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Dry Needling PowerPoint Presentation

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Description : This presentation titled "Dry Needling" by LT Michael Krok, DPT, OCS, CSCS, explains what dry needling is and is not, what the current literature says for dry needling, and how dry needling is being used in clinics today.

Tags : acupuncture, techniques, dry needling, physical therapists, physical therapy

Published on : Apr 15, 2021 | Views : 3497 | Downloads : 6

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Slide 1-

Dry Needling LT Michael Krok, DPT, OCS, CSCS 2014 Scientific Symposium
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Dry Needling: OBJECTIVES Understand what dry needling is and is not Understand what the current literature says and in relation to dry needling Understand how dry needling is being used in clinics today
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DRY NEEDLING History, Definitions, and Terminology
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Sir William Gowers BMJ 1;117-121 Fibrositis” Palpable tenderness and hardness of the muscle Fred H. Albee, MD, ScD “Myofascitis from an orthopedic standpoint” JH Kellgren Hypertonic saline injections Referral patterns DIFFERENTIAL DIAGNOSIS OF PAIN LOW IN THE BACK ALLOCATION OF THE SOURCE OF PAIN BY THE PROCAINE HYDROCHLORIDE METHOD JAMA. 1938;110(2):106-113 Arthur Steindler “Myofascial pain” “Trigger points” Karl Lewit, MD, DSc “The Needle Effect” Janet Travell, MD and David G. Simons, MD 1931 Max Lange 1st Trigger Point Manual Die Muskelhärten (Myogelosen): Ihre Entstehung und Heilung Myofascial Pain and Dysfunction, The Trigger Point Manual. Lippincott Williams & Wilkins. Trigger Point Model Coined “Trigger Point” 1996 C. Chan Gunn Radiculopathic Model
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Dry Needling-Definition Dry Needling A skilled intervention performed by a physical therapist that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues for the management of neuromusculoskeletal pain and movement impairments. (American Physical Therapy Association Dry Needling Task Force, May, 2012)
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Dry Needling Terminology
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Is Dry Needling within the Scope of Physical Therapy Practice?
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POSITION STATEMENT It is the position of the AAOMPT that dry needling is within the scope of physical therapist practice. October, 2009
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SUPPORT STATEMENT Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation. October, 2009
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Federation of State Boards Resource Paper 2010
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Federation of State Boards Resource Paper 2010
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Federation of State Boards Resource Paper 2010 CONCLUSIONS: Dry Needling by Physical Therapists meets requirements of: Historical basis Available education and training Educational foundation (CAPTE) Supportive scientific evidence IMT is not an entry level skill and should require additional training Will this be true for the future though? KinetaCore®
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Federation of State Boards Resource Paper 2010 CONCLUSIONS (cont.) Procedures do not define a profession, scope does There will be overlap of treatment techniques between different scopes
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Federation of State Boards Resource Paper 2010 It is clear that no single profession owns any procedure or intervention. Overlap among professions is expected and necessary for access to high quality care. Federation of State Boards: Intramuscular Manual Therapy (Dry Needling) Resource Paper, 2010
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APTA Resource Paper January 2012 Physical Therapist Education Licensure and Regulation Current Status of Dry Needling in Physical Therapist’s Legal Scope of Practice in the United States Distinction Between Profession’s Scopes of Practice Summary Research Review on Dry Needling
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Is Dry Needling Acupuncture?
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Dry Needling versus Acupuncture Evaluation Application Overall Goal Similarities Differences The Tool
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Tools don’t define a profession Calculator Accountant = Tool should never define the profession that uses it.
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Traditional Chinese Acupuncture Evaluation utilizes examination of tongue and pulse www.kinetacore.com
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Traditional Chinese Acupuncture Needle insertion points are founded in knowledge of meridians www.kinetacore.com
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Traditional Chinese Acupuncture Uses needle to balance energy, life-force, or qi in the body www.tcmcentral.com www.yangacupunctureherbalinstitute.com
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Dry Needling in Physical Therapy Needle insertion points based on assessment and knowledge of neuroanatomy
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Dry Needling in Physical Therapy Evaluation includes subjective and objective examination of the neuromuscular system
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Why Dry Needling? Understanding how and why it works starts with…
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Understanding Neuromuscular Dysfunction
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Trigger Points (Simons, Travell, and Simons, 1999) Definition Active Trigger Points hyperirritable spots taut band of skeletal muscle/fascia painful upon compression produce characteristic pain, referred tenderness, motor dysfunction and/or autonomic phenomena
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Trigger Points (Simons, Travell, and Simons, 1999) Definition Latent Trigger Points Satellite Trigger Points Painful upon palpation Sensations not recognizable Develop in a zone of reference of key trigger points (synergist, antagonist, neural link or referral zone)
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Trigger Points Travell and Simons Mapping Myofascial Pain and Dysfunction: The Trigger Point Manual Volume , 1 2nd Edition Image Copyright Lippincott Williams & Wilkins
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Trigger Point Characteristics: Spontaneous Electrical Activity Dysfunctional motor endplate potential at rest (From Ge H-Y, et. al., 2009)
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Trigger Point Characteristics: Biochemical Changes (J Appl Physiol 2005; 1977-1984) (Arch Phys Med Rehabil 2008; 89:16-23)
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Physiologic Effects of Dry Needling
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Physiologic Effects of Dry Needling Increase Blood Flow  Decrease Banding  Decrease SEA  Biochemical Changes  CNS Changes  Zystra E., www.kinetacore.com
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Physiologic Effects of Dry Needling: Decrease SEA SEA quiets following LTR (Chen, 2000)
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Physiologic Effects of Dry Needling: Biochemical Changes  nociceptive sensitizing agents: Substance P (Shah, 2008) CGRP (Shah, 2008; Hseih, 2012)  β-endorphin levels of treated muscle (Hseih, 2012) With repeated needling (Hseih, 2012):  capillarity of tissue DN x 1 DN x 5 TNF α (Hseih, 2012) Sham Sham Treatment Treatment Treatment Sham Sham Treatment DN x 5 DN x 1
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Physiologic Effects of Dry Needling: (continued) Sensory and proprioceptive stimulus drives gate control (Chou, 2012)  Substance P in DRG, (Hseih, 2012) Change in Neurotransmitters, cytokines, and chemokines (Shah, 2008) Sympathetic Response
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Why does dysfunction exist? KinetaCore® TheoreticalConstructs
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Theoretical Constructs Travell and Simons Trigger Point Model C. Chan Gunn Radiculopathic Model KinetaCore Functional Foundational Model
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Theoretical Constructs Trigger Point Model Energy Crisis Theory Motor End Plate Hypothesis Radiculopathic Model Focus = Tissue Focus = Spinal Segment
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Theoretical Constructs Functional Model Zylstra, E: www.kinetacore.com Muscles Fascia Peripheral Nerves Articular System CNS
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Functional Model Trigger Point Model Functional Model Radiculopathic Model
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Functional Model Recognition of Dysfunction Question 1 WHAT is Painful? Question 2 WHY is it Painful? Question 3: How is it affecting Function?
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Treatment of Dysfunction Manual Therapy Mobilization/manipulation Soft tissue Neural mobilization Dry needling to affect restriction or pain generator Movement re-education Segmental stabilization SFMA correctives Sahrman, Janda, Lee, Johnson, Pilates, Feldenkreis, etc…… Dry needling to restore efficient muscle contraction
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www.kinetacore.com
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www.kinetacore.com
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What Was Treated? Rectus Femoris www.kinetacore.com Attachment to Superior Acetabulum and anterior capsule. Why is that important?
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Summary Dry Needling may be used to:  ROM  Pain Restore Function
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Dry Needling in Clinical Practice  ROM  blood flow  banding locally or in segmental muscles Improve ability of muscle to move through range
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Dry Needling in Clinical Practice  PAIN Deactivate painful “trigger point”  nociceptive sensitizing agents  SEA  banding/compression of adjacent tissues Segmental Inhibition (DRG and dorsal horn) Affect on central mediators (PAG and endogenous opioids)
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Dry Needling in Clinical Practice RESTORE FUNCTION Restore length tension relationship  nociception Improve somatosensory mapping
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Questions? KinetaCore®