Download An Intro to Dry Needling for Physical Therapists

Beyond Stretching and Ultrasound;
Current Treatments for Musculoskeletal
Injuries
Julie Paolino
PT MS ATC MCTA CIDN
WHERE TO START….
Traditional physical therapy consists of stretching,
exercise, massage, heat or ice
But there is more!
NEWER INTERVENTIONS
Dry Needling
&
Therapeutic Taping
DRY NEEDLING
AAOMPT POSITION STATEMENT
“It is the Position of the AAOMPT Executive Committee that
dry needling is within the scope of physical therapist
practice.”
(AAOMPT. Position statement: Dry Needling. American Academy of Orthopaedic
Manual Physical Therapists, October 17, 2009.)
WHAT IS DRY NEEDLING AND HOW
IS IT EFFECTIVE?
WHAT DRY NEEDLING IS NOT!
• NOT acupuncture!
• Acupuncture
• Treating disturbances
of “Energy Flow”
• Needles are inserted
in pre-determined
areas in meridians
DRY NEEDLING VS ACUPUNCTURE
Dry Needling
Traditional Meridian Acupuncture
•
4-5 years of PT education
•
•
Knowledge – anatomy, PNS,
physiology, pathology, kinesiology
and manual therapy
2,000 hours education and training
in ancient Chinese medicine
•
Clinical training = 25-50 hours of
specialty training depending on
model
Knowledge of meridians which is
not related to modern medical
knowledge
•
Professional license exam
•
Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation.
Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT
WHY WE DRY NEEDLE?
• To decrease pain (local vs referred)
• To Improve function
• To DESENSITIZE the patient’s nervous system (Chronic
pain)
EFFECTS OF DRY NEEDLING
What does it do?
NEEDLING EFFECTS:
Creates a lesion which activates physiological mechanisms of
remodeling of injured and inflamed soft tissues in and around
the needling site
Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation.
Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT
NEEDLING EFFECTS:
•
Electrical stimulation:
• Rhythmic vibration
•
local and systemic effects
Non-specific pathophysiologic effects:
• Restores tissue homeostasis thus joint biomechanics are improved
•
Precise location of particular points:
• Traditional acupoint or trigger points - ???
• Needling the sensitized or inflamed area
Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation.
Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT
Clinical Limitations
DRY NEEDLING
CLINICAL LIMITATIONS
• Requires the process of homeostasis in order to promote selfhealing
• Therefore, if a patient’s self-healing potential is impaired, the
response to needling may be limited!!
• Most effective: soft-tissue pains thru localized symptoms
• Less effective: non-soft tissue pain symptoms
Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation.
Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT
AFTER CARE
• Manual Soft Tissue Mobilization
• Joint Mobilization
• Therapeutic Exercise/Stretching
• Corrective Exercise
• Ice or Heat
• Light activity encouraged
IS THERE EVIDENCE TO SUPPORT
INTRAMUSCULAR DRY NEEDLING?
DUNNING, J. ET AL. DRY NEEDLING: A LITERATURE REVIEW
WITH IMPLICATIONS FOR CLINICAL PRACTICE GUIDELINES.
PHYSICAL THERAPY REVIEWS 2014 VOL.19 (4)
• Several studies have demonstrated immediate or short-term improvements
in pain and/or disability by targeting trigger points (TrPs)
• However, to date, no high-quality, long-term trials supporting in-and-out
needling techniques at exclusively muscular TrPs exist
• The insertion of dry needles into asymptomatic body areas proximal and/or
distal to the primary source of pain is supported by the myofascial pain
syndrome literature
• Acupuncture’ literature supports the use of ‘dry needles’ to treat patients
with a variety of neuromusculoskeletal conditions in numerous, large scale
randomized controlled trials
IDN: LITERATURE SUMMARY
• Superficial and deep needling more effective than placebo,
or no treatment
• Inclusion of paraspinal points clinically significant versus
local needling in isolation
• Needling non-local trigger points reduces pain in primary
TrP sites
• Studies support immediate and short term results but need
high quality, long term trials
Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation.
Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT
THERAPEUTIC TAPING
Traditional taping techniques would restrict and
limit movements
3 DIFFERENT TYPES
• Mulligan : Mobilzation with Movement
• ROCK Taping / FMT
• Kinesiotaping
MULLIGAN MOBILIZATION WITH MOVEMENT
• Dev by New Zealand physio 1985
• Tape utilized to reposition “joint”
• promote mobility
• increase ROM
ROCKTAPE AND FMT
• Fascial Movement Taping
• Dr. Steven Capobianco
• Greg van den Dries
• FMT goal is to foster proper movement through treatment
• acute injuries
• use in chronic cases
• for prevention and performance improvement and training
• Simple and effective approach
• Stretches along length, but not width
• Recoil effect
KINESIOTAPING
• Dr. Kenzo Kase, DC
Developed in 1979
• Exposure 1988 Seoul Olympics, Introduced to US in 1995
• Effects: Skin, Fascia, Circulatory/ lymphatic, Muscle, Joint.
• Uses:
~Mechanical correction
~Fascial correction
~Space correction
~Ligament / Tendon correction
~Functional correction
~Lymphatic correction
EFFECTS OF THE TAPE
• Mechanical Decompression of the skin
EFFECTS OF THE TAPE
• Sensory motor
stimulation
• Sensory cortex
• Afferent signals to
the brain
EFFECTS OF THE TAPE: DECREASE PAIN
• Pain GATE theory
• Support for injured
muscles or joints
• Allowing a full, healthy
range of movement
APPLICATION
GENERAL INFORMATION
•
Health history and Test patches
• Prior experience w/ taping
• 15 min test patch to assess tolerance
• Sensitive Skin and Allergies
• There is no latex
• Allergic reactive rare
• Irritation created if stretch is placed at the anchors
GENERAL INFORMATION
• Sensitive zones
• Posterior knee
• Neck (anterior and posterior triangles)
• Armpit
• Anterior elbow
• Hands/Feet**
GENERAL INFORMATION
Contraindications
• Open wounds
• Skin infections,
Cellulitis
• Active cancer
• DVT
• Kidney disease
• CHF
Precautions
• Compromised skin
• Infants
• Elderly
• Pregnant patients
(especially 3rd
trimester)
• Prone to skin allergies
• Sensitive skin
ROCK TAPE
• Ability to wear for up to
5 days (3 days K tape)
• Waterproof, latex free
and hypoallergenic
• Do not heat tape!
• Remove if adverse
symptoms occur
ROCKTAPE
Step One:
Eccentrically Load Area
Step Two:
Stabilize Area
Step Three:
Decompression Strip(s)
KINESIOTAPE
• To Inhibit a muscle
~DistalProximal (I to O)
~Inhibit: Acute injuries, muscle spasm
~15% to 25% Tension
• To Facilitate a muscle
~ProximalDistal (O to I)
~Chronic conditions, weak
~15% to 50% Tension
KINESIOTAPE TAPE TENSION
Paper off tension: 10-15%
Light 15-20%
Moderate 25-50%
Severe 50-75%
Full 75-100%
0%: NO TENSION ON ENDS (ANCHOR)
KINESIOTAPE STRIPS
•
I strip: Applied directly over area to be treated
•
Y Strip: Anchor and two tails: Surround muscle to be treated.
•
X Strip: Can be used for muscles that cross 2 joints, Star for contusion, muscle
sprain / Tear.
•
•
Stretch middle 1/3 rd of “X” placed over muscle belly.
Fan Strip: Lymphatic issues.
~Anchor in areas of lymphatic system. Cut 3-4” long strips. Place through area of
swelling with Nil to paper off tension.
~Criss-cross fans through Rx area, anchor on each side of joint
EFFECTS OF TAPE: DECREASE PAIN
•
Support for injured muscles or joints
•
Allowing a full, healthy range of movement
EFFECTS OF TAPE: DECREASE EDEMA
• Enhanced blood flow
• Decreases pressure on pain receptors
• Improved lymphatic drainage will help minimize swelling
and bruising
LYMPHATIC CORRECTION
THE TRAINING ROOM
Ankle Sprain/Prevention
• To support sport-specific fascial chains
• Better engage and coordinate movements
• Increase efficiency
• Reduce fatigue
NOTHING IN THE UNIVERSE IS STATIC. EVERYTHING MOVES.
THE HUMAN BODY IS NO EXCEPTION.
Questions?