How can athletes can make better decisions about who they seek to help in recovery?
That was the question on FrictionLabs co-founders Keah and Kevin’s minds when they sat down with Dr. Ben Cowin, sports chiropractor and owner of Action Spine & Sports Medicine in Denver.
Dr. Ben has worked with athletes in multiple Olympic sports over his career and recently attended his first Olympic Games (in Rio), coordinating the healthcare for the World Rugby referees. Dr. Ben is an underground rockstar in the sports medicine world. He has almost 20 years’ experience, having worked with countless numbers of elite amateur athletes, and 1000+ professional athletes and Olympians. He’s worked with pro sports teams like the Texas Rangers, St. Louis Cardinals, and the San Francisco 49ers, plus a host of corporate executives. He’s a certified athletic trainer, has his master’s in athletic training with an emphasis in analytical biomechanics, and he tells us that less than 1% of sports chiropractors are also certified athletic trainers. We’re thrilled to bring an expert’s perspective to help you stay healthy and keep crushing.
There’s a lot of curiosity and skepticism around techniques like dry needling, trigger point therapy, myofascial release, acupuncture, etc. Our goal is to investigate, to ask questions, and to arm you with more knowledge to decide if it’s for you or not. Here are some highlights from our conversation with Dr. Ben.
How do everyday athletes who aren’t used to alternative therapies decide if it’s worth a try?
I think most people associate trigger points with pain—the universal signal that something is wrong. It could be acute, sharp pain, or it could be dull, achy, continuous pain that indicates wear and tear. Most athletes know enough about their bodies that they know when something doesn’t feel quite right - those are the signals that your brain is saying mechanically, something is off and you need to have it looked at.
Are certain people/athletes predisposed to certain types of imbalances?
Glute de-activation is extremely common in today’s world. The more we sit, the more deactivated our glutes become. Because most of us sit at a desk; sitting at computers, we are starting to see a trend where deactivated glutes is almost an epidemic. How does this affect climbers? One of the most common issues we see among entry-level climbers is hip mobility. Part of the ability to push your hips into the wall is glute activation; if you can’t get a good squeeze, your butt falls right off the wall.
Is there an at-home test a rock climber could do to figure out if their glutes are working?
Try and do an overhead squat as close to the wall as you can get. Ask yourself, can I get my toes up near the wall, get my hands up over my head, and squat straight up and down without falling back on your ass? Can you get your chest up over your hips without having to bail out? If your butt goes back, your chest will go forward, and you end up kissing the wall. If you can’t, your chest goes back, and if you can’t get your hips underneath you, then there’s only one way to go, from there.
How do you know which alternative therapy is right for you, and where do most people begin?
You can have the carpenter that only has one tool—he could be the best/most knowledgeable out there, but he has only one tool. On the flip side, there’s the carpenter that has more tools than anyone else out there, but doesn’t have the smarts to be able to solve the problem. You’re looking for someone in the middle—doesn’t need all the tools, but needs more than one and needs the expertise to know which tool is going to get you better in the shortest amount of time. Find a therapist who says that dry needling is the best mechanism to get you better the fastest, and lay out a logical plan. Many will want to try a lower-level modality first to see if you respond before trying needling.
How exactly does dry needling work? How can it help people with injuries?
Think about dry needling like a computer. Long-term memory in the human body is held in the human brain. Short-term memory is housed in the muscle itself. When we have compensation changes—like you reach too far and you go to pull and feel a twinge of your body telling you, too much—it goes into spasm mode, and the body stores that compensation information in short term memory, at the site of the muscle that was most at risk. Once that is stored in short-term memory, the body will continue to rely on that information until you give it a reason to reset. That’s where the needling comes in. Sharp sensation travels on two very specific pathways to the brain: one of which is the spinocerebellar tract, which will get to the cerebellum—the motor control center of long-term memory.If we can stimulate that track, we get a cerebellar response. And that response is resetting that information in your brain, wipe that short-term memory to get the muscle functioning properly again.
What do you advise clients do following a dry needling session to keep muscle pain away?
Immediately after a session:
In the long term, corrective exercises serve a very important role, but once the muscle is reset, the best thing you can do is continue to stay active. If climbing is your thing, the worst thing you can do for your muscles is to not climb. You need to let your body test the muscle. You’ll find that certain things become more sore, and those are things that you weren’t using, after that it’s just repetition to correct the form.
What’s an example of a condition that somebody walked in with that had been—in your opinion—totally misdiagnosed, and that you believe alternative therapy could have solved?
The most missed is something dealing with the knee. One of the reasons for that is the knee is a fairly simple joint, but in the grand scheme of things, it’s the joint that’s just stuck out in the middle of nowhere. It’s a byproduct of the mechanics of both the foot and the ankle, and also the hip. If any of those have faulty movement patterns, the knee gets stuck in the middle and takes the pain. There’s been quite a few times when someone has gone in for exploratory surgery for a knee without examining the foot/hip/ankle first. Often times dry needling in the hips and/or ankles and feet can correct the functional mechanics of the kinetic chain and as a result eliminate knee pain.
Walk us through a typical dry needling session for a climber with a shoulder issue.
After we’ve ruled out any structural limitations, like dislocations or broken bones I look at the range of motion. I’ll compare the shoulder with pain to other shoulder, looking at things like internal and external rotation, flexion and extension, and other ranges. I begin to put together a sort of check list in my head of muscles that aren’t ‘cooperating’. I isolate two or three of the nonfunctional muscles, dry needle them, and see how the body responds. Then immediately after, I take a look at the range of motion, see if it improved, and check if we were able to get any twitches out of the muscle. From there, we have two options: continue to treat, or we can let it rest and see. I look at it from where you are in season. If I’m treating you and you’re going to fight on the UFC card on Friday, then we treat aggressively. If it’s an Avalanche player in pre-season, we’re in no huge hurry to get you back, so time is on our side and we can start slower.
Do you hit a saturation point in one session?
You don’t just stimulate the cerebellum when you dry needle. You also stimulate the thamalus. If I overstimulate the thamalus by treating too much, you can pass out, become emotionally overloaded, or become super sensitive to pain. So you have to listen to the body.
Resources to learn more:
Functional Movement Screen Certification (FMS)
Certified Applied Functional Sciences (CAFS)
Selective Functional Movement Assessment (SFMA) certification