Physical Therapy Continuing Education: Trigger Point Dry Needling
Physical Therapy Continuing Education: Trigger Point Dry Needling
Trigger Point Dry Needling is a skill now being taught in Physical Therapy Continuing Education courses. To find out more about it, we recently interviewed a Trigger Point Dry Needling educator.
Here is what he had to say:
Interviewer: I know that you're a very experienced practitioner and so you're using it with most of your patients, but is there any type of patient that you would not want to use it for? You mentioned the contraindications. Could you maybe expand a little bit more on that?
Dry Needling Expert: Absolutely. Patients that are in an immune compromised situation I would definitely stay away from this because you do affect the immune system with this. It's a secondary issue and something that we recognize so again, if it's a patient that you wouldn't treat with other things you may stay away from the dry needling.
If it's someone that's had a mastectomy and they've had the lymph nodes removed as well as the breast tissue we would never treat that arm that has the possibility of getting lymph edema.
If it's a patient that we had red flags on with regards to maybe psychogenic chronic pain or some other issues where needling wouldn't be something that they would even consent to.
As we get more experienced as physical therapists we get better intuition on what treatments are most effective for our patients. At the same time we try to train our practitioners to see that it's a great tool that you don't have to use on every single patient. We can still use our hands to release a tissue, albeit not as effectively, but at the same time you have to recognize what patients are going to do well, which ones aren't.
If someone's a very anxious patient and they're very nervous about having needles stuck in them we obviously educate them very well and we try to have a very positive treatment experience with them and would not be as aggressive with them with the treatment itself. At the same time you'd be surprised at how many people are actually okay, once you educate them on it, with having you administer this treatment with these needles.
The pain that's associated with it is really not from the needle itself. It's from the dysfunction in the actual tissue, so if it's a healthy tissue you really don't feel much with a needle being placed in it.
Now there are plenty of other contraindications. Obviously children we really don't focus too much on treating them with it because we don't want them to have anxiety associated with it. There's a certain age where we can start actually administering this and they can handle it because they understand the technique.
Then if they have high doses of anticoagulants and they're INR's not balanced and their numbers are not at a homeostasis for them we would not actually treat them until we have permission from the physician.
If someone is post-surgical we would wait till we get permission from the physician. Also, I like to wait about four weeks before I administer the dry needling in the area that they had surgery just because of infection. I don't want anything to make that surgical intervention have a negative outcome.
We're actually starting to do research with CU Sports Medicine, one of the physicians there. We're just in the beginning stages of developing a research protocol. It's actually status post-rotator cuff patients and administering dry needling with these folks to see if we can actually hasten their rehab and their healing process. That's another place where research is really trying to determine when this should be administered and what groups are most effective.
We see it used often times in the athletic population with great success, but again I would never treat a patient prior to their athletic competition if I didn't know how they would respond to the treatment because sometimes the post-treatment soreness can be pretty significant.
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