Monday, Feb. 12, 2018

Dry Needling

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Technique used to treat various impairments

The name “dry needling” can sound peculiar to many who read it, and the topic raises some debate among practitioners as well. It is a treatment option that some physical therapists are using to treat conditions such as scarring, myofascial or musculoskeletal pain, motor recruitment and muscle firing problems, according to the Federation of State Boards of Physical Therapy (FSBPT). The objective in using this technique is to offer some pain relief and improve movement by increasing the extensibility of scar tissue. In a comprehensive review of dry needling published by “Healthy But Smart” author Sonja Ristevski writes that research on this modality of treatment is limited, and understanding the defining characteristics of what makes it effective, or different from acupuncture, can also be tricky to navigate.

Dry needling is defined by the FSBPT as the technique of using the insertion of a solid filament needle, without medication, into or through the skin to treat various impairments. It can sometimes be referred to as trigger point dry needling, and differing opinions on its practice and outcomes remain. The American Physical Therapy Association (APTA) lists a number of resources for both patients and practitioners in order to educate those who are considering receiving or administering the treatment. In addition, they have several state-issued opinions made by attorneys general on dry needling within the scope of practice of physical therapy, many of which agreed that the procedure is safe and within the reasonable practice of physical therapists so long as they are competent in performing the intervention.

Ristveski explains that dry needling is mostly used for myofascial trigger points, which can be active or latent spots within a taut band of muscle, meaning they can cause spontaneous pain or pain only when touched. Deep dry needling, as opposed to superficial, can “inactivate” myofascial trigger points by causing muscle contractions and relaxing the muscle. Ristveski writes that the process activates endogenous opioids, which is how the muscles become relaxed. Within this explanation of deep dry needling raises questions of how it differentiates from acupuncture. This qualification raises opposing arguments, some of which are highlighted within the statements made by attorneys general on the APTA website. The ultimate determination is that dry needling is to be examined through a physical therapy lens, determining whether or not it is within the scope of PT practice and not whether it’s part of acupuncture. In terms of legality, the APTA stands that it is, in fact, within the scope of practice; however, each state has its own rules and regulations.

Dry needling is said to be helpful or effective within a number of conditions, in addition to the above mentioned previously in this article, including inducing labor, tennis elbow, facial wrinkles, arthritis, plantar fasciitis (or heel pain), low back pain, shoulder pain (or “frozen shoulder”) and scar tissue. Within her research, Ristveski found that in terms of inducing labor, arthritis, tennis elbow, improving facial wrinkles and improving scar tissue, there is no evidence that supports the efficacy of dry needling in these conditions. Little or weak evidence exists that dry needling helps in short-or medium-term for lower back pain, shoulder pain or heel pain, and more high-quality research and trials are needed to determine long-term benefits.

As with any medical procedure or intervention used for physiological conditions, obtaining the most current evidence-based opinions and making informed decisions is critical, just as choosing a qualified and trained practitioner. Much of the findings for dry needling can be conflicting with similar reports, though there are numerous states that have agreed it is within the scope of practice for physical therapists and allow for the procedure to be performed by trained professionals. To learn more about the potential benefits and states that allow dry needling, visit the American Physical Therapy Association website at www.apta.org.

Additional research, considerations and in-depth investigation can be found within Ristveski’s article at www.healthybutsmart.com/dry-needling-therapy.

– Katie Ho

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