advanced msk - dry needling

physiologic effects of DN

- pain control

- increased blood flow

- decreased banding/less knots

- improved motor firing patterns/better activation of muscles

- CNS changes

2 types of DN techniques

- pistoning: inserting and redirecting needle

- in situ: put needles in and leave them (can also do e-stim)

when to use needling with ESTIM

- pts who can't tolerate twitch response

- prioritize type II muscle fibers (muscle recruitment, higher frequency)

- edema (muscle pump, lower frequency)

- poor general health or ability to recover

why may you not used pistoning on someone with poor general health

- pistoning disrupts tissue

- if really unhealthy --> may not be able to recover as well

- can still use pistoning but they may be more sore and not respond as fast

pistoning as a diagnostic tool

- do movement screen testing before and after

- needle feel when assessing tissue integrity

ex: healthy muscle feels like raw chicken; unhealthy = overcooked chicken

ex: spinal multifidi fatty infiltrate feels sticky; non fatty has a different feel

PF pain direct contributors

- ITB

- TFL

- vastus lateralis or medialis

when to use direct approach needling w/ ESTIM for patellofemoral pain

- if pt cannot tolerate twitch response --> can prioritize type II muscle fiber recruitment

- if edema is a factor

PF pain indirect contributors

- adductors

- glute med or min

- gastric/peroneals (effecting knee valgus)

shoulder impingement pain direct contributors

- supraspinatus

- biceps

- infraspinatus/teres major/minor

shoulder impingement pain indirect contributors

- traps

- lats

- pecs

- levator scap

- paraspinals

hip/groin/core pain direct contributors

- adductor longus and brevis

- rectus abdominis

- obliques

hip/groin/core pain indirect contributors

- pec major

- hip flexors

- HS

- paraspinals

needle should be inserted ____ to muscle

perpendicular (and fast!)

2 types of threading techniques

- grasp and thread (no bony backdrop)

- threading along a muscle that lies along the bone

can you use BFR and DN on the same muscle in the same session?

no

bracketing vs bracing

- bracketing: placing two fingers on either side of a target tissue or trigger point to isolate it (can't feel tissue responses as well)

- bracing: gathering, squeezing, or lifting the muscle belly away from the underlying structures using a pincer grip

how does dry needling affect the CNS?

- CNS is the control center for muscles, fascia, nerves, and the articular system

- Once they're all in better sync/better signal, then the body will have a decrease in pain --> improved movement --> better function

how does dry needling change movement and pain?

- needle enters into the TP which sends an afferent signal through dorsal roots of spinal cord to the brain

- "unsmudges" area in somatosensory cortex responsible for the muscle that was needled

- better signal between the muscle and brain

risks of dry needling

- pneumothorax risks

- nickel allergies

DN precautions

- post-surgical (~12 weeks until allowed to DN)

- immune system considerations (needling is considered a stress)

- bleeding considerations (allowed to DN on someone with blood thinners)

- active cancer (don't need involved sites)