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Transcript of Dry Needling
Betsy Smith, Carissa Thurman Differentiate between Acupuncture and Dry Needling Objectives: Understand the purpose and benefits of Dry Needling Understand how Dry Needling is performed and How it fits into a PT scope of practice “With the goal of releasing/ inactivating the trigger points and relieving pain. It improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor end plates and facilitates and accelerated return to active rehabilitation” (APTA) What is Dry Needling? -Integrative systemic dry needling
-Intramuscular stimulation dry needling
-Trigger point dry needling Types of Dry Needling: A point within a larger muscle that: What is a Trigger Point? Painful with palpation Associated with Referred pain Causes motor dysfunction Associated with involuntary nervous response Two Types:
Latent & Active Dry Needling
Injection of local anesthetic
Percutaneous electrical nerve stimulation (PENS)
Manual Therapy Types of Trigger Point Therapy: Western Medicine Chinese Philosophy Dry Needling vs. Acupuncture Trigger Points Acupuncture Points Scope of Practice Needle Depth Musculoskeletal Systemic With the goal of releasing/ inactivating the trigger points and relieving pain: Physical Therapy Use
of Dry Needling: improves pain control reduces muscle tension facilitates an accelerated return to active rehabilitation normalizes neuron firing Immediate reduction in local referred and wide spread pain Restoration of ROM and muscle activation patterns Normalization of immediate chemical environment of active myofascial trigger points Cont. Reduce peripheral and central sensitization 20 states in the US! Determined by the State! In 2009 The American Academy of Orthopaedic Manual Physical Therapy adopted a position statement that dry needling is within the scope of manual physical therapy. WHAT DO SOURCES SAY? Just as effective as Steroid Injection, without adverse side effects from medicine. More Efficient and Quicker method of inactivating Trigger points. Improves quality of life in patients with myofascial pain. Improves effectiveness of other Therapies. Specificity!
Trigger points can be inactivated with manual techniques and joint manipulations, but dry needling may be a more efficient and quicker method. Dry Needling vs. Manual Trigger Point Release Instant Relief Advantages & Disadvantages Longer lasting relief Tingling sensation or discomfort during treatment Possibility of soreness or hemorrhage at insertion site Approved by state
Extra certification required
Only PT can perform treatment Impact Reimbursement
-aspect of therapy or sole reason for therapy Sound professional judgement
Education and certification
Knowledge of current treatments available Legal: Ethical: Regulatory: Different types of needles are used, often the wrong type of needle could be used. Conflicting Results Placement of the needle could be cause of error Hard to measure pain objectively Difficult to have a blinded control group Yields similar results as other techniques Dry needling is an effective technique to relieve myofascial trigger points. Conclusion Dry needling is a manual therapy technique within a PT scope of practice based on musculo-skeletal dysfuntion. Dry Needling is NOT acupuncture Insert needle into trigger point (5-10mm) Penetration causes local twitching, this depolarizes the neuron Instant decrease in pain by controlling the electrical response from the neuron to the muscle. APPROVED! How Does It Work? References
DiLorenzo L, Traballesi M, Morelli D, Pompa A, Brunelli S, Buzzi MG, Formisano R. (2004). Hemiparetic shoulder pain syndrome treated with deep dry needling during early rehabilitation; a prospective, open-label, randomized investigation. Retrieved 12/06, 20012, from http://www.hookedonevidence.com/searchresults.cfm?process=1&ReviewID=15598
Dommerholt, J. (2011). Dry needling - peripheral and central considerations. The Journal of Manual & Manipulative Therapy, 19(4), 223-227. doi: 10.1179/106698111X13129729552065
Edwards J, K. N. (6/17/2008). Superficial dry needling and active stretching in the treatment of myofascial pain--a randomised controlled trial. Retrieved 12/06, 2012, from http://www.hookedonevidence.com/searchresults.cfm?process=1&ReviewID=10962
Fernández-Carnero, J., La Touche, R., Ortega-Santiago, R., Galan-del-Rio, F., Pesquera, J., Ge, H., & Fernández-de-Las-Peñas, C. (2010). Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. Journal of Orofacial Pain, 24(1), 106-112. Retrieved from http://ezproxy.twu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=20213036&site=ehost-live&scope=site
Huang, Y., Lin, S., Neoh, C., Wang, K., Jean, Y., & Shi, H. (2011). Dry needling for myofascial pain: Prognostic factors. Journal of Alternative & Complementary Medicine, 17(8), 755-762. doi: 10.1089/acm.2010.0374
Jonsson, C. (2012). The role of myofascial trigger points in shoulder pain: A literature review. Journal of the Australian Traditional-Medicine Society, 18(3), 139-143. Retrieved from http://ezproxy.twu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011694707&site=ehost-live&scope=site
Kalichman, L., & Vulfsons, S. (September-October 2010). Dry needling in the management of musculoskeletal pain. The Journal of the American Board of Family Medicine, 23(5), 640-646. doi: 10.3122/jabfm.2010.05.090296
Levent Tekin, Selim Akarsu, Oguz Durmus, Engin Cakar, Umit Dincer, & Mehmet Zeki Kiralp. (2012). The effect of dry needling in the treatment of myofascial pain syndrome: A randomized double-blinded placebo-controlled trial. Clinical Rheumatology,
PHYSICAL THERAPY CLINIC NEEDLES' PATIENTS FOR RELIEF. (2012, 06/12; 2012/11). States News Service. Retrieved from http://ezproxy.twu.edu:2199/ps/i.do?id=GALE%7CA292887327&v=2.1&u=txshracd2583&it=r&p=STND&sw=w
Vulfsons, S., Ratmansky, M., & Kalichman, L. (2012). Trigger point needling: Techniques and outcome. Current Pain and Headache Reports, 16(5), 407-412. doi: 10.1007/s11916-012-0279-6