Physical Therapy has emerged as the go-to approach for shoulder problems, whether that be for adhesive capsulitis (frozen shoulder), bursitis or issues associated with the rotator cuff. Clinicians and researchers alike, are quite rightly reviewing long held beliefs on what causes shoulder dysfunction (anatomy vs the lived experience), how we should label shoulder problems (impingements vs subacromial pain syndrome), and how best to support sufferers. Academic debates that cite peer reviewed research and clinical experience provide compelling reading, and whilst it can often leave the reader with a lot of head scratching (“so, what is going on / what do I call it / what do I do!”), it is exciting that physiotherapists, sports therapists & sports rehabilitators, osteopaths and chiropractors are the ones who are leading the talk, and will therefore ultimately drive change for the better.
Perhaps the area that triggers fewer opposing opinions, is the role of exercise in shoulder pain rehab. Of course, the activities which come under the exercise umbrella are numerous and diverse, so it is not enough to say “let’s exercise the shoulder”, but it is probably safe to assume that no matter what we label the issue, or consider to be the cause of it, we will very likely prescribe exercise as a first port of call. But when exercise hits a plateau, or is prohibited from started because of pain or apprehension, we have acupuncture.
Where does acupuncture / dry needling fit?
Actually, it is easier to start with where it does NOT fit. Needling as a stand-alone intervention is not advocated in any seminal TCM text, nor is it supported in any of Breeze Academy’s Masterclasses (which lean towards a western philosophy). Whilst needling can provide huge benefits, it does not replicate the physiological benefits achieved through exercises (for the medium to long term). In fact, no approach to shoulder rehab should be uni-dimensional – exercise without education would likely give poorer results than if the two were combined. BUT…….
Not everyone responds positively to exercise (or even the thought of movement), and quite often, Physical Therapists and their clients are unable to progress towards therapy goals. Introducing needling here, with the sole purpose of enabling the initiation or progression of shoulder exercises, can be an invaluable approach. That is to say, we can introduce acupuncture at any time point within the rehab journey, and we are not fixed to ‘a course’ of acupuncture – we provide needling to open a window of opportunity, whereby pain thresholds can be raised and movement anxieties soothed. Subsequently, we use this window to progress exercises.
If that happens after one session, or even within the first session, then mission accomplished: we may never need to reintroduce acupuncture again. Or, we might need several sessions to get to that point – recipients of acupuncture often gain pain relief at different time points within their rehab journey, so one session may not be enough. It would be unusual to go beyond 4 sessions of acupuncture if your client had not experienced any benefit, although there is no ceiling to how many times we can needle someone (especially if they are progressing towards their rehab goals). What’s more, acupuncture and dry needling can be reintroduced later within the rehab cycle, if progress plateau’s.
Finally, the confident needler will introduce acupuncture alongside exercise and manual therapy, within the same session. Taking advantage of segmental acupuncture theory, by needling the non-effected limb / strong distal points, it leaves the effected limb needle-free, allowing for targeted rehab. We have an online course, that provides detailed needling techniques and recipes, specifically targeting acupuncture for the upper limb.
So in summary, acupuncture and dry needling are not adequate replacements for high quality rehab that includes exercise and advice, but needling in cases where exercise is hampered through pain…..you are on to a winner!
Dr. Carl Clarkson
Interested to find out more? We have an online upper limb acupuncture course that covers the shoulder in lots of detail.