So you’ve been on a Dry Needling course and have started treating patients using the technique. This may not hold true for all of you, but I was somewhat nervous when first starting to use needles clinically. I quickly realised the apprehension could be perceived by my patient but once I became more confident in my handling and needle insertion I perceived my patients to find the technique more comfortable and better clinical results followed.
Good assessment is key
I have found the key to effective treatment in a MSK setting is a good assessment. This means getting your hands on the patient and performing a careful and deliberate palpation assessment as well as looking at other relevant objective findings. However preceding this, a good subjective should give you a very good indication of a patient's ‘sensitivity’ and will help guide your objective assessment and subsequent treatment.
Getting dosage right
The concept of ‘dose’ is becoming recognised as crucial to good clinical outcomes. Dose may be defined as the level of sensory input provided to the CNS during the process of needling. Too much in a sensitive patient may brings about an adverse reaction which may mean an exacerbation of symptoms. Too little and there may be no therapeutic effect. The aim is to get the dose right for the patient and this is the tricky part.
Dose may be controlled by adjusting the number of needles, the depth, duration and level of stimulation.
My personal experience with Physiotherapists who have been on Dry Needling courses is that they tend to be very vigorous with their technique and often overtreat a condition. This would be based on reports from patients who have received Dry Needling in other clinics and often been very sore and sometimes in tears, which is a bit of a concern. Here at Mount Merrion Physiotherapy we have had Physiotherapists who have joined our team trained in the Dry Needling technique who have needed retraining in the use of needling, in particular emphasising the importance of dose control. I am sure this observation does not apply to all who have been trained in Dry Needling and probably depends on where and how the training has been conducted. However a cautious reminder is applicable to us all - I encourage all Dry Needlers to be careful as vigorous lift and thrust techniques aiming to elicit twitches at every needle insertion may not always be necessary. Sometimes less really is more!
Fine tuning your technique
One of my intentions in providing a Masterclass in the use of Medical Acupuncture and Dry Needling in treatment of the shoulder girdle is to help clinicians fine tune their technique. The course emphasis will be on good handling and palpation skills, needle insertion, patient preparation, how expectations are managed and how dose may be controlled. These are just a few key areas I have found to be crucial in the success of needling.
Almost 15 years later I still feel I am learning. Given the range of possible techniques and approaches when it comes to using needles therapeutically, it can be quite overwhelming. My aim is always to simplify and do the basics well regardless of how you interpret or rationalise the technique you are using. Listen to the patient, observe their response and manage them well.
Medical Acupuncture, Dry Needling or whatever other label we wish to attach can be a truly effective technique but its up to the Physiotherapist to use it well. To summarise the best way to achieve this is to create a positive experience for the patient, make them comfortable and help alleviate their pain.
I have only a few places left on my Acupuncture course on April 26th in South County Dublin. If you would like to join us you can find more details here - Shoulder Seminar
I Look forward to seeing all participants soon.
Best, Simon
