Could Physios Be Needling With Better Technique?

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.

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1 Day Acupuncture Course - Treatment of the Shoulder Girdle - 26th April 2014

I am very pleased to announce the first in a series of Masterclasses I will be running over the course of the year. First up is Integrating Advanced Medical Acupuncture & Dry Needling techniques in Treatment of the Shoulder Girdle.

  • Date: Saturday 26 April 2014
  • Location: Mount Merrion Chartered Physiotherapists, 105 Trees Road, Mount Merrion, Co Dublin
  • Duration: 8.45 am - 17.15pm (7 hours CPD)
  • Cost: 140 euro early bird until March 20th, 160 thereafter. Places limited to 12.
  • Tutors: Simon Coghlan MSc, BSc Physio, Dip Med Ac & Lorraine Carroll MPhty (Manips), BPhysio, Cert Med Ac

Course Synopsis:

This one day course is for clinicians with foundation level training in Medical Acupuncture or Dry Needling who wish to enhance their skills in the assessment and treatment of the shoulder girdle. TCM trained practitioners who would like to develop their understanding of Acupuncture used in a western medical context are also welcome to attend.

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Dry Needling For Myofascial Pain Syndrome – An Evidence Review

In this weeks post I have given a quick rundown of the evidence relating to the use of Dry Needling as a technique falling under the ‘umbrella’ of Medical Acupuncture in the treatment of trigger points related myofascial pain.

I have not provided links to each study, however a quick Google scholar search of the author, year and subject should locate the full article’s if required.

The effectiveness and efficacy of Dry Needling

Kietrys DM (2013) in a meta analysis found that dry needling can be effective in providing pain relief. These studies noted that a “twitch” often occurs when a needle is inserted into the trigger point, and this “twitch” may be a sign that the treatment will be helpful. Effects of dry needling varied across studies and that more research needs to be done to determine whether dry needling is better for this condition than other treatment options.

Tough et al (2007) highlights problems with problem with diagnosis – most studies consider secondary myofascial pain i.e. in association with some other problem e.g. underlying OA which may negatively affect outcomes to dry needling. Studies need to be based on careful diagnosis i.e. treatment of primary myofascial pain to reveal true effectiveness of dry needling.

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Medical Acupuncture Does Not Work Simply Because People Expect It Will

I have previously written about the role of expectation and suggestion in the use of Medical Acupuncture (MA) and how this may positively influence local pain relief.

This is a subject I have always been interested in. In clinical practice such non specific effects no doubt play a very significant role in treatment outcomes, no matter what technique you are using.

As such when I came across a study by Sherman KJ, et al (2010) considering expectations and preferences as predictors of MA outcomes in low back pain, I was quick to take a read.

The study involved 638 low back pain sufferers who had never had MA as a treatment in other words ‘Acupuncture naive’. They underwent a 7 week course of treatment using MA, and the findings were as follows:

  • Those with high pre-treatment expectations of MA showed greater expectations of improvement in general and showed greater preference for MA
  • Those with high pre-treatment expectations were more likely to have heard that MA was a very effective treatment and to have a moderately positive impression of MA
  • However, those with such favourable beliefs towards MA did not predict improvement in back related function or pain at the end of the 7 weeks of treatment, nor after 1 year follow up
  • After the participants had received one session of MA, revised expectations were associated with an improvement in pain but not function at the end of the treatment period
  • After the participants had received 5 sessions, revised expectations were predictive of improvements in pain and function at 8 and 52 weeks
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Self Needling....Ever Tried It?

Firstly I need to introduce you to Dr. Max Forrester, past president and treasurer of the BMAS and proponent of self-acupuncture as way to allow patients to be treated more regularly and overcome accessibility issues. He presented a lecture and demonstration on this interesting topic at the BMAS Spring conference, 2013.

Dr. Forrester defines the approach as follows: “Self or home acupuncture (SHA) is acupuncture performed by a patient or patients acupuncture partner, following assessment and appropriate training by their attending regulated healthcare professional.”

There is a historical description, the first relating to SHA, by Ten Rhyne who witnessed a man “driving needles into his own abdomen in several locations and regaining his health as a result.” Sounds extreme but apparently effective.

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