Medical acupuncture which may include dry needling often gets criticised by other healthcare practitioners as being too ‘passive’. The concern seems to be that you as clients will develop a reliance when the emphasis should be on self management, exercise, movement and lifestyle modification etc.
I fully understand the concern and the importance promoting active involvement on the part of the client. We as physiotherapists know that some of the best evidence for the long term management of pain is with exercise. Lifestyle adjustments as well as an understanding of how thoughts, attitudes and beliefs towards pain is now better understood and should also be addressed by your physiotherapist if needed.
My view if that medical acupuncture is most effective when combined with exercise and lifestyle adjustments and this is how I practice. No session with me would be complete without getting you moving afterwards. My aim is to facilitate movement and function which is free and easy, comfortable and relaxed, I want you to trust your body and let it work for you without fear and concern. The type of movement and exercises I will recommend will be tailored to your needs and based on what I find on assessment.
Less is often more, and exercises don’t need to be overly complicated to be effective. Simple strategies which are functional and blend into your day are often a good choice as opposed to strictly regimented repetitions.
And what about manual therapy? In other words ‘hands on’ treatment which may involve mobilisations, manipulation and various forms of soft tissue release. Here too there is the risk of over reliance if these techniques are not used in the right context.
I use manual techniques as an essential part of my assessment and also treatment alongside medical acupuncture and exercise. Like medical acupuncture I use manual therapy to modulate pain and facilitate exercise and movement. If this is not achieved the long terms effects of manual therapy are poor.
The message is simple. I feel we should be using all the techniques we have at our disposal as physiotherapists within an evidence based context. No one technique has been shown in the research to be superior but all may help. If used in combination as part of an individualised treatment plan the overall effect may be better than using any one technique on its own based on my 20 years of experience.
Unfortunately the research is often focussed on comparing one physiotherapy technique with another but rarely considers a combined approach compared to say no treatment or drug therapy. The reason for this may be methodological issues, cost as well as the fact that there are very few physiotherapists who are able work effectively in this way.
Those that do are usually in busy clinics, away from a research environment focussed on being expert clinicians and getting their clients better by whatever means is necessary. I would be one of those physiotherapists.
Simon.
