Dry Needling

what is dry needling?

a technique that uses a needle without an injectate

FSBT definition of dry needling =

Dry Needling is a skilled technique performed by a physical therapist using thin filiform needles to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability

5 physiologic effects of dry needling =

- Pain control

- Increased blood flow

- Decreased banding "less knots"

- Improved motor firing patterns/better activation of muscles

- CNS changes

what is an example of of improved motor firing patterns/better activation of muscles?

someone with glute amnesia gets their glutes needled and suddenly can feel them during a bridge instead of just feeling hamstrings

dry needling has an immediate ____ , _______ and ______ effect on the MSK system

structural, electrical, biochemical

needling with ESTIM: patients who can't tolerate ____ response

twitch

needling with ESTIM: prioritize type _____ muscle fibers (muscle recruitment) (higher frequency)

2

needling with ESTIM: if edema is a factor, then we want to _____ frequency

lower

needling with ESTIM: poor general ____ and ability to _____

health; recover

needling with ESTIM: once the needs are in, they cannot _____

move

- dangerous to do so

needling with ESTIM: how long?

30 minutes minimum

pistoning: is a _____ tool

diagnostic

pistoning: _____ screen testing before and after

movement

pistoning: needle feel when assessing tissue integrity overall, including _____ _____

bony attachments

pistoning: spinal multifidi fatty infiltrate ___ _____ vs fatty infiltrate have different feel

bony attachment

the way we learn how to dry needle in certification courses is different from what?

how we actually needle when we treat

3 technique tips =

- needle insertion

- pistoning accurately (threading vs sliding)

- bony back drops

3 things to remember with needle insertion =

- perpendicular to the muscle

- know your anatomy

- break the skin quickly

2 ways to redirect the needle =

- bend

- sliding out the skin once in subcutaneous tissue

direct contributors to patellofemoral pain =

- ITB

- Tensor fascia Latae

- Vastus Lateralis

- Vastus Medialis

what is the direct approach of dry needling to patellofemoral pain?

needling with ESTIM

- If patient cannot tolerate twitch response

- Can prioritize type II muscle fibers

- If edema is a factor

indirect offenders of patellofemoral pain =

- Adductors

- Gluteus medius/ minimus/ and others

- Gastrocnemius/ peroneals (effecting knee valves etc)

how many times do you piston the muscle?

depends, the muscle will talk to you

direct contributors to shoulder impingement pain =

- Supraspinatus

- Biceps Brachii

- Infraspinatus/ Teres Major/ Minor

indirect contributors of shoulder impingement pain =

- Upper, mid, lower trapezius

- Latissimus dorsi

- Pec major/ minor

- Levator Scapulae

- Paraspinals (even lumbar)

direct contributors of hip/groin core pain =

- Adductor Longus and Brevis

- Rectus Abdominus

- External/Internal Obliques

2 ways to hit the abdominals for hip/groin pain =

- direct on the ilium

- threading

indirect offenders to groin pain =

- Pectoralis Major (video)

- Hip Flexors (Iliopsoas/Rectus Femoris)

- Hamstrings (video maybe in faber)

- Paraspinals (more weakness/imbalance)

needling below the ilium helps you avoid what?

the lung field

L2 and up, be careful of what?

the lung field

what is bracketing in dry needling?

a manual technique where a practitioner uses their fingers, thumbs, or adjacent anatomical structures (such as ribs) to frame or isolate a target muscle fiber or trigger point before inserting a needle

what is bracing in dry needling?

stabilizing, pinching, or fixating the target muscle tissue, skin, or trigger point with your non-needling hand (or fingers) while inserting or manipulating the needle

2 threading techniques =

- grasp and thread

- threading along bony backdrop

we should use needling as an adjunct with what?

other therapies

how is needling used as a diagnostic tool?

- Needle feel when assessing tissue integrity overall including bony attachments

- Needling which muscles makes the biggest difference in movement

- Multifidi fatty infiltrate on laminate

- Eg- needling low back improves hip range of motion all of a sudden, or needling adductors or abs improves toe touch, etc.

the CNS is the control center for what?

muscle, fascia, nerves and articular system

once the CNS system is more in sync/better signal then the body will have a decrease in pain, leads to what?

improved movement and better function

how does dry needling change movement and pain?

- Needle enters muscle into trigger point and sends afferent signal through dorsal roots of spinal cord to the brain...

- Evidence to show that dry needling "unsmudges" area in somatosensory cortex responsible for the muscle that was needled

- Better signal between the muscle and brain (improved mind to muscle connection)

4 pitfalls of dry needling =

- Pneumothorax risks

- In situ needling- don't bury it to the handle

- Nickel allergies

- Approaching a nerve

4 precautions of dry needling =

- Post surgical precautions: Usually wait 12 weeks to needle

- Immune system considerations: Common flu, severely immunocompromised, Needling is a "good" stress, but its still a stress...

- Bleeding considerations: Beware someone on blood thinners may be more prone to bruising, but we still have patients on blood thinners we needle

- Active cancer: Avoid radiation site, lesion or involved tissue