Dry Needling Flashcards
Tell me the difference between dry needling and acupuncture
Dry needling is performed by various health care providers in many countries.
Dry needling is not the same as injection therapy nor is it the same as acupuncture although it uses acupuncture needles
Acupuncture:
TCM involves the use of pulse diagnosis, balance and flow of energy, yin and yang, meridians and acupuncture points which must be learnt by heart or from charts.
Medical acupuncture is acupuncture reinterpreted in terms of modern anatomy, physiology and pathology.
Dry Needling:
Dry needling is the use of a solid needle for therapy. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue.
Dry needling relies on the stimulation of specific reactions in the target tissue for its therapeutic effect.
The term dry needling is also used to differentiate the use of needling in a western physiological paradigm from the use of needling in an oriental paradigm which is referred to as acupuncture.
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.
Tell me about the needles
Needles can be as short as 12.5 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 are used.
Guide tubes minimize pain by assisting with rapid insertion of the needle.
Management of trigger points
First identify all of the MTrPs from which the pain is emanating, and to deactivate them “one at a time”
Take measures to prevent reactivation of the MTrPs.
Started as early as possible, before pain-perpetuating changes take place, in particular spinal cord neuroplasticity (central sensitization).
Locate MTrPs not only in the primarily affected muscles, but also in their synergists and antagonists (secondary MTrPs).
Search for any satellite MTrPs that may be present in the primary and secondary MTrPs’ zones of pain referral.
Guidance as to where to look for these MTrPs may be obtained from carefully noting the distribution of pain and by observing which movements are restricted as a result of it.
Once all active trigger pointshave been needled the application of moist heat, prior to sub maximal stretching will help to reduce post needling soreness.
The patient should be coached on self management techniques such as gentle prolonged stretching to restore the resting length of the involved muscles.
At a later stage endurance and strength training to restore muscle should be introduced.
name 3 specific techniques
Deep Dry Needling
Superficial Dry NeedlingPeriosteal pecking
Intramuscular electrical stimulation (PENS)
Describe the radiculopathy model in terms of dry needling and its effects
In Gunn’s view, shortening of the paraspinal muscles, particularly the multifidi muscles, leads to disc compression, narrowing of the intervertebral foramina, or direct pressure on the nerve root, which subsequently would result in peripheral neuropathy.
TrP model
Myofascial pain originates from myofascial trigger point.
Deactivating the trigger points by needling is the management.
SDN:
Peter Baldry started SDN where the needle is inserted only a few mm.
Contraindications and complications
- fainting- in nervous, tense, tired patients (pt should be treated when lying down)
- local infections are very rare complication and are caused by inadequate sterilization
- pain during insertion (due to clumsy insertion, or blunt needles, or pt movement, tense/ anxious pts)
- injuries to internal organs
- needling of lung- cause by deep needling of points on chest wall, thus should be needled obliquely.
Contraindications and complications
Patients with needle phobia should not be needled.
Patients who are unwilling or very anxious.
Pregnancy (absolute)
Bleeding disorders and anticoagulants.
Local skin infections or disease.
Cardiac pace makers for electro-acupuncture.
