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Jenna Boren

on 14 March 2013

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Dry Needling By: Jenna Boren Skilled intervention that uses a thin solid filiform needle to penetrate
Myofascial trigger points
Muscular tissue
Connective tissue
Helps manage neuromusculoskeletal pain and movement impairments
Diminish persistent peripheral nociceptive input
Helps to reduce or restore body impairments
Return or increase activity and participation

(Dommerholt et al., 2006) Description APTA. (2012). Physical therapists and the performance of dry needling: an educational resource paper. American Physical Therapy Association, 1-141.
Baldry, P. (2002). Superficial versus deep dry needling. Acupuncture in Medicine, 20(2-3), 78-81.
Ceccherelli, F., Rigoni, M. T., Gagliardi, G., & Ruzzante, L. (2002). Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: A double-blind randomized controlled study. The Clinical Journal of Pain, 18(3), 149-153.
Dommerholt, J., Mayoral del Moral, O., & Grobli, C. (2006). Trigger point dry needling. Journal of Manual and Manipulative Therapy, 14(4), 70-87.
Physical Therapy Committee of the Board of Medical Licensure and Supervision meeting minutes. (2011). References To date, fifteen licensing boards have issued interpretive opinions that intramuscular manual therapy is within the scope of physical therapy  practice:  AL, CO, DC, GA, KY, LA, MD, NM, NH, NJ, NM, OH, OR, SC, TX, VA, and WY.
Currently the only states that have made a ruling against dry needling being within the scope of practice for physical therapists are California, Nevada, Tennessee, Hawaii and Florida, mainly due to verbiage in the practice act against puncturing the skin.
Oklahoma Physical Therapy Committee met in January 2011 and agreed that TP dry needling is part of PT practice in many states and anything beyond would be acupuncture.
It is currently accepted as a tool of physical therapy until further notice.
(Oklahoma PT Board Meeting, 2011) The Law Compare the therapeutic effect of the superficial and in-depth acupuncture treatment of patients with chronic lumbar myofascial pain
 42 patients with lumbar myofascial pain were divided into 2 groups and treated for 8 sessions
Group 1
Needle was introduced in the skin at a depth of 2 mm
Group 2
Needle was placed deeply into muscular tissue.
Outcome Measure
Pain was evaluated with the McGill Pain Questionnaire before and after treatment and at the 3-month follow-up examination
No statistical differences between the two different groups
Pain reduction was greater in the group treated with deep acupuncture
After 3-months the deeply stimulated group had with a better result
Results show that deep stimulation has a better analgesic effect when compared with superficial stimulation
Ceccherelli, F., Rigoni, M. T., Gagliardi, G., & Ruzzante, L. (2002). Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: a double-blind randomized controlled study. The needles become the electrodes
Need at least 2 needles per channel and can use multiple channels if necessary
Best results occur when needles are placed in dermatome pattern of dysfunction
Place either directly into trigger point or on either side of it
2 and 4 Hz with high intensity for nociceptive pain
Release endorphins and enkephalins
80 and 100 Hz for neuropathic pain
Release dynorphin and galanin
(Dommerholt et al., 2006) Dry needling and Electrical Stimulation Reduces local and referred pain
Improves Range of motion
It is not known if it has any influence on normalizing the chemical environment of active trigger points
Stimulates the A-delta sensory nerve afferents for up to 72 hours after dry needling
Just slightly inserted (5-10mm) into muscle but no local twitch response produced
Keep needle in place 30 seconds, withdraw to subcutaneous tissue, reassess trigger point
If trigger point continues to be sensitive then guide to muscle again and leave 2 minutes
Use when patients cannot tolerate deep dry needling or with excessive cramping or stiffness while deep needling
Recommended due to less invasive (min risk of damage to nerves or blood vessels), painless, and minimal blood.

(Baldry, 2002) Superficial Dry Needling Reduces local and referred pain
Improves range of motion
Decreases trigger point irritability
Used when muscle shortens and causes nerve root compression pain
Spondylosis or disc prolapse
It is painful and can produce post treatment soreness and hemmoraging

(Baldry, 2002) Deep Dry Needling Shown to inactivate trigger points by evoking local twitch responses
“ A Local Twitch Response is a spinal cord reflex that is characterized by an involuntary contraction of the contractured taut band, which can be elicited by a snapping palpation or penetration with a needle.”
Local twitch response is associated with alleviation of motor endplate noise or spontaneous electrical activity, reduce inflammatory and nociceptive chemicals

(Dommerholt et al., 2006) Deep Dry Needling Hyperirritable spots within a taut band of contractured muscle fibers
Produce local and/or referred pain
2 Categories (based on irritability)
Spontaneous pain
Larger in size
Reduction in circulation
Pain with stimulation
Smaller in size

(Dommerholt et al., 2006) Myofascial Trigger Points Must have present indications for dry needling
Make sure patient does not have needle phobia or other anxiety about the procedure
Patient must understand and give consent to treatment
NOT recommended for children younger than 12 years old
Avoid skin lesions
Make sure patient is not allergic to certain metals in the needle
Patients with abnormal bleeding tendency (anticoagulant
Local or systemic infections are contraindicated
Deep dry needling pregnant woman
Avoid using in presence of vascular disease (varicose veins)
Caution when using after surgery where joint capsule has been opened
Avoid directing needle toward the joint or implant
(Dommerholt et al., 2006) Patient Selection and the precautions/contraindications Need to be able to select appropriate patients
Create a safe and comfortable environment
Safe handling of needles
Handling and positioning of patient
Anatomical knowledge
Appropriate needle technique
REMEMBER!!!! “The effectiveness of dry needling is to some extent dependent upon the ability to accurately palpate.”
(Dommerholt et al., 2006) Can you use it? (Dommerholt et al., 2006) When myofascial trigger points are present
Restrictions in range of motion due to contractured muscle fibers or other soft tissue restrictions
Scar tissue
Fascial Adhesions Indications Reduces local and referred pain
Improves range of motion
Decreases trigger point irritability
Used when muscle shortens and causes nerve root compression pain
Spondylosis or disc prolapse
It is painful and can produce post treatment soreness and hemmoraging

(Baldry, 2002) Deep Dry Needling
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