DRY NEEDLING IN PHYSICAL THERAPY Alex Radjen SPT

DRY NEEDLING IN PHYSICAL THERAPY Alex Radjen, SPT

WHAT IS DRY NEEDLING 1 §Insertion of solid filament needles into the skin and underlying tissue to disrupt pain sensory pathways and relax contracted fibers §Treat dysfunctions in skeletal muscle, fascia, and connective tissue, and, diminish persistent peripheral nociceptive input, and reduce or restore impairments of body structure and function leading to improved activity and participation §Goal: releasing the active trigger points and relieving pain

1 TERMINOLOGY §Also Referred To As: § Myofascial Trigger Point Dry Needling, Intramuscular Therapy §Trigger Point § taut band of contractured skeletal muscle fibers that produce local and/or referred pain when stimulated § Not spontaneously painful, but research shows contributes to nociception

1 INDICATIONS v. Radiculopathies v. Joint Dysfunction v. Disc Pathology v. Whiplash v. Complex Regional Pain Syndrome v. Phantom Pain v Neurogenic Pruritus v To decrease local and referred pain v. Decreased ROM v. To decrease spasms and increase muscle extensibility v. Motor Recruitment v. Pain Management!!

1 CONTRAINDICATIONS v. Relative Contraindications v Abnormal bleeding tendency v. Ex. Anticoagulant therapy v. Compromised Immune System v. AIDS, Cancer, incompetent heart valve v. Acute Immune Disorders v. Vascular Disease v. Diabetes v. Pregnancy v. Epilepsy v. Children v. Absolute Contraindications v Needle Phobia v History of untoward reaction to needles v Into muscle or area in patient that is on anticoagulant therapy or thrombocytopenia v Into area or limb with lymphedema

2 APTA §Recognizes dry needling in the PT scope of practice, and that additional education for competency to practice is indicated, but no official position on dry needling § As of August 2017 this is a nationwide map of various stances on the practice of dry needling § Green: Dry Needling in the scope of practice § Red: Dry Needling is not in the scope of practice § Grey: No stance

DRY NEEDLING IN THE STATE 3 OF OHIO §January 2007 - Ohio Occupational Therapy, Physical Therapy and Athletics Trainers Board determined that dry needling is within the scope of physical therapy practice. §“It is the position of the Physical Therapy Section that physical therapist assistants cannot legally perform intramuscular manual therapy (dry needling) under the Ohio Physical Therapy Practice Act since it requires activities that are evaluative in nature and outside the scope of practice of the physical therapist assistant. ” OTPTAT

SUPPORTIVE 2, 4 RESEARCH v. Preliminary research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation v“Dry Needling Combined With Physical Therapy in Patients With Chronic Postsurgical Pain Following Total Knee Arthroplasty: A Case Series” v. Case series v 14 participants who underwent TKA, with persistent postsurgical pain and myofascial trigger points who failed with conventional PT and/or medication v Weekly dry needling with combined therapeutic exercise for 4 weeks v. Conclusions: After dry needling combined with therapeutic exercises, patients who had chronic pain following TKA showed clinically significant improvements in pain, range of motion, function, and myofascial trigger points

DN FOR HYPERTONIA AND 5 SPASTICITY v “Sensitivity, and Baropodometry After the Application of Dry Needling in Patients Who Have Had a Stroke: A Randomized Controlled Trial” v 34 stroke patients v. Objective: DN and effects on spasticity and plantar pressure in patients who have had a stroke v Groups v. Experimental: DN over the gastroc and tib anterior on the spastic leg, 10 minutes of intervention v. Control: no intervention v. Results: decreased spasticity, pressure pain thresholds, increased bilateral support surface in the forefoot v. Conclusion: single session of DN decreases spasticity and widespread pressure pain sensitivity in subjects. Deep dry needling induced changes in plantar pressure by increasing the support surface.

HOW TO GET v 6 CERTIFIED Kinetacore ( Theoretical and Practical Exams) v. Level 1 Functional Dry Needling v$1250, 2 day or 3 day course ( 3 day involves more onsite lab and SFMA instruction) v 6 month clinician, Current license as a PT, MD, DO, DC, PA or NP vmusculature taught involves areas of the hip, lower extremity, thigh, upper extremity, shoulder, lumbar spine and cervical spine v. Level 2 Functional Dry Needling v $1250 , prior Level 1 training, 200 hours vthoracic spine and trunk, lumbar spine, cervical spine, hip, hand, foot, upper extremity, temporomandibular joint, and connective tissues v. Level 3 Advanced Functional Dry Needling v$1000 vprogressing from the foundation of our Functional Dry Needling series and adding specific techniques targeting the peripheral joints and the TMJ v. Successful completion of FDN 1 and FDN 2, and 2 years dry needling experience, Current license as a PT, MD, DO, DC, PA or NP v. Functional Therapeutics v. Successful completion of level 1, Current license as a PT, MD, DO, DC, PA, NP vnew, intermediate FDN techniques, manual therapy techniques and corrective exercises v. Functional Dry Needling of the Pelvic Floor v$1000 vpelvic floor dysfunction commonly associated with pelvic pain, incontinence, voiding dysfunction and/or sexual pain or dysfunction v current license, level 1, completion of level 1 pelvic floor dysfunction cert course

RESOURCES 1) “ Description of Dry Needling in Clinical Practice. ” An Educational Resource Paper (2013): n. pag. APTA. Web 10 Apr 2018. 2) “Physical Therapists & The Performance of Dry Needling. ” An Educational Resource Paper (2012): n. pag. APTA. Web. 4 Apr 2018. 3) Occupational therapy, physical therapy, and athletic trainers board. Laws and Rules Regulating the Practice of Physical Therapy Web site. http: //otptat. ohio. gov/Portals/0/laws/Ohio%20 PT%20 Practice%20 Act%20 as%20 of%20 July%201%2020 15. pdf. Updated 2017. Accessed April 19, 2018. 4) Nunez-Cortes R Cruz-Montecinos C Vasquez-Rosel A, et al. Dry needling combined with physical therapy in patients with chronic postsurgical pain following total knee arthroplasty: a case series. J Orthop Sports Phys Ther. 2017; 47: 209 -216. 5) Salom-Moreno J. , Sánchez-Mila Z. , Ortega-Santiago R. , Palacios-Ceña M. , Truyol-Domínguez S. , Fernández-de-las-Peñas C. Changes in Spasticity, Widespread Pressure Pain Sensitivity, and Baropodometry After the Application of Dry Needling in Patients Who Have Had a Stroke: A Randomized Controlled Trial. J. Manip. Physiol. Ther. 2014; 37: 569– 579. doi: 10. 1016/j. jmpt. 2014. 06. 003. 6) Kinetacore functional dry needling courses for physical therapists. Kineta. Core Web site. https: //www. kinetacore. com. Updated 2018. Accessed April 23, 2018.