Can Chiropractic Care Help Relieve Ear Infections?

Picture of Nate Wiechmann, D.C., looking in a toddler's ear to assess for an infection.

Research shows that nearly 80 percent of children experience at least one ear infection by the age of three. Below, we discuss the common causes and symptoms of ear infections, as well as how chiropractic care can help.

What causes ear infections in children?

Ear infections are primarily bacterial infections. They happen when a child’s Eustachian tubes swell and become blocked. This swelling and blockage causes fluid to accumulate in the middle ear behind the eardrum. Typically, this occurs when a child has an upper respiratory infection. Swelling and blockage in the Eustachian tubes can also be attributed to excess mucus, allergies, changes in air pressure, swollen adenoids and secondhand smoke. Moving to an area with a significantly different climate, traveling from a high to a low altitude, or using a pacifier can also increase the likelihood of developing an ear infection.

It’s also worth noting that there are two different types of ear infections: chronic ear infections and acute ear infections. Acute ear infections don’t last very long and typically clear up without treatment. Chronic ear infections, on the other hand, usually require some sort of treatment to prevent them from reoccurring. If your child is experiencing chronic ear infections, it’s important to seek treatment right away in order to prevent permanent damage to the inner ear.

What are the symptoms of an ear infection?

Common symptoms include:

  • Trouble sleeping
  • Fussiness or frequent crying
  • Tugging or pulling at the affected ear(s)
  • Inability to detect low-decibel sounds
  • Pus-like fluid drains from the ear(s)
  • Fever, particularly in newborns and younger children
  • Pain (even mild) in the ear
  • A persistent feeling of excess pressure inside the ear
  • General lack of body balance
  • Changes in mood/mood swings

How can chiropractic care help?

Chiropractic care is a safe and effective way to relieve pain or discomfort caused by ear infections. At our clinic, we use a gentle, non-invasive treatment known as a chiropractic adjustment to reduce joint restrictions and misalignments in the spine. Upper cervical adjustments help promote fluid drainage, reducing the likelihood of buildup and subsequent infections. Chiropractic adjustments of the occiput (back of the skull) and atlas (first cervical vertebra) help prevent chronic ear infections by correcting misalignments and dysfunction.

Below are some of the benefits chiropractic adjustments provide for children with ear infections:

  • Relief from pain and discomfort
  • Increased mobility in the upper spine
  • Decreased inflammation

Want to learn more about pediatric chiropractic care? Visit our blog post. Please use our online scheduling tool to book an appointment, or call 712-249-8231 for more information.

Five Benefits of Pediatric Chiropractic Care

Chiropractic care is not only for adults. From babies to toddlers to teens, children can also benefit from a trip to the chiropractor’s office.

As a father myself, I observed several benefits with our daughter, who was born 12 weeks early. Because she was born prematurely, she was at an increased risk of certain neurological and digestive disorders. She also had to spend several weeks in the Neonatal Intensive Care Unit (NICU), hooked up to several cords that limited her range of motion. Shortly after we brought her home, my wife and I noticed that our daughter occasionally had trouble latching or going to the bathroom, and would become overly fussy or inconsolable. When these things would happen, I’d gently assess her spine to provide relief. I could instantly tell a difference, as her body would relax into my arms and she’d stop crying. In many cases, she’d be able to resume nursing right away and/or go to the bathroom within 12-24 hours. Having a little one of my own has made me more aware of the importance of regular pediatric chiropractic care, and I’m honored to be able to help parents find similar relief for their children.

Below are five important benefits of taking your child to the chiropractor.

Improved Sleep

Sleep is an essential part of a child’s life. It doesn’t just help them function. It’s also important for their development and emotional wellbeing. Unfortunately certain tensions can make it difficult to sleep, often leading to insomnia. Since chiropractic care works to relieve stress in the body, it can also improve sleep.

Immune System Function

Chiropractic care has many benefits for a child’s immune system. It can help those suffering from a cold or infection, as well as improve immunity functions. Going to a chiropractor can also improve a child’s digestive system and target related issues, such as stomach problems, constipation and acid reflux.

Better Behavior

Less stress leads to better behavior. Chiropractic care helps children improve their attitudes by releasing tension. Improved sleep can also reduce stress, which can help your child function better during the day.

Nervous System Support

The benefits of pediatric adjustments extend into the nervous system. Chiropractors make sure the spine is growing in the correct way. This prevents and treats certain nervous system issues like ear infections. Pediatric chiropractic care can also treat asthma, allergies and other respiratory issues by targeting misaligned nerves that affect a child’s respiratory system.

Brain Development

Chiropractic care can improve your child’s neural brain development by releasing pressure on bones and joints as well as the spine. Increased brain development promotes better concentration, improved focus and reduced hyperactivity. This includes targeting conditions like ADD and ADHD.

Please use our online scheduling tool to book an appointment, or call 712-249-8231 for more information.

Ionic Foot Bath: What Is It and How Does It Work?

We’re honored to be one of the only providers in the region to offer the Ionic Foot Bath, a foot soak treatment that helps restore the body’s balance and energy levels by detoxifying or eliminating harmful toxins and pollutants.

What are the benefits of an ionic foot bath?

Ionic foot baths offer several benefits, including:

  • Improving lymph circulation, similar to a Swedish massage
  • Relieving migraines and headaches
  • Improving skin conditions
  • Increasing natural energy levels
  • Improving sleep quality and relaxation
  • Strengthening immune system function to help fight off viruses
  • Relieving muscle/joint pain and swelling

How does an ionic foot detox work?

An ionic foot bath combines water, salt and a small electrical current to produce charged ionic energy that helps promote detoxification. During the 30-minute session, the water in the bath changes color. This change in color is caused by the oxidation of the metal plates in the bath reacting with solutes in the water as toxins release from the body. Over the next 24-48 hours, toxins continue to flush out of the body naturally through the lymphatic system (network of tissues and organs that help rid the body of toxins) and excretory system (part of the body that performs excretion or discharges waste).

What do the colors in an ionic foot bath mean?

Each person’s foot bath looks a little different. Some baths are really thick and full of multiple colors, while others are thinner and not very colorful. Patients who do regular sessions may notice that their foot baths become less murky as time goes on and they begin to feel better.

Depending on your specific condition(s) and environmental exposures, you may observe the following during your session:

  • Yellow-green: Indicates detoxification of the kidneys, bladder, urinary tract and/or female prostate area; may be an indication of gynecological or prostate disorders.
  • Orange: Indicates detoxification of the joints or arteries; may be an indication of arthritis, gout, neuropathy or pleurisy (inflammation of the tissues that line the lungs and chest cavity).
  • Brown: Indicates detoxification of the liver, lungs, tobacco or cellular debris; often seen in patients who smoke or have been exposed to heavy second-hand smoke or another air pollutant.
  • Dark green or black: Indicates detoxification of the gallbladder or liver; may be associated with gallstones, acid reflux, a weak immune system or nausea.
  • Red flecks: Typically a sign of blood clot material; may also be associated with arterial blockage, bruising, hypertension or cold hands/feet.
  • White foam: Indicates detoxification of the lymphatic system or lymph nodes; may be an indication of a menstrual disorder, tender lymph nodes or clogged skin caused by an allergy.
  • Black flecks: Indicates detoxification of heavy metals; other symptoms of toxicity may include chronic fatigue or memory problems.

Who is a good candidate for an ionic foot bath?

Nearly everyone, except for those with open sores or an infection on their feet, can benefit from an ionic foot bath. The body is built to detoxify on its own. However, we are constantly bombarded by toxins, which can place added stress on the body, causing pain and dysfunction. An ionic foot bath is a safe and effective way to assist the body in detoxifying these stressors.

How long does a foot bath take?

This treatment lasts approximately 30 minutes and can be offered in conjunction with other treatments or on its own.

Please use our online scheduling tool to book an appointment, or call 712-249-8231 for more information.

Seven Tips to Manage Stress

person grabbing faceElections are stressful — and this one particularly so. It’s hard not to feel overwhelmed, helpless and anxious when it feels like the fate of our country is so precarious.

Fortunately, there are steps you can take to minimize conflict and take care of yourself.

  1. Seek chiropractic careChiropractic services, such as adjustments or manipulation, trigger point dry needling and soft tissue therapy, can help release muscle tension, soothe irritated spinal nerves and improve blood circulation — changes that can often alert the brain to switch off the fight-or-flight response and help your body relax.
  2. Schedule a massage – Regular massages can rebalance your hormones and release muscle tension caused by stress. Research also shows that it can lower your heart rate and blood pressure, as well as increase the production of “feel good” endorphins, serotonin and dopamine.
  3. Make time for fitness – Your body can fight off stress better when it’s physically fit. Consider going for a walk, lifting weights or swimming for at least 30 minutes most days per week to stay active and keep your body in shape.
  4. Practice relaxation techniques – Yoga, meditation and Tai Chi are great relaxation techniques for managing stress. Practicing these methods for even a few minutes each day can provide a sense of overall calmness as well as ease anxiety.
  5. Get adequate rest – In addition to regular exercise, your body needs proper time to recover. Give your body the rest it needs by taking breaks when necessary and getting at least 7-9 hours of sleep (more for children and teens) each night.
  6. Eat a balanced diet– Chronic stress can make you more susceptible to viral illnesses, GI issues and infections. Consuming processed food and beverages, like chips, soda and candy, actually increases the volume of stress on your body and contributes to other health issues. Consider reaching for nutrient-dense foods that promote good gut bacteria, such as prebiotics and probiotics. Fruits and vegetables with inulin, like asparagus, bananas, garlic and onions, contain prebiotics. Fermented foods, like kefir, kimchi, kombucha, sauerkraut and yogurt are great sources of probiotics.
  7. Avoid drugs and alcohol – If you typically reach for a cigarette or a glass of wine when you’re stressed, consider a new vice. Drugs, alcohol and tobacco can stress your body out even more and often lead to serious health issues like heart disease, liver disease, respiratory diseases and GI problems.

While it’s impossible to completely eliminate all stress from your life, the strategies above can help you manage your symptoms. Prioritizing self-care first can help you cope with what comes next. And remember, there’s nothing wrong with asking for help. For more information or to schedule an appointment, call 712-249-8231.

Benefits of Chiropractic Care During Pregnancy

One of the most important times to receive chiropractic care is during pregnancy. As your body changes to accommodate your growing baby, your center of gravity shifts and so does your spine. This can cause a ripple effect, stressing your musculoskeletal and nervous systems, which can cause pain and discomfort.

Fortunately, chiropractic care offers several benefits, including:

  1. Relieving low back pain and pelvic pain

Studies show that more than 75 percent of pregnant women experience pregnancy-related low back pain, pelvic pain or a combination of the two. Chiropractic care is a safe, effective and drug-free way to manage these and other musculoskeletal symptoms during pregnancy. Adjustments can help correct posture and spinal curvature to keep back pain, hip pain and pelvic pain at bay.

2. Reducing morning sickness

Nausea, or morning sickness, is one of the most common pregnancy symptoms, and it can be highly uncomfortable. Chiropractic care can help reduce nausea and vomiting by realigning the spine and improving nervous system function. If you suspect your nausea is being triggered by heartburn or constipation, chiropractic care can also help improve digestive issues to settle your stomach.

3. Optimizing baby positioning

Chiropractic care during pregnancy can help you maintain healthy pelvic balance, so your baby has enough room to freely move head-first into the correct delivery position. During your eighth month of pregnancy, consider making regular chiropractic adjustments a priority to avoid breech presentation and optimize positioning.

4. Improving labor and delivery

Women who want to experience natural childbirth without the use of medications can benefit from chiropractic care during pregnancy to help simplify and improve the birthing experience. Getting regular chiropractic adjustments can help ensure the pelvis, spine and hips are properly aligned for a faster labor and easier delivery.

5. Controlling edema (swelling)

Edema, or water retention, is an all-too-common side effect during pregnancy. In fact, research shows that nearly half of pregnant women will experience this condition, with edema usually occurring in the fingers, face, back, feet and ankles. Chiropractic care can help flush water from the body through a series of spinal adjustments, manipulations and massage techniques.

Even if you’ve gone through most of your pregnancy without seeing a chiropractor, it’s not too late. Perhaps you felt great for eight months but your baby still hasn’t flipped into the proper head-down position and your due date is rapidly approaching. Or, maybe you simply need a little relief during the final home stretch. Rather than toughing it out and waiting until your baby is born, consider adding regular chiropractic care into your routine to get the relief you need.

Please use our online scheduling tool to book an appointment, or call 712-249-8231 for more information.

What to Expect During Your Chiropractic Visit If You’re Pregnant

In many ways, chiropractic care during pregnancy looks a lot like the chiropractic care you receive when you’re not expecting. ç

  1. If you’re new to our practice, you’ll be asked to fill out patient forms about your medical history, your due date and any specific concerns you’d like to address, such as sciatica or low back pain. This is also a good time to review your insurance benefits to see what’s covered.
  2. We’ll conduct a physical assessment to gauge your overall mobility, identify areas of misalignment or dysfunction and create a customized treatment plan.
  3. Depending on your condition, we may recommend a variety of treatments, including chiropractic adjustments, trigger point dry needling or soft tissue therapy. If you’re receiving an adjustment, we’ll have you get comfortable face down on a special maternity cushion and then we will provide gentle adjustments. (The health and safety of you and your baby are of the utmost importance, and it’s not necessary to use a great amount of force to achieve positive results.)
  4. After your adjustment, we’ll assess your condition and see how you are feeling. We’ll also encourage you to drink plenty of water to support healthy levels of hydration and give your body the fuel it needs to heal.

How often should expectant mothers receive chiropractic care?

In our office, we see women regularly from preconception through the postpartum period. For those without pain or other symptoms, we recommend coming in twice a month. However, if an expectant mother is experiencing chronic neck/back pain, headaches, digestive issues, sciatica, carpal tunnel or other pregnancy-related symptoms, she may need more frequent adjustments to help alleviate stress from her nervous system.

When is chiropractic care not recommended, and why?

Chiropractic care is generally a safe, effective practice during pregnancy. However, it is not recommended if you are having symptoms of preterm labor. In those cases, it is important to contact your birth provider for the best course of action.

If you’re experiencing chronic pain or discomfort, or you simply want help optimizing baby’s positioning before delivery, contact us or use our online scheduling tool to book an appointment. Or, check out our blog post to learn more about the benefits of chiropractic care for pregnant women.

Caring for Your Body When You’re Stressed

Picture of man with hands over his faceIf the outbreak of Coronavirus Disease 2019 (COVID-19) has you stressed, you’re not alone. Fear and anxiety about a disease can be overwhelming, causing strong emotions in adults and children. Below, we discuss the effects of stress and provide tips for caring for your body during stressful situations.

The Effects of Stress ON the body

Stress hormones trigger your body’s fight-or-flight response, which can help you cope with potentially serious situations by increasing your heart rate and readying your muscles to respond. However, when stress levels are elevated for prolonged periods of time, it can take a serious toll on your health. Symptoms of stress include:

  • Irritability and anxiety – Your central nervous system (CNS) is in charge of your fight-or-flight response. In most cases, the hypothalamus (the part of the brain that controls the stress hormones that rev up your response in an emergency) tells all systems to return to normal when the perceived fear is gone. However, if the stressor doesn’t go away or the CNS doesn’t work properly, the prolonged fight-or-flight response can lead to irritability or anxiety.
  • Respiratory and cardiovascular issues – Stress can cause you to breathe faster in an effort to quickly distribute more oxygen-rich blood to your body. This response helps protect your body in an emergency by preparing you to react, but it can make it harder to breathe and causes your blood pressure to rise, which in turn, can increase the risk of having a stroke or heart attack.
  • Tight muscles, aches and pains – When you’re stressed, your muscles tense up to protect your body from injury. They tend to release again once you relax, but if you’re constantly under stress, your muscles may not get the chance to relax. Chronically tight muscles can cause neck painback pain, shoulder pain and headaches.
  • Headaches – During stressful events, certain chemicals in the brain are released to combat the situation (known as the fight-or-flight response). The release of these chemicals can cause vascular changes that can lead to tension headaches and migraines. Repressed or bottled up emotions surrounding stress, such as anxiety, worry, excitement and fatigue, can also increase muscle tension and make migraines worse.
  • Weak immune systems – People under chronic stress are typically more susceptible to viral illnesses like the flu and the common cold, as well as other infections due to high levels of cortisol (stress hormones). Stress can also increase the time it takes to recover from an illness or injury.
  • Gastrointestinal (GI) issues  – Stress can wreck havoc on your gut and digestive system, leading to short-term issues like loss of appetite, overeating, constipation, diarrhea, indigestion and upset stomachs. Chronic stress (over prolonged periods) can also lead to more serious issues like irritable bowel syndrome, Crohn’s disease, colitis and other GI disorders.

Tips for Managing Stress

Fortunately, there are several steps you can take to manage stress and lead a healthier life.

  • Chiropractic careChiropractic services, such as adjustments or manipulation, trigger point dry needling and soft tissue therapy, can help release muscle tension, soothe irritated spinal nerves and improve blood circulation—changes that can often alert the brain to switch off the fight-or-flight response and help your body relax.
  • Massage therapy – Regular massages can rebalance your hormones and release muscle tension caused by stress. Research also shows that it can lower your heart rate and blood pressure, as well as increase the production of “feel good” endorphins, serotonin and dopamine.
  • Regular exercise – Your body can fight off stress better when it’s physically fit. Consider going for a walk, lifting weights or swimming for at least 30 minutes most days per week to stay active and keep your body in shape.
  • Relaxation techniques – Yoga, meditation and Tai Chi are great relaxation techniques for managing stress. Practicing these methods for even a few minutes each day can provide a sense of overall calmness as well as ease anxiety.
  • Adequate rest – In addition to regular exercise, your body needs proper time to recover. Give your body the rest it needs by taking breaks when necessary and getting at least 7-9 hours of sleep (more for children and teens) each night.
  • Proper nutrition – As mentioned, chronic stress can make you more susceptible to viral illnesses, GI issues and infections. Consuming “junk food” actually increases the volume of stress on your body and contributes to other health issues. Consider reaching for foods that offer adequate nutrients and promote good gut bacteria, such as prebiotics and probiotics. Fruits and vegetables with inulin, like asparagus, bananas, garlic and onions, contain prebiotics. Fermented foods, like kefir, kimchi, kombucha, sauerkraut and yogurt are great sources of probiotics.
  • Avoid drugs and alcohol – If you typically reach for a cigarette or a glass of wine when you’re stressed, it’s time to rethink your coping technique. Drugs, alcohol and tobacco can stress your body out even more and often lead to more serious issues like heart disease, liver disease, respiratory diseases and GI issues.

In today’s world it’s easy to find things to stress about. While it’s impossible to completely eliminate all stress, the strategies above can help you combat some of its effects and prevent long-term damage. For more information or to schedule an appointment, call 712-249-8231.

We originally presented the above information to teachers and staff at Riverside High School as part of an in-service learning day on Feb. 19, 2020. Per request, we recapped the information on our blog. If you’re interested in having us out to your organization or place of work for a similar presentation, please contact us. We love sharing tips for helping people live healthier lives!

Five Things to Love About Chiropractic Care

Love scrabble tilesBeing a chiropractor is an unbelievable experience, and something I don’t take for granted. Every day, I get the opportunity to work with a variety of patients, who put their health and healing in my hands. It’s truly humbling to hear why they love chiropractic care and continually encourage their friends and family to seek it out as well.

In honor of Valentine’s Day, we rounded up a list of the top five reasons why our patients love chiropractic care:

  1. Reduces pain and inflammation – One of the main purposes of a chiropractor is to alleviate pain, and it’s the primary reason patients love coming to Pott. County Sports & Family Chiropractic. Through a combination of manual therapies and advice on diet, exercise and positive lifestyle choices, we help your body heal itself and get you on the road toward better health, faster and more efficiently.
  2. Doesn’t require pills or surgery – We believe in treating you to relieve your pain and make you more mindful of your body. While certain conditions may require additional treatment, our goal is to get you back to doing the things you love by exhausting all forms of conservative care first.
  3. Improves sleep – Chiropractic care helps improve blood flow in the nervous system as well as addresses misalignments in the spine, which in turn allows patients to rest more easily.
  4. Reduces anxiety – The nervous system runs along the spinal cord, and studies show that any interruptions along the way can have negative impacts on mood and behavior. We offer a variety of treatment options to improve the nervous system and remove roadblocks that can cause stress and anxiety.
  5. Prevents injuries – As a former collegiate athlete, I understand the physical demands that are required to live a healthy and active lifestyle. That’s why I’m so passionate about helping other athletes prevent injury and get back in the game safely. In addition to chiropractic manipulation, soft tissue therapy and corrective exercise techniques, we offer discounted sports physicals and rehabilitative taping for student athletes. (A full list of our services is available on our website.)

Tell us: What do you love most about chiropractic care? Comment below to share your thoughts, or contact us to learn more about how we can help you get back to doing the things you love. To book an appointment, please use our online scheduling tool.

Class IV Laser Therapy for Pain and Inflammation

Picture of Class IV Laser Therapy treatment on patient's shoulderRecently our clinic added the industry’s leading and most powerful Class IV Laser. We are excited to bring this service to our patients as a way to help alleviate pain, reduce inflammation and accelerate recovery times. Read on to learn more about the benefits, or contact us to find out if it’s right for you.

How does Laser Therapy work?

Laser Therapy uses specific wavelengths of light (red and near-infrared) to create therapeutic effects, including:

  • Decreased pain levels
  • Reduced inflammation
  • Increased tissue proliferation and regeneration
  • Accelerated soft tissue and bone repair
  • Enhanced nerve regeneration and function
  • Increased circulation and lymphatic flow
  • Creation of new blood vessels
  • Increased tissue tensile strength
  • Optimized enzymatic responses
  • Increased collagen production

What type of conditions can be treated with Class IV Laser Therapy?

  • Auto and work-related injuries
  • Back and neck pain
  • Burns
  • Carpal tunnel syndrome
  • Chondromalacia patellae (a.k.a “runner’s knee”)
  • Diabetic foot ulcers
  • Diabetic neuropathy
  • Edema
  • Fibromyalgia
  • Knee pain
  • Lateral epicondylitis (a.k.a. “tennis elbow”)
  • Ligament sprains
  • Muscle strains
  • Myofascial trigger points
  • Osteoarthritis
  • Repetitive stress injuries
  • Rheumatoid arthritis
  • Plantar fasciitis
  • Shoulder pain
  • Sports injuries
  • Tendinitis
  • Venous ulcers
  • Wrinkles and skin elasticity concerns

Is Laser Therapy approved by the FDA?

Laser Therapy has been widely used around the world in both human medical and veterinary settings since the 1970s. It was approved by the FDA in 2003 as a way to help patients alleviate pain, reduce inflammation and accelerate recovery times.

What does Laser Therapy feel like?

Laser Therapy is a pain-free, non-invasive treatment option. With the exception of a subtle warmth or brief feeling of sensitivity during treatment, most patients do not experience any discomfort.

How often should a patient receive Laser Therapy?

Most acute conditions should be treated daily, particularly if they are accompanied by significant or debilitating pain. Chronic conditions typically respond better when treatments are received 2-3 times a week, tapering to once a week or once every other week with improvement.

How many treatments does it take?

Treatment times vary depending on the condition. For most acute conditions, 3-6 treatments are usually sufficient. Patients with more chronic conditions may require 10 or more visits. Conditions like severe arthritis may require ongoing periodic treatments to control pain.

How quickly do patients see improvements?

Most patients note improvements after only 1-2 sessions. These sessions may be scheduled at 2-3 times per week for a number of weeks and then 1-2 times a week until the condition is under control. For more chronic conditions, 1-2 times a week is usually recommended.

Can Laser Therapy be used on patients with tattoos or scars?

We take extra caution when caring for patients with tattoos or scars, as the areas can heat up more easily. However, laser therapy can be a highly effective treatment option for healing wounds and scars.

For more information on Laser Therapy or to schedule an appointment, call 712-249-8231.

Now Offering Trigger Point Dry Needling for Pain Relief

Trigger point dry needlingWe’re thrilled to announce that we are now offering trigger point dry needling! Nate Wiechmann, D.C., recently completed the 50-hour course in Dynamic Neuromuscular Trigger Point Dry Needling in Kansas City, Mo.

Have you ever come across a spot on your neck, back, hip or shoulder that is painful and tight? Found a knot in the muscle that just won’t release? Chances are you found a trigger point, a hyper-irritable spot in a muscle that can be directly treated with trigger point dry needling.

During this type of treatment, Dr. Wiechmann carefully inserts a “dry” needle (one without medication or liquid) directly into a knot or pressure point, which helps release tension in the surrounding muscle area.

Although the treatment is similar to acupuncture, it is not the same. The primary goal of dry needling is to relieve muscle pain and tension, whereas acupuncture focuses on returning energy flow to a state of balance by removing blocked or interrupted chi.

Contact us to learn more about trigger point dry needling.