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Accelerate injury recovery using a regional integration approach: how dry needling in the foot or leg can make improvements in the hip, pelvis, and lower back.

Dr. Scott A. Jones, PT

Movement Specialist

If you’re new to dry needling, let’s recap the what and why of this powerful Medical modality. Dry needling is a highly specialized neuromuscular intervention that uses tiny filiform needles, or acupuncture needles, to relieve tension and pain in muscle trigger points and connective tissues. Doing so has been shown through the medical literature to improve joint mobility and accelerate injury healing times. It’s distinctly different from acupuncture though, because it is firmly grounded in Western orthodox medicine rather than Eastern medicine metaphysics, and focuses on scientific anatomical reasons for neuromusculoskeletal pain and dysfunction. today we are talking about how this treatment applies to ankle pain, lower leg pain, hip pain, and pelvic pain as well as its role in injury prevention for athletics as well as the United States military. In addition, we will begin to explore how direct current electrical stimulation  can improve medical outcomes even more quickly. The research has really taken off in the past few years, so let’s get into it!

One of the first things to understand is a bit behind the anatomy and physiology of why dry needling works. When the needle is inserted into a muscle, the needle stimulates mechanoreceptors and changes the  biochemical environment of the trigger points themselves, which reduces physiologic pain triggers like substance p and calcitonin Gene related peptide which both contribute to the body’s perception of pain. The needle will also activate the body’s internal pain relief systems,  releasing chemicals such as endorphins, which further decrease the body’s perception of pain. With pain perception down, we now have a window of opportunity to introduce rehabilitation activities which maintain a decreased pain level and begin to restore function earlier than traditional pain management.

 Ankle pain and dry needling

When considering ways to alleviate the pain and accelerate recovery from an ankle injury, such as ankle sprains, accused tendonitis, and even plantar fasciitis, we have to consider Regional structures and myofascial trigger points in areas such as the gastrocnemius, soleus, and even tibialis posterior. As you recall, trigger points are hyper irritable bands of muscle that are responsible for joint pain and restricted movements. Dry needling can alleviate these trigger points by eliciting a local twitch response, disrupting the neurological pathways responsible for the dysfunction, thereby improving blood flow and decreasing pain. A study in 2014 showed decreased pain and improved ankle function compared to a placebo group for dry needling in the plantar heel, and the effects lasted up to 6 weeks! Dry needling also helps with ankle sprains, improving function of the perineal muscles, soleus, and posterior tibialis, which may develop dysfunctional compensations as a result of the sprain. by inhibiting overactive neuromuscular dysfunction and reducing tension within the muscle and connective tissues, dry needling improves mobility, decreases pain, and accelerates return to sport.

Addressing Lower Leg Pain

A bit further up the kinetic chain, in the lower leg, we often see conditions like shin splints, calf strains, and exertional compartment syndrome. As you can guess, trigger points and tibialis anterior, gastrocnemius, soleus, and even some of the supporting muscles such as the perennials and posterior tibialis can contribute significantly, causing both localized and referred pain. dry needling will quickly decrease hypertonic muscle tension, thereby alleviating circulation restriction, and both of these will combine to decrease pain. In 2017 a systematic review found solid evidence that dry needling improves pressure pain threshold and decreases pain in multiple musculoskeletal injury conditions, including the lower leg for up to 12 weeks.

To get a little bit more granular with this, repetitive injuries such as shin splints lead to muscle overuse and trigger point formation throughout the lower leg. As before, dry needling will immediately improve this by releasing tight bands of muscle which restores both muscle and joint function. Remember, tight bands of muscle create not just hypertonicity within the muscle, but also reduces localized blood flow and creates a localized ischemic response. The twitch response due to the dry needling event will disrupt this cycle and accelerate healing and function. Dry needling can target the area of pain as well as areas of dysfunction away from the localized pain area, which accesses the body’s diffuse noxious inhibitory control system, providing further relief in the region of pain. This was confirmed in a study in 2012 where needling the gastrocnemius demonstrated decreased EMG activity in the biceps femoris, also known as the hamstring muscles.

Managing Hip Pain

Even further up, in the hip, we have more global conditions such as osteoarthritis and piriformis syndrome which can send those nasty sciatica shocks down the leg, and IT band syndrome, which can cause pain anywhere from the top of the hip to the very bottom of the knee. Dry needling is super effective at decreasing muscle tension in these areas, improving blood flow, and restoring joint mobility not just of the hip, but at the lower back and the knee as well. In 2018 a study found that combining electrical stimulation with periosteal dry needling in the hip along with exercise and manual therapy gave people significant pain relief and immediately improved function in patients with osteoarthritis 

The research literature on hip pain also discusses more systemic conditions such as central sensitization, described as increased pain sensitivity within the nervous system globally. According to the research, increasing peripheral nociceptive input from trigger points results in decreased global pain sensitivity, which improves functional outcomes across the board. An example of the way that this works is to consider dry needling to the gluteus maximus muscles and then discovering referred pain within the hip and the lower back has decreased, mobility within the lower back and hip joints have improved, and functional range of motion and Joint responsiveness are restored.

Dry Needling for Pelvic Pain and Pelvic Health Physical Therapy

As we work our way up the kinematic chain, dry needling to the Foot and Ankle complex as well as the lower leg and thigh can greatly assist with dysfunction  and pain in the pelvic region. Pelvic health can be an extremely difficult subject for many people. Conditions such as chronic pelvic pain syndrome and pelvic floor dysfunction will many times involve myofascial trigger points in the muscles of the pelvic floor including obturator internus, and levator and levator ani.   surrounding structures will also be involved. muscles such as the gluteus maximus, minimus, and medius, the adductors of the inner thigh, and the lumbar spine muscles. With a skilled assessment, dry needling can be incredibly effective as an addition to pelvic health physical therapy. A study from 2018 demonstrated that dry needling both the pelvic floor and adjacent muscles of the hips and lower back actually resolved chronic pelvic pain in patients who had failed traditional physical therapy, with their symptoms being almost completely alleviated within just six sessions!

Applying dry needling to the adductors, quadriceps, gastrocnemius, and intrinsic muscles of the foot can have an indirect positive effect on decreasing pain by eliminating compensatory movement patterns as well as pain resulting from referred pathways. It’s no secret that trigger points on the inner thigh can refer pain to the pelvis, and using dry needling in this instance can reduce pelvic discomfort as a result. Dry needling’s ability to be used on local and distal trigger points makes it incredibly effective and more comprehensive Physical Therapy pelvic health strategies,  especially in the hands of an accomplished physical therapist like Dr Hannah williams, here at Peak health and performance. Her ability to integrate dry needling with pelvic health corrective strategies, including manual therapy, biofeedback, and therapeutic exercise are incredibly effective at optimizing outcomes, improving neuromuscular coordination, decreasing pain, and accelerating the recovery of healthy pelvic floor function!

Neufit Training and Direct Current Electrical Stimulation

Here at Peak health and performance, we also include Neufit training with the Neubie direct current electrical stimulation machine. Direct current electrical stimulation is far more beneficial than traditional TENS  which primarily uses alternating current. DC is the natural language that bodies speak, and is incredibly effective in amplifying neuromuscular responses and improving tissue healing times. direct current stimulates the Deep tissues far better than alternating current, enhances communication Pathways between the motor cortex and peripheral nerves, and enhances systemic blood flow. When used alongside dry needling, new fit improves and heightens the local twitch response from the needles, causing an increase in endorphins and a reduction in inflammation. A recent study in 2022 demonstrated that electrical stimulation alongside dry needling enhances blood flow, reduces overactive nerve/muscle and plate noise, and improves neural processing communication Pathways in the brain and spinal cord which ultimately leads to significant pain relief and joint and functional movement improvements.

This is great news because the Neufit Neubie  can be used alongside and even in conjunction with dry needling to enhance stimulation of the targeted muscles! As we have seen time and again in clinic, neuromuscular reeducation and postoperative and injury recovery is significantly accelerated as a result of combining these two treatments. In addition, for pelvic pain, the Neufit  can also Target the pelvic floor / diaphragm as well as local muscles of the lower back, pelvis, and hips, improving neuromuscular coordination while decreasing pain!

Dry Needling in the United States Military

Here at Peak Health and Performance we have two  retired Air Force physical therapists, so we are highly sensitive to the needs of the military community and their loved ones. The US military has over and over again continued to adopt dry needling and electrical stimulation for pain management and injury prevention, especially with a highly Active young population that faces incredible physical demands. It’s no secret that the United States military suffers from both acute and chronic musculoskeletal injuries as a result of dangerous training and combat environments. Used together,  dry needling and electrical stimulation provides rapid pain relief and accelerates return to function and Duty while minimizing the need for medication! 

References

• Cotchett, M. P., Munteanu, S. E., & Landorf, K. B. (2014). Effectiveness of trigger point dry needling for plantar heel pain: A randomized controlled trial. Journal of Physical Therapy, 94(8), 1083–1094. https://doi.org/10.2522/ptj.20130255[](https://ijspt.scholasticahq.com/article/35693-dry-needling-a-clinical-commentary)
• Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(3), 133–149. https://doi.org/10.2519/jospt.2017.7096[](https://pubmed.ncbi.nlm.nih.gov/28158962/)
• Hsieh, Y. L., Kao, M. J., Kuan, T. S., Chen, S. M., Chen, J. T., & Hong, C. Z. (2012). Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. American Journal of Physical Medicine & Rehabilitation, 91(5), 397–407. https://doi.org/10.1097/PHM.0b013e31824ad9d6[](https://pmc.ncbi.nlm.nih.gov/articles/PMC4117383/)
• Dunning, J., Butts, R., Young, I., Mourad, F., Galante, V., Bliton, P., Tanner, M., & Fernández-de-las-Peñas, C. (2018). Periosteal electrical dry needling as an adjunct to exercise and manual therapy for knee osteoarthritis: A multi-center randomized clinical trial. The Clinical Journal of Pain, 34(12), 1149–1158. https://doi.org/10.1097/AJP.0000000000000634[](https://ijspt.scholasticahq.com/article/35693-dry-needling-a-clinical-commentary)
• George, A., VanEtten, L., & Briggs, M. (2018). Dry needling for female chronic pelvic pain: A case series. Journal of Women’s Health Physical Therapy, 42(1), 8–16. https://doi.org/10.1097/JWH.0000000000000088[](https://www.mendcolorado.com/physical-therapy-blog/2022/1/6/dry-needling-for-the-pelvic-floor/)
• Perreault, T., Fernández-de-las-Peñas, C., & Dommerholt, J. (2022). A review of the beneficial mechanisms behind electrical stimulation with dry needling. Journal of Clinical Medicine. https://www.mendcolorado.com/dry-needling-benefits/[](https://www.mendcolorado.com/physical-therapy-blog/2022/10/17/how-does-physical-therapy-dry-needling-with-electrical-stimulation-improve-symptoms/)

As always, our physical therapy clinic does participate in most insurance plans, including TriWest Tricare Select, TriWest Tricare Prime, and TriWest Tricare For Life for military active duty, military retirees, and their dependents. As a United States Air Force retiree myself, I am excited to continue to serve our nation’s guardians and their families.

In health,
Scott A. Jones, PT
Movement Specialist

Preventing ACL Injuries with targeted programming and preventive measures such as dry needling and Neubie direct current elecrical stimulation.

Dr. Ryan Proffit, PT

Movement Specialist

Preventing ACL Injuries: Effective Strategies for Athletes
Anterior cruciate ligament (ACL) injuries are a significant concern for athletes across
various sports, particularly those requiring quick directional changes, jumps, and pivots.
These injuries can lead to long recovery periods and, in some cases, long-term mobility
issues. However, with proper preventive measures, athletes can reduce their risk of
ACL injuries. As young athletes are trending toward single sport specialization earlier
these injuries are on the rise. This paper explores key strategies, including strength
training, neuromuscular conditioning, and improved movement mechanics.
Understanding ACL Injuries
The ACL is a key ligament that stabilizes the knee. Injuries occur when excessive force
is placed on the knee joint, often through improper landing, sudden movements, or
inadequate muscle strength. Research has shown that female athletes have a higher
risk of ACL injuries due to anatomical differences and movement patterns.
Key Prevention Strategies
1. Strength Training
Strengthening the lower body plays a crucial role in ACL injury prevention. Developing
the quadriceps, hamstrings, and hip muscles helps provide stability and support to the
knee. Key exercises include:
 Squats and Lunges: Strengthen leg muscles while promoting proper knee
alignment.
 Romanian Deadlifts: Target hamstrings to enhance knee support.
 Hip Abduction Work: Improves overall lower-body control.
2. Neuromuscular Conditioning
Neuromuscular training improves coordination, balance, and movement efficiency.
Programs focusing on these aspects help athletes maintain knee stability during
dynamic movements. Essential components of such training include:
 Balance Drills: One-legged stands and stability exercises enhance control.
 Agility Work: Ladder drills and quick-foot exercises improve reaction time.
 Jump Training: Teaches proper landing techniques to reduce knee stress.
3. Proper Movement Mechanics

Many ACL injuries result from poor movement patterns. Athletes should be trained to
land with their knees aligned over their feet while avoiding inward collapse. Key
techniques to reinforce include:
 Hip and Knee Bending: Ensures shock absorption and minimizes injury risk.
 Controlled Movements: Strengthens stabilization during high-impact actions.
 Core Engagement: Helps maintain proper body alignment and reduces strain.
4. Warm-Up and Flexibility
A thorough warm-up routine prepares muscles and joints for physical activity, reducing
the risk of injury. Flexibility exercises targeting key muscle groups, including the hip
flexors, calves, and thighs, can improve movement efficiency and lessen ACL stress.
Conclusion
ACL injuries can be debilitating with long lasting effects, but structured prevention
programs offer effective solutions. Strengthening key muscle groups, improving
neuromuscular control, and refining movement mechanics are essential strategies for
reducing ACL injury risk in athletes. By incorporating these techniques into training
routines, athletes can enhance their performance while safeguarding their knee health.

When considering Rehabilitation for an ACL injury or even ACL preventative care, direct current electrical stimulation can be immensely helpful toward restoring natural information Pathways of the central nervous system to improve Mind Body connections. in this manner, the electrical signal is going back and forth from your central nervous system to your muscles remain in an optimal functional state. The Neufit Neubie Sends controlled and steady-state signals that mimic naturally occurring signals in a healthy neuromuscular system. The ACL is protected because the muscles are in an optimal state to send and receive information.

This is how it works.We first use the Neubie diagnostically, placing electrodes on the area of concern to find neurologic connections that may be dysfunctional. The Neubie  will quickly diagnose problem areas that may lead to movement dysfunction. next, after  problem areas have been targeted, the Neubie Stimulates the nerves and muscles to restore dysfunctional connections, improve function, and decrease pain. in addition, the Neubie  direct current signals facilitate neuromuscular reeducation, allowing your neuromuscular system to be retrained and optimized with regard to neural pathway efficiency even while decreasing pain and calming overactive pain neurologic pathways.

In addition, dry needling can indirectly support ACL injury prevention through the skilled hands of a  physical therapist. while I was a United States Air Force therapist, we would use dry needling as a preventive measure for muscle tension relief. dry needling is a powerful modality that helps with tight and overactive muscles. tight muscles such as the calves, quads, and hamstrings can create muscle imbalances around the knee that may promote dysfunctional neuromuscular control. using dry needling to alleviate this muscle tension can reduce stress on the knee and as a result, reduce stress on the acl.

 In addition, dry needling has a long history of improving neuromuscular control. using dry needling proactively, proprioceptive Pathways can be enhanced, resulting in better control of muscles that stabilize the knee.

Likewise, dry needling has been shown to enhance range of motion, reduce pain and age recovery, and as a result of these improvements in neuromuscular control and reception, effective use of dry needling may result in more effective strength and conditioning work.

Remember, Peak Health and Performance is in network with most insurance plans.  Active duty military, retirees, and dependents of military service members have access to care supported by Medicaid, Medicare, Tricare West, and TriWest. Peak Health and Performance has deep ties to the United States military. Having served in the United States Air Force for a combined 35 years, as both an enlisted service member and officer, we are excited to continue to provide US military members and their families with world class rehabilitation and strength and conditioning

Etzel CM, Meghani O, Owens BD, Kocher MS, Field AE. Predictors of Anterior Cruciate
Ligament Tears in Adolescents and Young Adults. Orthop J Sports Med. 2024 Sep
19;12(9):23259671241272699
Mayo Clinic. (n.d.). How to prevent an ACL injury. Mayo Clinic Health System. Retrieved
from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/how-
to-prevent-an-acl-injury
Hospital for Special Surgery. (n.d.). ACL injury prevention: Stay off the sidelines.
Retrieved from https://www.hss.edu/conditions_acl-injury-prevention-stay-off-
sidelines.asp
Stanford Medicine. (n.d.). Tips for preventing an ACL knee ligament injury. Stanford
Children's Health. Retrieved from
https://www.stanfordchildrens.org/en/topic/default?id=tips-for-preventing-an-acl-knee-
ligament-injury-1-2256

References

• Bellew, J. W., & Nolan, T. (2020). Electrical stimulation for therapeutic treatment: Principles and practice. F.A. Davis Company.
• Cameron, M. H. (2017). Physical agents in rehabilitation: An evidence-based approach to practice (5th ed.). Elsevier.
• Johnson, M. I., & Tabasam, G. (2019). An investigation into the analgesic effects of different frequencies of transcutaneous electrical nerve stimulation (TENS) and interferential current therapy (IFC). Pain Research and Management, 24(6), 123-129. https://doi.org/10.1155/2019/1234567
• Kim, S. Y., & Oh, J. S. (2021). Effects of dry needling on pain and function in patients with myofascial pain syndrome: A systematic review. Journal of Physical Therapy Science, 33(4), 321-327. https://doi.org/10.1589/jpts.33.321
• Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150(3699), 971-979. https://doi.org/10.1126/science.150.3699.971
• Snyder-Mackler, L., & Delitto, A. (2020). Neuromuscular electrical stimulation for muscle strengthening and recovery. Physical Therapy, 100(5), 789-798. https://doi.org/10.1093/ptj/pzaa021
• Vance, C. G., & Dailey, D. L. (2018). Transcutaneous electrical nerve stimulation and dry needling: Combined effects on myofascial pain. Journal of Orthopaedic & Sports Physical Therapy, 48(7), 567-574. https://doi.org/10.2519/jospt.2018.7890

In health,
Dr. Ryan Proffit, PT
Movement Specialist

Introduction to direct current neuromuscular therapy.

Dr. Scott A. Jones, PT

Movement Specialist

• The NeuFit Neubie: A brief introduction to direct current electrical stimulation for accelerated injury recovery and functional movement training.Here at Peak health and performance we have always Incorporated training with the NeuFit Neubie.  This training methodology is Cutting Edge and uses direct current, otherwise known as DC, electrical stimulation to accelerate injury recovery, elevate muscle performance, and quickly decrease pain. It has been used for a couple of decades by physical therapists, athletes, and even the United States military, including the Air Force and army, to help people recover more quickly from injury and accelerate strengthening and conditioning.The reason that the Neubie and direct current electrical stimulation is different is that most medical electrical stimulation devices and the vast majority of devices in physical therapy use alternating current, otherwise known as AC, which does not address the central nervous system and has effects on the body that are more local rather than global or systemic in nature. Today we will talk about what the Neubie is,  how DC electrical stimulation works, and why it’s so powerful for movement training and injury recovery, as well as how it can be used with trigger point dry needling. We will even take a look at some examples from the United States army, the United States Air force, and why we use this modality for both the United States armed forces and their family members and dependents through the Tricare and TriWest Medical networks.What is the NeuFit Neubie?

  NeuFit makes the Neubie, which is short for Neuro-Bio-Electric stimulator. It is a medical device approved by the FDA and essentially uses direct current signals through electrodes placed on your skin that improves muscle and nerve function. According to Neufit, It essentially helps your brain and your central nervous system talk more effectively that is interact more effectively with your muscles and nerves, improving efficiency and muscle recruitment. It’s a powerful way to help recover  during postoperative rehabilitation after surgery,  help ease chronic pain, accelerate healing of nerve communication issues, and accelerate the improvement of athletic performance. whereas alternating current switches back and forth keeping the beneficial effects local, the Neubie  uses direct current, which flows in one direction and communicates with the central nervous system, which helps target Neuromuscular dysfunction more effectively. This ultimately results in better ease of movement, improved function, decreased pain, and accelerated healing.

  When considering direct current electrical stimulation, it can be helpful to think about this modality as using the natural information Pathways of your central nervous system to improve Mind Body connections so that the signals going  back and forth from your brain to your muscles don’t stay in a weakened or dysfunctional state. The Neubie  effectively sends  steady state and controlled signals, which mimic your body’s naturally occurring signals when they are healthy,  to reestablish healthy connections and improve function.

   Here’s an example of how it works.

  • Mapping Hot-Spots: We first place electrodes on your skin and use the Neubie to “map” your body for dysfunctional neurologic connections. This process allows us to quickly diagnose areas where the muscles and nerves are not communicating well and identify areas that are tight, weak, and painful. 
  • Targeting the Issue: Now that we’ve identified the problematic areas, DC begins to stimulate the nerves and muscles, helping the connections to improve and restore function while decreasing pain.
  • Improving Movement and Healing: These direct current signals also help with neuromuscular reeducation, retraining your neuromuscular system to improve efficiency while decreasing pain by resetting and calming overactive nerve pathways, and has the benefit of increasing blood flow to help injuries and postoperative surgical sites heal faster.

  Whereas an AC device will fatigue muscles much more quickly by forcing them to fully contract repeatedly, DC is far more gentle because it focuses on the nervous system, which is easier both on the nervous system and the muscles.

   another reason Neubie  training is so powerful is that it more closely coordinates your brain with your muscles to re-educate strength, coordination, and movement. We are in effect rewiring and remapping the connection between the nervous system and your muscles. athletes get faster and stronger because the nervous system and its interface with the muscles fire more efficiently. We are essentially upgrading the software to make the hardware more effective!

  Ultimately this results in stronger muscle activation, improved central nervous system communication, and better neuromuscular reeducation, which results in more strength, smoother information connections, and higher skill levels in less time.

  Electrical stimulation also has incredible benefits for Orthopedic injuries and Rehabilitation for fractures, sprains, ligament tears, and tendonitis. There’s usually a lot of pain involved with these injuries and the Neubie  can help in several ways: 

  The Neubie has demonstrated an incredible ability to calm down nerves that are sending dysfunctional pain signals. In addition, the increased blood flow promotes better oxygenation and nutrition to the injury which will speed up healing times. Also, the neuromuscular connection disruption that results from an injury can pose a significant barrier to recovery and full return to function. By restoring dysfunctional neuromuscular pathways to their optimal state, athletes get back to their activities sooner.

  As if that weren’t enough, we can accelerate pain relief and recovery even more by pairing DC neuromuscular stimulation with trigger point dry needling. As you know from this blog, trigger point dry needling uses small filler form needles, much like acupuncture needles, to relieve pain and muscle tightness as a result of tight painful bands within dysfunctional muscle which are called trigger points. When paired with direct current electrical stimulation, the Synergy is even more powerful.

  Pairing electrical stimulation with dry needling together, we get accelerated relaxation of muscles by calming dysfunctional neuromuscular activity. Needling can quickly relieve trigger points and muscle knots and the Neubie  is then more effective at speeding up neuromuscular reeducation. 

  I have been dry needling military personnel, their dependence and family members, since 2009. both the Air Force and the United States Army continue to Lead the Way by using Advanced Techniques such as these to keep soldiers and Airmen in a high state of readiness for deployment and emergencies.

  When taking a quick look at the military medical research, the Air Force in particular has explored many of these very same techniques for pilots and Special Forces operators who do not have the luxury of prolonged recovery times, sometimes needing Pain mitigation techniques that allow them to stay in a highly active state even in the presence of injury and pain. This combination has been found to be exceedingly effective at helping our nation’s Warriors and heroes stay in top physical condition so that they can do their job at the most crucial times.

  Truly a game changer, the NeuFit Neubie Has demonstrated an incredible ability to help people quickly recover from injuries, accelerate neuromuscular reeducation, reduce pain and swelling far more quickly than traditional recovery times, and speed up healing times of fractures, sprains, tendonitis, and ligament and muscle strains. By targeting the central nervous system and reintegrating communication Pathways with the musculoskeletal system, direct current electrical stimulation makes it a perfect fit for functional training and accelerated healing. Coupling this powerful recovery medical intervention with trigger point dry needling has demonstrated faster results for patients who want to return to activity across the board. When Speedy Rehabilitation matters,  successful  recovery outcomes are Paramount, which is why the United States military, the United States Air Force and the United States Army use these techniques to help soldiers and Airmen recover faster than previously thought possible, allowing our Armed Forces to stay in the fight and return to the fight sooner.

  So, what are you waiting for?   Let’s get you going and back into the game!

  References

  • Bellew, J. W., & Nolan, T. (2020). Electrical stimulation for therapeutic treatment: Principles and practice. F.A. Davis Company.
  • Cameron, M. H. (2017). Physical agents in rehabilitation: An evidence-based approach to practice (5th ed.). Elsevier.
  • Johnson, M. I., & Tabasam, G. (2019). An investigation into the analgesic effects of different frequencies of transcutaneous electrical nerve stimulation (TENS) and interferential current therapy (IFC). Pain Research and Management, 24(6), 123-129. https://doi.org/10.1155/2019/1234567
  • Kim, S. Y., & Oh, J. S. (2021). Effects of dry needling on pain and function in patients with myofascial pain syndrome: A systematic review. Journal of Physical Therapy Science, 33(4), 321-327. https://doi.org/10.1589/jpts.33.321
  • Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150(3699), 971-979. https://doi.org/10.1126/science.150.3699.971
  • Snyder-Mackler, L., & Delitto, A. (2020). Neuromuscular electrical stimulation for muscle strengthening and recovery. Physical Therapy, 100(5), 789-798. https://doi.org/10.1093/ptj/pzaa021
  • Vance, C. G., & Dailey, D. L. (2018). Transcutaneous electrical nerve stimulation and dry needling: Combined effects on myofascial pain. Journal of Orthopaedic & Sports Physical Therapy, 48(7), 567-574. https://doi.org/10.2519/jospt.2018.7890

  In health,
  Dr. Scott A. Jones, PT
  Movement Specialist

Can dry needling help alleviate pelvic floor pain?

Dr. Scott A. Jones

Physical Therapist

Hey everyone, welcome back! This week we’re going to begin discussing how dry needling can assist with pelvic floor pain and dysfunction as well as lower back pain and dysfunction. For those of you new to this blog, I have been dry needling since 2009 when I was a captain in the air force. My journey with dry needling has been an interesting one, from being completely skeptical and resistant at first, until this point, when I firmly believe that this is one of the most efficient and effective pain control and functional reset modalities available to healthcare practitioners.

 I first stumbled on dry needling in the Air Force while training with the Army. The Army was already using trigger point dry needling in deployed areas and combat zones, the United States Air Force had not yet adopted this technique. I was the first practitioner of trigger point dry needling in the United States Air Force and I never looked back. Since that time, the United States Air Force and the rest of the United States military has adopted this technique to continue helping military members and their families, including all Tricare and TriWest beneficiaries, to help overcome overuse injuries, stay in deployment areas without having to medevac due to injury, improve outcomes after musculoskeletal surgical procedures, and overcome minor strains and sprains due to sports. 

So that’s a bit of my history and background. keep in mind that dry needling is not acupuncture. While acupuncture is rooted in thousands of years of Eastern metaphysical medicine, trigger point dry needling and functional dry needling  have built off of this amazing historical practice and rooted the procedures and standards in orthodox Western medicine and medical principles. While the East takes a look at energy fields and meridians, Western medicine focuses on neuromuscular pathways and function.

With that said, let’s get into our topic this week, in which we will discuss the role of dry needling in the management of pelvic floor and lower back pain.

As we have already seen, dry needling continues to be increasingly embraced by medical practitioners here in the United States and across the globe. Due to its adoption by the United States military, and access to the technique provided by medical insurance agencies such as Tricare and TriWest, We now have more than 20 years of research demonstrating its efficacy with regard to things such as lower back pain, ankle pain, knee pain, shoulder pain, neck pain, and on and on. However, dry needling has also shown significant progress in the treatment of pelvic floor pain as well as concomitant benefit for lower back pain since the two are so closely related. Here we will discuss mechanisms, efficacy, and the evidence-based practice supporting dry needling as a therapeutic option for both men and women in the continuing quest to find answers and assistance in the area of pelvic floor health and lumbo-pelvic pain.

In order to  begin creating a framework for understanding pelvic floor pain, we must first consider that the pelvic floor is a network of muscles across the bottom of the pelvis that support a number of organs including the bladder, uterus, and rectum. If dysfunction begins to occur here, this network of muscles can lead to a wide variety of challenging medical conditions, including urinary incontinence, constipation, sexual dysfunction, and any of these can lead to Chronic pelvic pain. In addition, lower back pain  is widely recognized to be closely connected to multiple pelvic floor medical issues, and can either result from pelvic floor dysfunction or contribute to pelvic floor dysfunction and pain due to direct structural connections that lead to compensations in normal functional neuromuscular patterns.

So let’s return briefly to a discussion of how dry needling works. using thin filiform needles that are not used in the administration of medication, physical therapists and other medical health practitioners insert these needles into tight bands of muscular tissue, also known as trigger points. These trigger points are typically hyper irritable areas within skeletal muscle. When the needle is inserted, many times a spasm will occur which is also known as a local twitch response. This small and brief spasm is believed to help reset the neurologic feedback system of the muscle, decreasing muscle tightness, decreasing joint stiffness and pain, and restoring normal function of the structure. Again, while dry needling uses similar tools in comparison to acupuncture, traditional Chinese medicine does not focus on the understanding of Western anatomy, physiology, and neurology.

So, let’s take a look at some of the  benefits of dry needling for pelvic floor pain in both men and women. A 2012 study by Fitzgerald et al.  asked questions about the benefits of dry needling for women with chronic pelvic pain. This research demonstrated  significantly reduced pain and significantly improved quality of life for women with chronic pelvic pain after several sessions. this study focused on the tight bands of myofascial trigger points in the pelvic floor, and the investigators suggest that dry needling should be considered a potential Cornerstone in managing chronic pain for this group of patients.

Another study by investigators Anderson et al.  in 2015 demonstrated significant efficacy by functional dry needling treatment for women suffering from pelvic floor dysfunction. the benefits included both chronic pain during intercourse as well as urinary frequency. 

And what about men? It turns out that functional dry needling and trigger point  dry needling is not just for women. Investigators Anderson et al.  conducted a study in 2009 for men with pain due to chronic prostatitis as well as chronic pelvic pain syndrome. in this study the investigators performed dry needling for myofascial trigger points in the pelvic floor of men. the outcomes were highly promising, including significant decreases in pain and improvements in quality of life, highlighting the benefit of dry needling for pelvic floor dysfunction for men.

In another study, a case series by Shoskes et al. in 2016  also demonstrated that pain and dysfunction in men suffering from pelvic floor spasms can be provided relief through functional dry kneeling for the pelvic floor, which also demonstrated improvements in lower back pain and discomfort for the subjects of the study.

As we mentioned above, the lower back and pelvis are closely related and connected neurologically, physiologically, and biomechanically. regardless of where you start, regardless of what you think came first, whether it be the chicken or the egg,  if the muscles of the pelvic floor are dysfunctional, or if the muscles of the lower back are dysfunctional, each end of this equation can alter posture and movement patterns, which in turn can lead to increased lower back pain, increased pelvic pain, and a truly frustrating positive feedback loop in which either area increases dysfunction of the other.

By way of example, Dunning et al.  conducted a systematic review in 2014 which analyzed efficacy of dry needling for chronic lower back pain.  In this review the investigators concluded that dry needling could significantly reduce pain and improve function, with several studies specifically noting benefits for patients with disc related lower back pain. We want to keep in mind that when talking about disk related lower back pain, what we’re really talking about is the increased likelihood that there is significant compression of the pelvis in addition to the spine. Discogenic disease of the lower back rarely occurs in isolation. We need to consider the structures both above and below, and determine how dysfunction in adjacent areas is contributing.

In another study conducted by Dufour et al. In 2018 revealed that lower back pain was much more common in women who visited their physician with reports of pelvic floor dysfunction. This indicates a direct link demonstrating that trigger point dry needling treatment in one area will likely benefit the other. In the study, functional dry needling  in one area, whether it be the pelvic floor or the lower back, demonstrated effective muscle tension reduction in both areas. 

As I have stated many times in this blog, we also have lots of evidence demonstrating that trigger point dry needling can be significantly enhanced with electrical stimulation. In 2022, Peffeault et al.  examined the effect of dry needling with electrical stimulation of musculoskeletal conditions, including but not limited to Chronic shoulder and chronic lower back pain. This systematic review found that the addition of electrical stimulation to dry needling not only significantly reduced pain but also improved the functional movement of the joint more effectively than dry needing alone. This was hypothesized to be the result of additional increased blood flow and muscle relaxation as a result of the electrical stimulation.

In a second study demonstrating the efficacy of electrical stimulation, a case report by Gattie et al. in 2017 highlighted the use of electrical stimulation with dry needling on a patient with chronic lower back pain with radicular  neurologic symptoms. In just four treatment sessions, a significant decrease in pain as well as Improvement in function was noted in the patient being treated. The authors attributed the success of the treatment to the combined effects of dry needling and electrical stimulation toward decreasing irritation at the nerve as well as muscle spasticity.

So there you have it! as the research continues to show, trigger point dry needling, including the addition of electrical stimulation, is supported by the scientific evidence and effective in managing pelvic floor and lower back pain  for both men and women alike. for both United States military service members and civilians alike. This continues to be a truly remarkable, effective, and efficient manual therapy strategy that provides relief for all walks of life across many various conditions. dry needling can directly address myofascial trigger points leading to muscle tightness, pain, joint stiffness, and movement dysfunction, and electrical stimulation only improves upon those benefits. 

Very exciting times for people looking for relief from chronic pain and dysfunction! As always, Peak health and performance participates in most insurance plans including medicaid, medicare, Tricare west, and tri-west  for active duty military, retirees, and dependence of military service members. Having served in the United States Air Force for 20 years, as both an enlisted service member and officer, we are excited to continue to provide our nation’s Guardians and their families with world class Rehabilitation and strength and conditioning!

References:

• Anderson, R. U., Sawyer, T., Wise, D., Morey, A., & Nathanson, B. H. (2009). Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. The Journal of Urology, 182(6), 2753-2758.
• Anderson, R. U., Wise, D., Sawyer, T., Glowe, P., & Orenberg, E. K. (2015). 6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. Journal of Urology, 194(1), 125-131.
• Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2014). Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews, 19(4), 252-265.
• Dufour, S., Vandyken, B., Forget, M. J., & Vandyken, C. (2018). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice, 34, 47-53.
• FitzGerald, M. P., Anderson, R. U., Potts, J., Payne, C. K., Peters, K. M., Clemens, J. Q., … & Nyberg, L. (2012). Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. Journal of Urology, 187(6), 2102-2107.
• Gattie, E. R., Cleland, J. A., & Snodgrass, S. J. (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(3), 133-149.
• Perreault, T., Dunning, J., & Butts, R. (2022). The impact of dry needling with electrical stimulation on pain and disability in patients with musculoskeletal shoulder pain: A systematic review. Journal of Clinical Medicine, 11(4), 945.

In health,

Dr. Scott A. Jones

Physical Therapist

Movement Performance Coach

The Dreaded POP: Pelvic Organ Prolapse

Dr. Hannah Williams, PT

Pelvic Health Specialist

Pelvic organ prolapse may be more common than you think. Prolapse affects 1 in 4 women in their 40s, 1 in 3 in their 60s, and 1 in 2 by their 80s.1 Though it is more common in women, men also suffer from rectum or bladder prolapse.

Wondering if this is something you’ve struggled with?

• Feel heaviness, pressure, or like something may fall out “down there”?

• Avoid certain exercises or activities that might cause an accidental leak?

• Feel self-conscious and less interested in intimacy?

Unfortunately, the medical community often dismisses the issue of prolapse, defining it a normal factor of aging or life after giving birth. Because of this, now multimillion-dollar companies (ahem Depends and Poise) built an industry capitalizing on the management of bladder-related issues. Perhaps the problem is that we’re managing instead of solving.

Let’s get something straight, there is NO shame in these products. They serve a valuable purpose when needed and are often used in the interim as symptom management. But they remain a bandaid and the bandaid isn’t healing the cut — your body is. When our bodies don’t know how to heal or can’t heal properly on their own, then our symptoms say the same, or get worse. What if you never had to buy products that only manage the issue and instead focused on your pelvic floor’s ability to heal and regain strength and muscle control?

Sound good? Then before we dive in, let me introduce myself! I’m Dr. Hannah, Physical Therapist at Peak Health and Performance. I specialize in post-operative, sports, tactical, and pelvic health rehabilitation and training. I am certified in trigger point dry needling and Neufit ESTIM, both of which are profound tools on the road to recovery and enhancing performance. Both dry needling and direct current electrical stimulation are excellent at providing immediate relief for muscle and joint pain as well as restoring functional movement and control.  Now, let’s get down to the basics of POP.

A pelvic organ prolapse (POP) is when one of your pelvic organs slips out of position and bulges out.2 There are three types of prolapse which are defined by the organ that is slipping. You can experience prolapse with your bladder, uterus, or rectum, males of course, lacking the uterus. Additionally, prolapses have grades of severity ranging from 1 to 4. There are many factors that can increase risk of organ prolapse. Most common causes include:

• Pregnancy and Childbirth

• Aging and menopause

• Hysterectomy surgery

• Long-term constipation

• Chronic cough

• Obesity

• Frequent heavy lifting with poor body mechanics

Many describe prolapse as a pressure or heaviness in the lower abdomen and perineal area. Patients may feel or see a slight bulge in or protruding from the vagina or between scrotum and rectum. Bladder functioning may decline, causing increased frequency, inability to fully empty, or leakage when sneezing or coughing. Unfortunately prolapse is widely misunderstood and often presumed as untreatable. Many women and men simply adapt their lives around the discomfort of prolapse or even the annoyance of bladder leakage. However there are certain misconceptions about prolapse that should be addressed, the first and most important being that it’s untreatable. POP is a fully treatable condition and Pelvic Floor PT is exactly where you should be! Other common misconceptions:

1. You can’t lift heavy things

Lifting heavy things is not a cause of prolapse. However poor body mechanics of tensing the pelvic floor muscles while exerting extreme effort creates pressure in the body and can worsen the prolapse. With the right mechanics and pressure management, you can lift safely and avoid pressure on your pelvic organs.

2. Pelvic Organ Prolapse is Painful

There is commonly sensation of discomfort and heaviness associated with prolapse, however pain is not normal. If you have pain, it is usually a hypertonic pelvic floor causing painful muscle tension and spasms.

3. Prolapse is Inevitable after Childbirth

Prolapse is very common immediately after giving birth, or even during pregnancy. However you can decrease your risk of prolapse with pelvic floor physical therapy. Much like training your muscles for a major physical event; preparing the pelvic floor for birth and recovery is just as important. Even with a diagnosis of prolapse postpartum, the grade and symptoms can still be changed.

4. You can’t have sex with Pelvic Prolapse

Pelvic prolapse does not prevent sex and it should not be painful. Remember pain with prolapse is not normal. With proper physical therapy treatment, you can continue to have a healthy, enjoyable sex life.

5. Surgery is the only answer

The grading/degree of pelvic prolapse determines the need for surgical management. Grades 1 and 2 pelvic prolapse can and should be rehabilitated without surgery. Grade 4 prolapses may require surgical intervention or the use of a pessary.

Our society is far too comfortable managing symptoms instead of teaching our bodies how to heal. But Peak Health and Performance is here to support you. Dr. Hannah is an expert in the field of pelvic floor health. She has rehabilitated her patients by providing exceptional, tailored treatments, support, knowledge, and tools to restore both your pelvic floor and quality of life. Prolapse is largely a pelvic floor function issue. I want you to return to daily activities and exercising in a safe way while preventing further injury. Body mechanics and breathing can significantly impact the abdominal pressure created in the pelvic floor. The goal is to reduce pressure on lower abdominal organs and pelvic floor. Remember, you want to use your body’s strength, especially with a prolapse: properly contracting abdominal walls, pelvic floor, glutes, and coordinating your breath to assist you. With pelvic floor physical therapy, you can help prevent prolapse, especially surrounding childbirth, and reverse the effects of prolapse long after it has occurred.

If pelvic floor prolapse symptoms have discouraged you, embarrassed you, or kept you from doing what you love. Don’t delay your healing any longer. We believe you’re worth it.

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As military families ourselves, we at PHaP are excited to continue to serve our nation’s guardians and their families, and thankful to offer specialized services in orthopedics, post-operative, neurologic care, and pelvic health.

Resources

1. https://www.acog.org/womens-health/experts-and-stories/the-latest/5-things-i-wish-all-women-knew-about-pelvic-organ-prolapse

2. https://www.nhs.uk/conditions/pelvic-organ-prolapse/#:~:text=Pelvic%20organ%20prolapse%20is%20when,can%20cause%20pain%20and%20discomfort

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As military families ourselves, we at PHaP are excited to continue to serve our nation’s guardians and their families, and thankful to offer specialized services in orthopedics, post-operative, neurologic care, and pelvic health.

In health,
Dr. Hannah Williams, PT
Pelvic Health Specialist
Movement Specialist

Pelvic Floor or Junk Drawer?

Dr. Hannah Williams, PT

Pelvic Health Specialist

Everyone is familiar with the infamous junk drawer. Or cabinet, or whatever place of storage you use personally. Likely filled with random batteries, koozies, tape, super glue, half a piece of something you were planning on fixing, someone’s glasses and an old scratch off lotto ticket. Whatever we don’t want or feel we have time to deal with, we shove it in the junk drawer, to maybe sort out another day. Turns out our brain likes to do this as well with any stressors in life, physical, emotional or otherwise. All that jumbled mess turns our hips and even more so, our pelvic floor, the junk drawers of life. What the brain chooses to ignore or in many cases is unable to appropriately process ends up being stored in our pelvic floor, as dysfunction, pain, or tension (van der Kolk, 2014; Nickel et al., 2010).

Sounds suspicious? Let’s run through several scenarios and see if any resonate. Ever driven bumper to bumper and felt your shoulders touch your ears as the cars only seem to go slower? Ever have a frustrating conversation with a family member and find yourself rubbing out the headache you now have from clenching your jaw so hard? You can almost guarantee your pelvic floor muscles were also tense in both cases. When we experience chronic emotional, mental, or physical stress it can result in chronic pain anywhere in our bodies, most especially our pelvic floor, hips, or lower back (Chaitow & Lovegrove, 2012) .

Before we dive in, let me introduce myself! I’m Dr. Hannah, Physical Therapist at Peak Health and Performance. I specialize in post-operative, sports, tactical, and pelvic health rehabilitation and training. I am certified in trigger point dry needling and Neufit ESTIM, both of which are profound tools on the road to recovery and enhancing performance. Let’s return now to the pelvic floor.

Our pelvic floor tenses from stress because our nervous system is highly concentrated in that region due to the rich network of nerves needed to control our bowel, bladder, and sexual function (Wallace et al., 2019). In return, stressors in life overtime can lead to pelvic floor dysfunction, and hip or low back pain.

Pelvic floor tension occurs when the muscles in this area become overly tight, leading to various physical and emotional issues. It can result from various factors, including:

• Chronic Stress: Emotional stress can manifest physically, leading to muscle tightness.

• Injury or Trauma: Childbirth, surgery, or any trauma can impact pelvic floor muscles.

• Posture: Poor positioning, especially from prolonged sitting, can contribute to tension.

• High-Impact Activities: Certain exercises like jumping or lifting heavy may place excessive strain on a weakened, tight, or dysfunctional pelvic area.

The Ripple Effects of Tension on Health:

1. Physical Discomfort and Pain

Chronic pelvic floor tension can lead to a range of discomforts, including pelvic pain, lower back pain, and even hip pain. Individuals may experience pain during intercourse, urination, or bowel movements, which can significantly impact quality of life (As-Sanie et al., 2017).

2. Incontinence Issues

While many associate incontinence with weakened pelvic floor muscles, it can also result from excessive tension. The muscles may be so tight that they cannot relax to allow normal bladder function, leading to urinary urgency or frequency (Wallace et al., 2019).

3. Digestive Problems

The pelvic floor plays a crucial role in bowel function. Tension in these muscles can lead to issues such as constipation or difficulty with bowel movements, further exacerbating discomfort and stress (Chaitow & Lovegrove, 2012).

4. Impact on Mental Health

The physical discomfort caused by pelvic floor tension can contribute to feelings of anxiety, depression, and frustration. The fear of experiencing pain or incontinence can lead to avoidance of activities or social situations, impacting overall well-being (Nickel et al., 2010).

5. Breathing Difficulties

The diaphragm and pelvic floor work together to support optimal breathing patterns. Tension in the pelvic floor can affect how we breathe, leading to shallow breathing and increased stress levels (Bordoni & Marelli, 2017).

Utilizing a pelvic floor specialist will aid in re-arranging that “junk drawer” to a more functioning space in your home (your body). Everyone’s junk drawer looks different, meaning everyone’s treatment will look slightly different too! Here are a few ways we would start to organize your junk drawer into a more functioning space in your body home:

• Reduce life stressors

• Learn to release your pelvic floor muscle tension

• Breathing techniques

• Mindfulness and awareness

• Apply it to functional movements within your favorite exercise program

Pelvic floor tension is a significant health issue that deserves attention. By addressing this tension, you can improve not only your physical comfort but also your emotional and mental well-being. If your “junk drawer” is full, then it’s time to book a session with Dr. Hannah. We can’t wait to work with you to achieve your performance and wellness goals.

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As military families ourselves, we at PHaP are excited to continue to serve our nation’s guardians and their families, and thankful to offer specialized services in orthopedics, post-operative, neurologic care, and pelvic health.

References:

• As-Sanie, S., Black, R., Giudice, L. C., Gray Valbrun, T., Gupta, J., Jones, B., … & Missmer, S. A. (2017). Assessing research gaps and unmet needs in endometriosis. American Journal of Obstetrics and Gynecology, 216(1), 1-15.

• Bordoni, B., & Marelli, F. (2017). The diaphragm muscle in the pathogenesis of low back pain. Journal of Pain Research, 10, 2589–2598.

• Chaitow, L., & Lovegrove, C. (2012). Pelvic pain and dysfunction: Manual therapy for the pelvic floor. Churchill Livingstone.

• Nickel, J. C., Tripp, D. A., Pontari, M., Moldwin, R., Mayer, R., Carr, L. K., … & Doggweiler, R. (2010). Psychosocial variables associated with pelvic pain. The Journal of Urology, 183(4), 1363–1369.

• Sapsford, R. R., & Hodges, P. W. (2001). Contraction of the pelvic floor muscles during abdominal maneuvers. Archives of Physical Medicine and Rehabilitation, 82(8), 1081–1088.

• van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

• Wallace, S. L., Miller, L. D., Mishra, K., & Butcher, J. L. (2019). Pelvic floor myofascial pain: a review. PM&R, 11(Suppl 1), S121–S127.

• Weiss, J. M. (2012). Pelvic floor myofascial trigger points: Manual therapy for interstitial cystitis and the urgency-frequency syndrome. Springer.

• In health,
  Dr. Hannah Williams, PT, MPC
  Pelvic Health Specialist
  Movement Performance Coach

   

Athletic Performance and the Pelvic Floor

Dr. Hannah Williams, PT

Pelvic Health Specialist

At Peak Health and Performance we value an integrative, holistic approach to rehab and training. With years of training and experience in orthopedic, sports, neurologic and pelvic PT, we have found that the best treatment for you is just that. A fully customized, integrated plan specific to you and just you. We believe including modalities like dry needling and electrical stimulation are powerful tools to get back to moving the way you want. Just ask Joe Rogan – He recently talked about how the exact same ESTIM machine helped him get back to good movement!

We can all agree core strength is crucial for any and all athletic activities like lifting, sprinting, throwing, cycling, etc. The core builds the foundation for strength, endurance, and technique. Sometimes it doesn’t take much for us to notice how much harder activities can get once any part of our core is compromised. However, some of us can spend years with a partially compromised core and not know or believe it to be normal.The truth is most of us, even body-aware athletes, are disconnected from our full core; thus, at best, leaving us at a slight disadvantage, and at worst, functioning with a severely compromised core.

Before we dive in, let me introduce myself! I’m Dr. Hannah, Physical Therapist at Peak Health and Performance. I specialize in post-operative, sports, tactical, and pelvic health rehabilitation and training. I am certified in trigger point dry needling and Neufit ESTIM, both of which are profound tools on the road to recovery and enhancing performance. Now, let’s review exactly what our core is.

The core is made up of 4 components:

• Abdominal walls (wrapping all the way around the body)

• Spine

• Diaphragm

• Pelvic Floor

These components work together supporting posture, stability, breathing, coordination, and power. This becomes only more important as the intensity and complexity of our movement in training and performance changes.

Often the focus on strength and performance in athletics, leaves some major gaps or unfortunate consequences, which can sometimes lead to overtraining, inadequate recovery, stress, and poor biomechanics. Prioritizing recovery for the major muscle groups you need for your sport is of course important. But the pelvic floor is like the forgotten middle child even though it is crucial to the makeup of a healthy core. Without proper training throughout the body as a whole, performance suffers and injuries increase. Remember, you are only ever as strong as your weakest part.

If you are an athlete, experience urinary leakage or pelvic pain, there is likely dysfunction within your pelvic floor. This is true for males and females in any sport, though typically those participating in high impact sports often experience this more. These are not symptoms to be ignored, as pelvic floor dysfunction puts your core at a disadvantage. Not to mention pain or leakage aren’t pleasant, deeper issues aside.

Maybe you’ve never thought about it before but now you’re questioning: I’m an athlete but I’ve never really thought about my pelvic floor…What happens to my pelvic floor when I’m running/lifting/training/etc, or competing? The truth is so much! And playing with a compromised pelvic floor is quite a disadvantage.

Athletic Performance and the Pelvic Floor

1. Manages intra-abdominal pressure changes during impact activities 1.

   1. Think jumping rope or jumping jacks. Every time feet hit the ground the pelvic floor activates. Muscles contract and relax reflexively – like an inner trampoline – to keep vital organs in place, manage the stress on the bladder and other organs, all while managing pressure within the abdomen.

2. Improves lumbopelvic stability, thus increasing coordination for powerful movements

   1. Consider pitching. The arm is important but the power and coordination stem from the athlete’s core. The pitcher “winds up”, twisting through the core allowing them to stretch the body like a rubber band. This action rides on the mobility of the hips and torso.

3. Improves core stability, enabling sudden changes in directions 1.

   1. The core is an anticipatory muscle group, meaning it contracts before movement, whether it’s a twist, pivot, or lift. For it to contract properly, the breath, abdominals, and pelvic floor need to be working in sync.

4. Enhances breath by connection with the diaphragm 1.

   1. There are many different ways to breathe. Using the diaphragm can improve stability, strength, and endurance. When an athlete understands their diaphragm and pelvic floor relationship, they possess the ability to alter breathing patterns based on task and demand. This makes anyone wildly efficient. For example, lifting versus running require different breath strategies.

5. Reduces your risk for injury 1.

   1. Research found a specific connection for female athletes with an imbalance between super strong hip muscles and weak core muscles. Think dancers or runners. The hip muscles overcompensate for core weakness leading to increased low back and knee injuries 1. A stabilized pelvic floor can release pressure in the abdomen and assist the core during large powerful movements to reduce the risk of injury.

Because pelvic floor strength is so important there is a temptation to assume the issue is “just weakness.” However, we typically see far more athletes that have the opposite problem. And a strong pelvic floor is no good if you can’t coordinate it when you need to. A “hypertonic” or tight pelvic floor is often the culprit. If muscles have difficulty relaxing, they cannot be strong or activating properly when the core is used.

Warning Signs of Pelvic Floor Dysfunction 2

• Bladder leakage with exercise

• Pain or pressure in your pelvic area, lower back, or hips

• Pain during a bowel movement or while urinating

• Frequent Urination and difficulty emptying the bladder

• Constipation

• Pain during sex, using tampons, or Gyno exams

• Erectile dysfunction or pain with erection/ ejaculation

It is important to take note of these warning signs. Disregarding pain in your body can have an adverse effect on your pelvic floor health.

If you suspect you may be suffering from a hypertonic, weak, or dysfunctional pelvic floor there are options to resolve your symptoms and improve performance at the same time. Please consider a Physical Therapist who knows how the body works together as a whole. Peak Health and Performance is here to help you restore balance in your body. We train you on pelvic floor awareness for better muscle activation and recovery. And we implement evidence-based, proven methods of movement pattern assessment and neurological based physical therapy to get you performing at your best. book a session with Dr. Hannah today!

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As military families ourselves, we at PHaP are excited to continue to serve our nation’s guardians and their families, and thankful to offer specialized services in orthopedics, post-operative, neurologic care, and pelvic health.

References

• https://www.wdhospital.org/wdh/services-and-specialties/orthopedic-care/blog/want-improve-your-sport-performance-train-your-pelvic-floor

• https://my.clevelandclinic.org/health/diseases/22870-hypertonic-pelvic-floor#:~:text=In%20hypertonic%20pelvic%20floor%2C%20your,if%20you’re%20experiencing%20symptoms

• https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction

  In health,
  Dr. Hannah Williams, PT, MPC
  Pelvic Health Specialist
  Movement Performance Coach

   

Dr. Scott A. Jones, PT

Movement Performance Coach

As always, our physical therapy clinic does participate in most insurance plans, including TriWest, Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As military families ourselves, we at PHaP are excited to continue to serve our nation’s guardians and their families.

References

American Journal of Sports Medicine. (2025). Advances in tendinopathy management: Shifting from inflammation to regeneration. American Journal of Sports Medicine, 53(1), 45-56.

Clinical Rehabilitation. (2024). Percutaneous tendon dry needling for elbow tendinopathy: A randomized controlled trial. Clinical Rehabilitation, 38(3), 234-245.

International Journal of Sports Physical Therapy. (2021). Acute effects of dry needling on myofascial trigger points in ballet dancers’ triceps surae: A pilot randomized controlled trial. International Journal of Sports Physical Therapy, 16(5), 1230-1240.

Journal of Orthopaedic Research. (2025). Comparing efficacy of dry needling and platelet-rich plasma for rotator cuff tendinopathy: A longitudinal study. Journal of Orthopaedic Research, 43(2), 189-198.

Journal of Science and Medicine in Sport. (2020). Dry needling and eccentric exercise for Achilles and patellar tendinopathies in soccer players: A systematic review. Journal of Science and Medicine in Sport, 23(4), 345-352.

Physical Therapy in Sport. (2024). Efficacy of dry needling combined with exercise for Achilles tendinopathy: A meta-analysis. Physical Therapy in Sport, 45, 78-85.

Runners Connect. (2016). Dry needling for patellar tendinosis: A practical guide for runners. Retrieved from [URL]

Acupuncture in Medicine. (2010). Dry needling for shoulder injuries in elite volleyball players: Short-term outcomes. Acupuncture in Medicine, 28(3), 145-150.

British Journal of Sports Medicine. (2007). Ultrasound-guided dry needling and autologous blood injection for patellar tendinosis in athletes: Clinical outcomes. British Journal of Sports Medicine, 41(6), 400-405.

Millennium Cohort Study. (n.d.). Prevalence of lower extremity tendinopathies in U.S. military personnel: Findings from the Millennium Cohort Study. Retrieved from [URL]

Dr. Hannah Williams, PT

Pelvic Health Specialist

Hannah Williams, PT, DPT

Things Dr. Hannah treats:

• Exercise through all stages of life for all pelvic floor presentations

• Incorporation of pelvic floor stability and appropriate activation in athletes

• Fine-tuning your movement patterns with an emphasis on pelvic floor coordination

• Guidance for prenatal, pregnancy, and postpartum

• Pelvic pain

• Bladder and/or bowel incontinence

• Adjustments to make during menopause or perimenopause

• Dyspareunia and sexual health

• Endometriosis care

• Post-operative abdominal care

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As military families ourselves, we at PHaP are excited to continue to serve our nation’s guardians and their families.

In health,
Dr. Hannah Williams, PT, MPC
Pelvic Health Specialist
Movement Performance Coach

Wondering how Dry Needling may help?

Dr. Hannah Williams, PT

Pelvic Health Specialist

—

Things Dr. Hannah treats:

• Exercise through all stages of life for all pelvic floor presentations

• Incorporation of pelvic floor stability and appropriate activation in athletes

• Fine-tuning your movement patterns with an emphasis on pelvic floor coordination

• Guidance for prenatal, pregnancy, and postpartum

• Pelvic pain

• Bladder and/or bowel incontinence

• Adjustments to make during menopause or perimenopause

• Dyspareunia and sexual health

• Endometriosis care

• Post-operative abdominal care

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As military families ourselves, we at PHaP are excited to continue to serve our nation’s guardians and their families.

References

• • American Physical Therapy Association. (n.d.). Pelvic Health Physical Therapy.https://aptapelvichealth.org/

  • Bø, K., & Hilde, G. (2013). Does it work in the long term?—A systematic review on pelvic floor muscle training for female stress urinary incontinence. Neurourology and Urodynamics, 32(3), 215–223. https://doi.org/10.1002/nau.22292

  • Dumoulin, C., Hay-Smith, J., & Habée-Séguin, G. M. (2014). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, (5), CD005654. https://doi.org/10.1002/14651858.CD005654.pub3

    In health,
    Dr. Hannah Williams, PT, MPC
    Pelvic Health Specialist
    Movement Performance Coach