I was fortunate enough to serve as brand ambassador for iDryNeedle from October through March, 2020. It was a great experience, and I wrote a blog back then as part of my commitment. Well, that’s great but you know I’m going to say good things, because…brand ambassador.
Well…my ambassador term is over, but I continue to be an experienced clinician, who newly values needling, who used to not (click the link for the full story). So here, I just wanted to share my most recent, personal needling story… where I am both the patient and the clinician.
Sport and medical background: I was an all-conference soccer player at Case Western Reserve University. I played defense, but came to college as a goalkeeper, which I played all through high school and club. I never ran for exercise before college. During soccer tryouts, we had to make a 7-minute mile. If we could not, we had to repeat the attempt every day until we got it. By the third day I was the only one left and the coach let me in anyway. During that first season, the team ran a Race for the Cure 5k. My time was 32 minutes and I remember my coach not thinking I would even be able to do the whole thing! Since this post is not about running, I’ll fast forward and say that I am a hard worker, and soccer was my life, so by the time I graduated from college, I had a 6:12 mile time and a 21:17 5k time... which I was, and still am, proud of!
Soccer ended and I didn’t know what to do besides run and lift weights, so... I ran a marathon. I’ll skip the gory details - I finished (4:30ish), but in the process I ended up with an osteochondral lesion (cartilage injury), which the doctor attributed to not only the distance, but also my ankle sprain history. I had surgery to repair the cartilage injury and lateral ankle ligaments in July of 2005, just in time to kick off my second year in PT school.
Surgery went great and I was able to return to both running and soccer. Sometime after that, I don’t remember exactly when but 2012-2014 is my best guess, I started noticing a numb pain in my foot when I ran longer distances. At first it was episodic… it would bother me for a couple of months, then with rest, I could get it to go away again for a period, before it returned again.
In 2013 I found CrossFit. Gradually as my foot got worse, CrossFit became something I could do instead of longer distance running. Interval training like we did in CrossFit never bothered it back then, even while doing longer intervals - like 1 mile repeats.
Over the years though, the symptoms have worsened, and starting about 2016 I became unable to run a 5k without feeling it (and, it’s not just annoying – it makes me limp and finally stop). Before long I could make it just over 2 miles, then only about a mile and a half, and now I start to feel it around 1 mile. It builds and builds until I stop running. It does go away when I stop. Besides longer-distance running, it is not an issue at all. This is important, because to me it is not appropriate for any sort of surgical consult.
I should also mention that my specialty in physiotherapy is the foot and ankle. I feel really confident understanding what is going on down there, and it was probably 75% of my patient load over my first 9 years of practice. Over the years, I have tried footwear (soft soled Asics, Vibrams, Nike Free, Brooks, Saucony with wide toe box), metatarsal pads, custom orthotics, Kleenex to spread my toes, intrinsic foot strength, ankle mobility. Nothing really touched it. Until...dry needling.
The skills to needle this area of the foot are taught in Level 2 of the KinetaCore/EIM Functional Dry Needling courses... I am not taking Level 2 until this fall. But because of the pandemic and not having all the usual CrossFit equipment, not to mention that running is one of my preferred strategies to stay balanced, I hit a point where I needed to take action, I needed to do something to try to be able to run without this pain. So I asked a friend who is a dry needling instructor to please teach me how to needle the intrinsic foot muscles around my 4th digital nerve.
With the help of the instructor and the videos that I had access to as a Level 2 registrant, I have been experimenting with needling around my 4th digital nerve prior to running. The first time, I tried needling my foot before I ran. I realized about a mile into this run that I was not used to steady long distance running, so I changed to intervals of 2:00 moderate pace and :30 walk to better match what I could do well. Surprisingly, I didn’t get any symptoms until right at 2.8 miles! But… I had no way to know if that "good day" was because of the needling or the interval training.
The next run, I didn’t needle and I ran the same run-walk plan: 2:00 on and :30 off. Well… this time I felt my foot pain starting around 1 mile, then building the whole time. The 30 second walks were my saving grace, but the entire last mile was pretty uncomfortable.
Also, some unique-to-me anatomy knowledge I learned in the process: My symptoms have always been pretty clearly a 4th digital nerve pattern. I feel like if it was a true neuroma that I would have symptoms at SOME other time besides 1 mile+ of running. What I learned with the needle is that I hardly have any space at all between my 3rd and 4th metatarsals. It is like threading the needle (needling a thread?!?!) to find a space between those two bones. So maybe that is where and how the nerve is getting compressed.
My personal needling intervention:
-4 total needles, 30mm: 2 placed between 3-4th metatarsal and 2 between met 4-5. One as proximal as I can get it – for the one with more joint space I can get toward cuneiform and that feels really good. For the one with less joint space, both needles are more distal, and in general they feel more nervy going in. I would NEVER have known this without needling.
-Needles in your foot feel just fine, actually I think they feel really good, as long as you go slow and piston slowly. I piston less there than I do with other muscles and so far I have not been able to elicit a twitch despite really successful placement.
-I stim with my Pointer Excel handheld unit to know where it is and how it feels. I seem to get mostly interossei.
-Then I switch to my E-Stim II for the intervention. I put one channel on the lateral two needles (Met 4-5) and the other on the medial two (Met 3-4). It feels best if I get a strong contraction at Met 4-5, and then superimpose the stim at Met 3-4 (more nervy stim) on top of it. I keep my pulse width as slow as possible, personal preference.
-Stim on for 5-10 minutes. It feels so good.
-Once I remove the needles, I do nerve glides but just at the foot (ankle plus toe, inversion and eversion plus toe), active toe abduction, MP flexion and it’s weird but I have a lot more sensation down there and I like to do a metatarsal “wave” where I move one at a time. It’s hard to explain but imagine tapping your fingers from pinky to thumb against the table. Same thing, but with metatarsal heads! I’ll video sometime.
NOTE: I would not try needling any muscle I have not been formally trained in on any foot other than my own.
At any rate, I’m optimistic to play with needling and running during this pandemic, and if you want a follow up to this physio experiment of N=1, please let someone know and I’ll write more in a month after I run my next few experiments!
This is long, but hopefully you made it (I KNOW you did!). I want you to know that this is my personal story and I am sharing it with no strings attached as an ambassador, and no goals or intetions other than to share an experience of how needling can work when nothing else has.
Judy Gelber PT, DPT
Board Certified in Orthopaedics
CrossFit L-2 Trainer
IG: @judy.gelber, @movement.physio