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Brittany Peschel PT, DPT
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§ Participant will be able to identify patients who are appropriate candidates for Physical Therapy and Integrative Dry Needling.
§ Participant will acquire the knowledge of mechanisms and systemic effects of Integrative Dry Needling with clinical applications.
§ Patients will acquire knowledge of pain statistics and applicable needs for conservative therapy.
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§ Use of monofilament needle to § RESTORE homeostasis § PROMOTE self healing
§ By § Reducing tissue tension§ Improving micro circulation§ Normalizing physiological processes
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§ Used to address soft tissue dysfunction
§ Provides Physical (tissue stretch) and Biomechanical (lesions) stimuli
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§ Begins with insertion of needle which punctures the skin à physical stretching of tissues à creates lesion in soft tissue
§ Lesion induced process activates physiological mechanisms of remodeling injured and inflamed soft tissues in and around needling site§ 1. reduce physical stress/tissue tension§ 2. normalize inflammation § 3. replace injured tissues with fresh tissues of same type
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§ Reduces both physical (muscular) and physiological stress (body systems and local physiological dysfunctions)
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§ IDN will not treat any specific disease but may restore tissue homeostasis § Activates biological self-healing and self-repair
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§ Normalize inflammation by triggering regulatory mechanisms of blood and fluid circulation § Balance of sympathetic nervous system
§ We can address chronic inflammation by introducing acute inflammation§ Shortly after IDN: Increase levels of NO, O2 and Adenosine in local area
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§ Sensitized nerve endings
§ Tissue edema
§ Infiltration by immune cells § Fluids normally contained in blood vessels shifts to interstitial spaces and results in
further release of sensitizing fluids.§ Firing threshold decreases causing light pressure to initiate CNS impulses which normally
would not fire § Over time leads to chronic inflammation
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§ Goals of decreasing aggravating factors and improving blood flow
§ Match that of the goals of IDN
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§ Efficacy varies from person to person§ The same soft tissue pain can be completely relieved for some individuals, partially for
others and no significant change in some.
§ Severity of pathological condition *stressor* § As stressor increases, self healing potential decreases § If self-healing potential significantly hindered, IDN response limited.
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§ Appropriate for any soft tissue dysfunction
§ Violent physical injuries
§ Cumulative injuries§ Emotional stress
§ Unconscious injuries
§ Overloading fatigue § Injuries from chemical toxins
§ Overweight injuries § Post-surgical injuries
§ Disease related injuries
§ Environmentally-related injuries § Injuries caused by abnormal physiology
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§ Needle aversion or phobia
§ Significant cognitive impairment
§ Unable to communicate directly or with assistance of an interpreter
§ Need to be able to give consent (under 18)
§ Pt not willing to be treated with DN
§ Local skin lesions
§ Local or systemic infections
§ Local lymphedema (no evidence that DN would cause or contribute)
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§ Severe hyperalgesia or allodynia
§ Allergic to certain metals (can use silver or gold plated needles)
§ Abnormal bleeding tendencies
§ Compromised immune system
§ First trimester of pregnancy (no evidence of abortifacient effects)
§ Vascular disease including varicose (not directly on vein)
§ Following surgical procedure (can perform not directed toward joint or implant)
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§ New guidelines from CDC released in 2016 recommend PT over prescription pain killers. § More than 42,000 people died from opioid overdose that same year
§ 17,000 of which were due to prescribed opioid overdose
§ “Non-pharmacological therapy and non-opioid pharmacological therapy are preferred for chronic pain”.
§ Sales of prescription opioids has quadrupled even though there has not been an overall change in the amount of pain that Americans report.
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§ CDC guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, as well as acute care situations.
§ For all other pain management, the CDC recommends non-opioid approaches including PT.
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§ The risks of opioid use outweigh rewards
§ Patients want to do more than mask the pain
§ Pain or functional problems are related to low back pain
§ Opioids are prescribed for pain
§ Pain lasts longer than 90 days
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§ Develop a plan taking patient’s medical history, presentation, etc into account
§ Individualized treatment program which may include: § Exercise§ Stress management § Manual therapy§ Sleep hygiene § Pain neuroscience education
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§ Purpose: to compare efficacy of each treatment in short-term relief of myofascial trigger points and pain.
§ Included 8 studies on manual therapy, 23 studies on DN and 2 studies on dry cupping
§ Moderate number of RCTs supporting use of manual therapy
§ Evidence for dry needling low to moderate
§ Future studies: address small sample size
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§ Purpose: Determine effects of deep dry needling into a treatment session following the Bobath concept on spasticity, motor function and postural control following stroke.
§ Two treatment groups: Bobath only or Bobath plus dry needling
§ Both groups received session including strengthening, stretching and reconditioning exercises following Bobath concept
§ Dry needling group received needling of tibialis posterior.
§ ANCOVA showed patient’s who received Bobath + DN had greater balance, sensory, range of motion and stability improvements.
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§ Purpose: To assess efficacy of DN and cervical joint mobilizations to reduce CHA.
§ 36 yo female with reported 4-5 headaches per week.
§ DN with electrical stimulation administered 6 times for 10 mins in addition to cervical joint mobs in a posterior to anterior direction (Gr II-IV) and HEP twice per day.
§ Improved ROM by 4th treatment and 0 headaches in 10 day stretch.
§ Pt discharge after 6 visits.
§ 16 month follow up: pt was symptom free for both cervical pain and headaches for 4 months following discharge; at time of follow up having 1 headache per week.
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1. Boyd, ATC, PTA, DPT, Robert J., et al. “The Use of Electrical Dry Needling and Cervical Joint Mobilizations to Treat Cervicogenic Headaches: A Case Report.” Orthopaedic Physical Therapy Practice, vol. 31, no. 3, 2019, pp. 132–135.
2. Sanchez, Mila Z, et al. “Effects of Dry Needling on Post-Stroke Spasticity, Motor Function and Stability Limits: A Randomised Clinical Trial.” Acupunct Med, 9 July 2018.
3. Charles, D, et al. “A Systematic Review of Manual Therapy Techniques, Dry Cupping and Dry Needling in the Reduction of Myofascial Pain and Myofascial Trigger Points.” J Bodyw Mov Ther, vol. 23, no. 3, July 2019, pp. 539–546.
4. Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health. (2018). American Physical Therapy Assosication, 1–15.
5. Gargano, D. F. (n.d.). Dr. Ma's Integrative Dry Needling: Advanced Integrative Dry Needling for Pain Management and Performance Enhancement. Dr. Ma's Integrative Dry Needling Institute LLC.
6. Gargano, F., Griswold, D., & Ma, Y.-tao. (n.d.). Dr. Ma's Integrative Dry Needling: Pain Management & Sports Rehabilitation. Dr. Ma's Integrative Dry Needling Institute LLC.
7. Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management. (2019, October 30). Retrieved from https://www.choosept.com/Resources/Detail/physical-therapy-vs-opioids-when-to-choose-physica
8. Using Opioids for More Than 30 Days Could Increase Depression Risk. (2016, June 16). Retrieved from https://www.breakthrough-pt.com/2016/08/using-opioids-for-more-than-30-days-could-increase-depression-risk/
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