to know anatomy. We need to know the segmental and peripheral nerve innervation of the skin and the muscles, like the dermatomes, the myotomes, the sclerotomes, all that. And a full understanding of the neuroanatomy of the autonomic nervous system, because it plays a major portion with needling. And not just in acupuncture, also in dry needling. Acupuncture— when we treat somebody with acupuncture, we stick a needle in them, and that needle stimulates a local and a centralized reaction. The local reaction is the sensory nerves in the skin that we're sticking. The central reaction occurs when the signal goes up the arm into the spine and then onward up into the midbrain and into the brain. And the acupuncture points that we mostly treat are usually around superficial nerves. Blood vessels, neuromuscular attachments where vessels and nerves penetrate the muscle fascia, or specific trigger points. And we have both a central as well as a peripheral effect when we needle. And needle— needling in acupuncture really influences the nervous system, the cardiovascular system, the endocrine system, and the immune system. And it does it through these 5 effects. The local segmental, extra segmental, myofascial trigger point, and central. So local effects, it promotes local healing. So when we stick a needle into the tissue, we get a release of these 9 major biochemicals immediately released from the body to start the healing process. We also will see, as you can see on this picture of the woman here, these little red rashes. that form around the needle. That's called a physiological wheel that occurs because the area becomes hyperemic as we create a little microlesion, which starts the healing process. Next, we have the segmental effect. So acupuncture reduces pain in the segment where the needles are inserted. So when I insert a needle into the body anywhere here, it's going to go through— the sensory neurons into the spinal cord, where it's gonna communicate and connect and relay in the spinal cord to the motor neuron. And the motor neuron is gonna carry an impulse back to the muscle, which is going to release the muscles at that same segmental effect. So any muscle being released, being innervated at that segment, will be relaxed when you stimulate the sensory point in the nerve. Next thing we have is an extra segmental effect. And in the extra segmental effect, acupuncture reduces pain throughout the body. And one of the ways that it does it is our brain is an opioid center in the hypothalamus. So when we needle them, we initiate a signal to the brain to release beta endorphins. And we get a release of that both at the spinal cord, in the midbrain, and in the higher levels of the brain. So, and this stimulates the body's pain suppression mechanisms throughout the body. So say you're injured in sports, you don't notice the pain till after you relax because the brain inhibited the pain through descending nerve pathways, which released these neurotransmitters. So it has an effect on the entire body. And its effect is more related to how much we stimulate rather than how many points we stimulate. And it has regulatory or calming effects. It improves well-being. So at the midbrain, we're also influencing the cerebral cortex, the hypothalamus, the limbic system. It further reduces pain, has a calming effect. Improves well-being, reduces nausea, influence the autonomic nervous system and various hormones, which is why one of the reasons why acupuncture is very effective at treating menstrual disorders. And lastly, we already talked about this. Acupuncture inactivates myofascial trigger points. Their trigger point is a response to injury or overuse. They're slow to heal. They cause pain. And they're also thought to be a protective mechanism to ensure the muscle rests while healing. Or it may be a malfunction of the healing process. Those are the 2 theories. But a trigger point's always tight. It always produces pain. The pain can be local. The pain can be referred. And there's always movement restriction caused by the pain.

That's it for today's episode. Be sure to tune in for part 2, where Dr. Estat will walk us through real-world applications and success stories that showcase the quick and profound effects of needling on complex conditions like frozen shoulder, peripheral neuropathy, and even phantom limb pain. You won't want to miss it. Episode 86 drops in 2 weeks. Please be sure to check out our show notes for a link to watch the full webinar replay. And of course, please also click the link in the show notes to our podcast website, where you can use our AI features to chat with each episode and create your game plan to implement what you've learned. And if you're interested in pursuing a dry needling or acupuncture certification, be sure to click the link to our online learning platform that we've included for you there as well. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on FACTOR Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.