2.Dry needling evidence Flashcards
does dn help
yes
in studies with joint OA, Migraine prophalexis, tension type headache, neck disorder there was + evidence
mixed results were found on shoulder, LBP, and lateral elbow pain
(-) results for RA
how does DN help
Primarily neurophysiologic at the level of the spinal cord. Explains sensorimotor effect to other muscles innervated by the same spinal level.
does DN provide long or short term results?
short to medium results
- seen with studies wit, self reported pain, pain sensitivity as outcome (pain pressure threshold PPT) and self reported disability - less consistant results have been found for long lasting results
what are areas with systemiatic reviews that support DN?
- heel pain
- LBP
- FAce/tmj
- Heachache
- upper quarter
- not always in longterm
What is a take home msg for DN
DN creates a window for tx, should be used early and used with other TXs.
Can you DN on a tendon?
-tendon needling improves patient reported outcomes in patients with tendinopathy
Who does DN work on?
best (but not a slam dunk):
- Pain with multifidus lift test (MLT)
- No Aggravation with Standing
Others:
- Belief that acupuncture will help
- Back pain with hip flexion (SKC
Who does DN work on?
best (but not a slam dunk):
- Pain with multifidus lift test (MLT)
- No Aggravation with Standing
Others:
- Belief that acupuncture will help
- Back pain with hip flexion (SKC
what are common risks of DN
Bleeding/hematoma
Pain before and during tx
Fatigue
what are uncommon risks of DN ?
vertigo
nausea
local inflammation
emotions: aggravation, drowsy, feeling faint, headache, nausea, fatigue shaky, itchy, clausterphobic, numbness
what are rare risks of DN?
local infection
nerve injury
unconsciousness
what are very rare risks of DN ?
Pneumothorax
systemic infection
What is a perspective on risk you should consider with the risks of DN?
Very rare risks of Dn are the less% of risk compared to vertebral artery dissection with cervical manipulation 1/million or Risk of sudden death from exercise ≈ 0.001% (1 in 100,000) - same as pnemo
what is the conclusion of the risk benefit ratio for DN ?
dry needling/acupuncture provided by physicians and physical therapists is a very safe treatment.
what is the difference btwn clean vs sterile technique ?
clean: handwashing btwn patients, nonsterile gloves, alcohol swab prior to injection, sterile needle, immdiaetly isolate needles that have been used
dont touch sterile needle with clean glove
what do you do if you have a needle stick injury ?
bleed it
wash it
cover it
report it
what are the 3 things you should know about DN?
- solid knowledge of anatomy
- clean technique
- conscientious use of dn
what are patient contraindications of Dn ?
- Local infection
- Local lymphedema
- Bleeding disorders
- Needle phobia
- Pregnancy in first trimester
- Area over a joint replacement, breast implant or cardiac pacemaker
Immediate effects of Dn are seen on:
- Blood Flow and Oxygenation
2. And pain and inflammatory biochemical
can we change proximal (rather than distal) symptoms with DN?
yes
seen in a study with TrG in upper trap and DN to extensor carpi radialislongis
sig findings:
decr. Pain intensity
incr. Pressure threshold
incr. Cervical ROM
-the catch is short-term local hypoalgesia in areas innervated by the same spinal level
Does DN effect muscle force?
- no effect on muscle force
- does not increase fxn or ability to contract
- with the exception of increased isometric neck strength in 2 studies in patients with neck pain
what evidence suggest a neural pathway of DN?
Dr. K study - those who imprived pr. DNing had improved LM contraction and decreased pain pressure sensitivity = “lasting, clinically-relevant sensory motor changes”
- Dn has a inhibitory effect on spontaneous E activity from Trg
- results showed that results occured in ipsi and contralateral sides where increase in mus. activity during Dn was present and decreased afterwards - suggests nuerologic level at spinal cord
- after needling, muscle is electrically silent
what are the proposed physiologic effects of DNing>
1.Local immediate effects
SEA = spontaneous electrical activity)
2.Sensorimotor effects at level of spinal cord
= Primary mechanism
- Supraspinaleffects
(e. g. placebo)
Does evidence suggest deep or superficial Dning?
- Deep
- All found better outcomes with Deep DN than with Superficial DN
- lumbar, shoulder, neck
What does evidence show about about the local twitch response (LTR)?
-Larger improvements if LTR. Statistically significant after 4 weeks.
According to evidence, is the Trigger Point (TP) important?
Large clinically and significantly larger improvements Pain, Disability, and PPT for patients receiving DN to TP
Does evidence show that a needle is more effective that manual therapy for mgmt of Trgs?
both groups has similar results for improvement in pain, disabilty, and C-spine ROM
- study for chronic neck pain
- BUT DN group had had statistically larger increases in PPT
According to the impact of needle diameter study for tx of chronic lumbar myofascial pain syndrome, does size matter
yes,
Larger improvements in Pain (VAS) and quality of life (SF-36) 1 & 3 months after DN with largest needle
Can Treating TPs in distally may help proximal TP pain?
yes
Can “carry over” from needling muscles innervated by the same spinal level occur?
yes, seen with rabbit study that suggest effects occur on spinal level
is twich repsonse important indicator of tx?
yes
should you Dn the Trg or next to it ?
DN in TP likely most effective
can robust manual therapy treatment be the same at Dn
maybe
can you get more pain relief with more needle stimulation?
maybe
