Introduction to dry needling

Basics of dry needling

1. Introduction to Dry Needling DR. SUBHANJAN DAS, PT Dry Needling Instructor MPT (Musculoskeletal & Sports) Assoc. Prof., BIMLS, Burdwan Ex Asst. Prof. Physiotherapy, Geetanjali Medical college & Hospital, Udaipur, Raj.

2. Also in the series http://www.slideshare.net/SubhanjanDas/introduction-to-dry-needling http://www.slideshare.net/SubhanjanDas/2-brief-hisory-of-needling http://www.slideshare.net/SubhanjanDas/3-superficial-dry-needling http://www.slideshare.net/SubhanjanDas/4-indications-of-dry-needling http://www.slideshare.net/SubhanjanDas/6-dangers-of-dry-needling http://www.slideshare.net/SubhanjanDas/7-physiologic-background-of-dry-needling http://www.slideshare.net/SubhanjanDas/8-dn-vs-acupuncture http://www.slideshare.net/SubhanjanDas/9-electroacupuncture http://www.slideshare.net/SubhanjanDas/10-legalities-involved-in-dry-needling

3. What comes to our mind first when we think of Dry Needling

4. What comes to our mind first when we think of Dry Needling Acupuncture

5. What comes to our mind first when we think of Dry Needling CHINESE

6. What comes to our mind first when we think of Dry Needling Placebo

7. What comes to our mind first when we think of Dry Needling UNSCIENTIFIC?

8. What comes to our mind first when we think of Dry Needling And still, we feel a little curious!

9. Is it acupuncture? “ From a physical therapy perspective, TrP -DN has no similarities with traditional acupuncture other than the tool.”- Jan Dommerholt 1

10. Is it Chinese? Early proponents of dry needling include Klellgren (British), Chan Gunn (Canadian) and other people of western world.

11. Is it unscientific? A no. of independent research validates Dry Needling. 2 systematic reviews 3,4 have validated dry needling including a Cochrane review (highly prestigious!)

12. Is it placebo? Various studies in animal and human models have found specific physiological changes related with dry needling. Some placebo effects may be present but there is a sea of evidence showing objective measurable changes which rules out ‘placebo only’ theories.

13. What is dry needling? Dry needling is a procedure where filiform needles are tapped through the skin to the target tissue to bring about a therapeutic effect. No medicine is delivered, thus it is called ‘dry’, compared to injections, which are ‘wet’. Other names/variations are IMS, TrP DN etc.

14. Needles Needles can be as short as12.5 mm or as long as 100 mm. the choice of needle is based on the target tissue and specific techniques used. Disposable filiform acupuncture needle with guide tube is used. ( filiform = solid) Guide tube minimizes pain

15. Disposable sterile needles packed

16. Needles with guide tubes

17. Needles sans guide tube

18. How is it performed?  With careful precision the structure to be needled is chosen. Then sterilized disposable needles are pierced through the skin into the target tissue. Choice of needle is dependent upon depth of target tissue. A clean field technique is used. As there is minimal or no bleeding, sterile field is not needed. The needles are kept inserted for a span of 30 seconds to few minutes and then withdrawn and disposed properly.

19. How is it performed? A sharps bin is mandatory for needle disposal. Alternate to sharps bin

20. Specific techniques Deep Dry Needling: When needle is pierced deep into the muscle/target tissue. Local Twitch Response is elicited. Superficial Dry Needling: Started by Peter Baldry , where only the skin overlying the target tissue is pierced. Periosteal pecking Needle manipulation Intramuscular electrical stimulation (PENS)

21. PENS

22. Response to needling Dry needling, much like MWM, when indicated, produces immediate effect. Different people respond to needling differently and are thus classified as strong, average and weak responders. A strong responder will need minimal needle stimulation to achieve needling effect; overstimulation can worsen patient’s pain 2 .

23. To sum up With proper judgment and precision dry needling is a powerful tool for the physiotherapist. It is a quick, cost efficient treatment which when indicated produces immediate result. The risks are real. Need for training and safety precautions can not be over emphasized.

24. References Dommerholt et. al, Trigger point dry needling. Baldry P. Acupuncture treatment of fibromyalgia and myofascial pain. Fibromyalgia syndrome. Elsevier, 2010:149 Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review.  Arch Phys Med Rehabil 2001;  82 : 986–92. Furlan AD, van Tulder MW, et al. Acupuncture and dry-needling for low back pain.  Cochrane Database Syst Rev  2005;(1):CD001351

25. References 5. Travel and Simon’s Myofascial pain and dysfunction the trigger point manual 6. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle . J Appl Physiol 2005;99:1980-1987. 7. Lundeberg T, Stener-Victorin E. Is there a physiological basis for the use of acupuncture in pain? Int Congress Series 2002;1238:3- 10.

26. References 8. Baldry PE. Acupuncture, Trigger Points and Musculoskeletal Pain. Edinburgh, UK: Churchill Livingstone, 2005. 9. Langevin HM, Bouffard NA, Badger GJ, Churchill DL, Howe AK. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: Evidence for a mechanotransduction -based mechanism . J Cell Physiol 2006;207:767-774