Dry Needling

Question 1

Types of Needling

Answer 1

• Wet Needling: Injection
• Acupuncture: Traditional Chinese medicine where needles are used to normalize the flow of “Qi” through the body to manage pain and many other medical condition.
• Dry Needling

Question 2

Dry Needling Types: Trigger Point Model

Answer 2

• Identify and needle local trigger points.
  ~ Lesion causes healing response.
  ~ Elicits local twitch response and
  muscle relaxation.
  ~ Increases circulation.

Question 3

Dry Needling Types: Integrative Dry Needling (IDN)

Answer 3

• More holistic approach focusing on the nervous system.
  ~ Needling is done at the site of pain
  and remotely based on innervation of
  the complaint.
• Pain at the elbow = needles at the elbow and neck

Question 4

Effects of IDN: Local

Answer 4

• Creates a small lesion and proportional inflammatory response.
  ~ Stimulates resolution of chronic
  inflammation.
  ~ Increases Circulation
• Physically stretches soft tissue.
• Further increase in circulation due to increased nitric oxide and adenosine levels.

Question 5

Effects of IDN: Systemic

Answer 5

• Increase in circulation restores normal function of the nervous system

Question 6

Effects of IDN: Desensitizes Nervous System

Answer 6

• At the site, proximally, and distally
• Increased circulation allows nerve to function normally

Question 7

Effects of IDN: Sensitization

Answer 7

• Increased sensitivity to painful stimuli.
• Longer Lasting Pain
• Perception of pain in reaction to non-painful stimuli.
• Cause of the problem is not clear.
  ~ Not about injury, it is about
  sensitivity.
  ~ Nervous system
  malfunction/hyper-function.

Question 8

Dry Needling: Common Short Term Reactions

Answer 8

• Relaxation
• Energized
• Drowsy
• Other positive response

Question 9

Dry needling Saftey: Pneumothorax

Answer 9

• 1:1 rule in Thoracic Spine
  ~ Use only < or = 1 inch needle that’s
  one finger width lateral of the spinous
  process
  ~ Angle needle medially
• Use care in:
  ~ Supraclavicular Area
  ~ Between shoulder blades
  ~ Anterior and lateral Thorax

Question 10

Dry needling Saftey: Kidney Puncture

Answer 10

• 2:2 Rule between L1-L3 (12th rib at L2)
  ~ Use only < or = 2 inch needle that’s
  two finger widths lateral of the
  spinous process
  ~ Angle needle medially

Question 11

Dry needling Saftey: Possible Outcomes

Answer 11

• Bleeding
  ~ PPE precautions should be followed
  ~ Sharps container can be disposed of
  in trash after duck taping and writing
  “Do Not Recycle” in Michigan
• Fainting
• Bruising

Question 12

Dry Needle Manipulation

Answer 12

• Needles can be set with no manipulation
• Manipulation increases stretching of tissues and lesion
• Basic: Low speed, large movement.
• Pistoning: High speed, small movement, with or without conical pattern.
• Rotation
• Tenting: Pull needle up after rotation.

Question 13

Dry Needling Neuro-Trigger Points: Symptomatic

Answer 13

• Located in any structure/site of injury of dysfunction.
  ~ Ex: If a person has lateral
  epicondylitis the needle goes into
  the specific site of pain, which would
  likely be one of the extensor/
  supinator muscles.

Question 14

Dry Needling Neuro-Trigger Points: Paravertebral

Answer 14

• Located in the paravertebral muscles.
• Sites correspond to the segmental innervation of the injured/dysfunctional area.
• May also be symptomatic points.
• Paravertebral points should be done bilateral.
• Ex: In addition to needles in the area of epicondylitis, needles would go in at the paravertebral sites of C6 since that nerve root innervates the lateral elbow.

Question 15

Dry Needling Neuro-Trigger Points: Homeostatic

Answer 15

• Sites found throughout the body that provide a way to access the larger nervous system.
  ~ Sites with relatively large, superficial
  nerves that are able to target the
  CNS more effectively
• Choose points proximal and distal to area of injury/dysfunction.
• May be symptomatic points.