Dry Needling

Sarah Guarino

Ithaca College

2/12/15

What is Dry Needling?

Skilled intervention used by PTs that uses a thin, solid filiform needle (without medication) to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective

tissue for the management

of neuro-musculoskeletal

pain and movement

impairments.

Dry Needling

Terminology

• Dry needling, trigger point manual therapy, trigger point dry needling, intramuscular manual therapy.

• Trigger Point: a taut band of skeletal musclelocated within a larger muscle group.

-Usually tender to the touch and can refer pain.

Uses of Dry Needling

• Research Supports:

–Pain control.

–Reduces muscle tension.

–Normalizes biochemical and electrical dysfunction of motor endplates.

– Facilitates an accelerated return to active rehabilitation.

Common Impairments• Acute/chronic tendonitis

– Overuse injuries

• Scarring & post-surgical pain• Carpal tunnel• Sciatic pain • TMJ• Myofascial pain• Headaches & whiplash• LBP• Motor recruitment • Neuromuscular firing problems • Decrease spasm/ increase mm. extensibility

Goals of Dry Needling

• To release/inactivate the trigger point and relieve pain.

Adverse Events

• Practiced for over 20 years by PTs.• Most common side effects include post-needling

soreness and minor hematomas. • FSBPT’s ELDD has 0 entries of harm caused by DN

performed by PTs. • Europe: 2 reports of pneumothoraces, 1

autonomic response, no other serious side effects.

• DN is under-utilized with no real danger/side effects involved in its practice by PTs.

APTA

• Recognizes dry needling as being part of the Physical Therapist professional scope of practice.

2012= 27 states

• As of April 2014 states that include dry needling in PT scope of practice include but are not limited to Alabama, Arizona, Georgia, Kentucky, Maryland, Massachusetts, New Hampshire, North/South Carolina, Texas, Wisconsin.– 9 State boards (Idaho, Kansas, New York, South

Dakota, Hawaii) have stated it is not within PT scope of practice. • Others :“not-prohibited”, “no position”, “unresolved”

• Countries that currently practice dry needling include Australia, Belgium, Canada, Chile, Denmark, Ireland, The Netherlands, New Zealand, Norway, South Africa, Spain and the United Kingdom.

Dry Needling in NJ

As of October 23, 2012:• “The NJ State Board of Physical Therapy

Examiners statutes and regulations do not prohibit the use of dry needling techniques or trigger point release by a physical therapist provided the physical therapist is trained and competent in the technique. Dry needling is not solely under the practice of acupuncture.”

• “The NJ Acupuncture Examining Board considers dry needling by a NJ PT to be the unlicensed practice of acupuncture.”

Dry Needling VS. -Based on Western neuroanatomy

and the scientific study of the musculoskeletal and nervous

system.

-Not curative.

Acupuncture-Based on ancient Chinese medicine.

-Uses Meridians/Channels, energetic physiology and energy flow patterns.

-Can treat smoking termination, fertility, depression, allergies

and other non-musculoskeletal conditions.

-Promotion, maintenance and restoration of health and the prevention of disease.

-3 yr. graduate program.

Billing/Reimbursement

• Medicare part A:– Dry needling not covered.

• Medicare part B:– Medically necessary services: Services or supplies that

are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

– Preventive services: Health care to prevent illness (ex: flu) or detect it at an early stage, when treatment is most likely to work best.

Cost to PT and patient

• For patients:– $75-$100 per initial evaluation.– $30-$60 per average treatment.– Based on time.

• For PTs:– #1 Brand: Lhasa Oms Inc.

• DBC Spring Acupuncture Needles ~$35-$50.– Box of 1000 disposable needles.– Various length/thickness.

– Additional Features:• Wires for E-Stim through needle ~$20/ pair.

Opportunities

• Not being taught in most entry level PT programs with the exception of Georgia State University, Mercer University, University of St. Augustine for Health Sciences and the Army PT program at Baylor.

THERAPY CONCEPTS COURSE

• Level 1: 3 day course $950– Theory and physiology of myofascial trigger points,

history of dry needling, anatomy review and referral patterns. • Cervical & lumbar spine, hip, LE, shoulder and forearm.

– 20 participants/course, min. 2 years experience.

• Level 2: 3 day course $950– Lecture, testing, demo & hands on lab sessions.

• Ant. Neck, head/face, thoracic spine, rib cage, hand, foot and other musculature.

http://www.therapyconceptsinc.com/#!/physical-therapy-continuing-education

GLOBAL EDUCATION FOR MANUAL THERAPISTS

• Level 1: 3 days (27.5 contact hrs.) $950– Evaluation/ application of dry needling of

neuromyofascial trigger points for basic musculature.

– Lecture, testing, demo, hands on lab sessions.

• Level 2: 2 days $550– Research based, specific Dx.

• Level 3: 2 days $550http://www.gemtinfo.com.au

Various Seminars: ~55 hrs. of online/ home study + 3 day theoretical and practical examinations. ~$1295http://dryneedlingcourse.com/schedule-and-registration

Case Study 1

“Efficacy of myofascial trigger point dry needling in the prevention of pain after TKA.”

• Randomized, double-blind, placebo controlled.

• Population: >65 yr. old (mean age: 72)– Acute care

• Subjects: 40 participants (29 F, 11 M)

• Involved knee: 60% R, 40% L

• 70% general anesthesia, 30% spinal anesthesia

Treatment Groups

• Group 1: After anesthesia and before surgery. Myofascial trigger points located in TFL, hip add., H/S, quads, gastrocnemius, popliteal. – Both active and latent trigger points marked.

– 20 insertions in each trigger point with consistent patient/ joint positions.

– Patients were unable to see their LE during Tx.

• Group 2: Sham, no treatment given for myofascial trigger points.

• Purpose: Is dry needling of myofascial trigger point effective in the prevention of pain post-TKA?

• Conclusion: Group 1 experienced reduced pain in 1st month post-op compared to group 2, when pain is typically at its highest.

– Group 1 reached the same degree of pain reduction in month 1 as group 2 reached by month 6.

– Significantly reduced need for post-op analgesia for group 1.

– No difference in WOMAC, knee ROM or knee strength at any time post-op.

Case Study 2“Management of shoulder injuries using dry needling in elite volleyball players.”

• Case report/ case study• Population: 18-64 yr. old (mean age: 25, SD 2)

– Outpatient care– 4 women on Great Britain national volleyball squad with

complaints of anterior/anterolateral shoulder pain

• Subjects: 4- all female – Right arm dominant

• Pain in shoulder ranging from 4/10 to 8/10 prior to tx, shoulder ROM limited in all cases in ABD and IR due to pain.

Treatment Group

• Group 1: Dry needling to myofascial trigger points, STM to shoulder, Cryo post-training, exercises and stretching prn.– 1 session of dry needling, 5-12 needles used and left inserted

for 10 minutes.

• Purpose: To describe the ST benefits of dry needling on shoulder problems in 4 elite athletes, with replicable measures of functional pain scores on court and objective measurements of AROM.

Results:

• Pain decreased to 3/10 or less

-3 with outcome, 1 without

• Full pain-free ROM post-Tx into shoulder ABD

-3 with outcome, 1 without

• Full pain-free ROM post-Tx into shoulder IR @ 90 ABD

-2 with outcome, 2 without

• Conclusion: Supports use of trigger point dry needling in elite female athletes with ST pain relief and improved AROM in the management of acute shoulder injuries, during an intense competitive period.

Resources

• Adrian, Leslie. "FSBPT Dry Needling Resource Paper." Intramuscular Manual Therapy 4 (2013): 1-16. Pub-Med. Web. 28 Jan. 2015.

• Mayoral, Orlando, Isabel Salvat, María Teresa Martín, Stella Martín, Jesús Santiago, José Cotarelo, and Constantino Rodríguez. "Efficacy of Myofascial Trigger Point Dry Needling in the Prevention of Pain after Total Knee Arthroplasty: A Randomized, Double-Blinded, Placebo-Controlled Trial." Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1-8. Pub-Med. Web. 1 Feb. 2015.

• Osborne, N. J., and I. T. Gatt. "Management of Shoulder Injuries Using Dry Needling in Elite Volleyball Players." Acupuncture in Medicine 28.1 (2010): 42-45. Pub-Med. Web. 1 Feb. 2015.

• "Physical Therapists & The Performance of Dry Needling." An Educational Resource Paper (2012): n. pag. APTA. Web. 28 Jan. 2015.