One thing that sets NAIOMT apart in the world of post professional manual therapy education is our faculty. We are an eclectic, ever-evolving group of practicing clinicians dedicated to moving the profession forward. This week, the Journal of Manual & Manipulative Therapy released its July issue with a focus on dry needling. In it, NAIOMT faculty member, Gary Kearns, instructor of our Advanced Dry Needling course, presents New perspectives on dry needling following a medical model: are we screening our patients sufficiently?, along with colleagues César Fernández-De-Las-Peñas, Jean-Michel Brismée, Josué Gan & Jacqueline Doidge.
Abstract: The effect of dry needling for myofascial trigger points in the neck and shoulders: a systematic review and meta-analysis. Ong J1, Claydon LS2.
This systematic review and meta-analysis sought investigate the efficacy of dry needling of myofascial trigger points in the neck and shoulders. Four of the quality articles reviewed compared dry needling to lidocaine injections on pain relief.
I had a 34 year old gentleman I was treating for a textbook L5 radiculopathy. He was responding beautifully to a combination of a Medrol dose pack, mechanical traction and an extension biased program. After 3 weeks his radicular symptoms were abolished and he was left with mild right lumbosacral pain that was resistant to further treatment. Honestly, at this point I was a bit stuck. Objectively, ROM testing was non-provocative, repeated movements did nothing, biomechanical assessment was unremarkable, neural testing was non-provocative and palpation only revealed bilateral multifidus atrophy at L5. Do I chalk it up to low level dural irritation I can’t provoke? What about very minor inflammation producing a chemically mediated pain I can’t provoke? Or, is it just the posterior annulus that remains painful? I could go on, but I think you see my paralysis by overanalysis.
In orthopaedic manual physical therapy, the techniques get all the attention. Manipulation, mobilization, muscle energy, neural mobilization, soft tissue mobilization, etc. You can now add Dry Needling (DN) to this list. Any seasoned clinician will tell you that learning these techniques, with practice, is the easy part. Being able to implement them efficiently and effectively is the hard part. Considering DN, understanding the genesis of myofascial pain, applicable pain science, the mechanisms of DN, its application to orthopaedic diagnoses, and the proper historical context is crucial to understanding the theory behind DN. However, when not placed in the context of a thorough subjective history, a comprehensive neuromusculoskeletal examination, appropriate differential diagnosis and clinical reasoning, it can be challenging to accurately identify the most appropriate patients and achieve optimal patient outcomes.