My lovely wife. I blame her for sparking my passion for dry needling. A little background on her will help. She’s a pediatric physical therapist, smart as a whip, and very skeptical of my manual techniques. As I was completing my fellowship I was feeling pretty confident in my skills when she came to me with complaints of bilateral cervicothoracic junction and upper trapezius pain.
Shortly after being trained in dry needling, I was searching for willing subjects who would allow me to hone my skills. I had a long term patient I was seeing who I was treating for a thoracic compression fracture. We had a pretty good rapport and it came to light that he had had a rotator cuff and labral repair 2 years earlier. He voiced frustration that he never could attain full end range elevation compared to his uninvolved side. He heard me talk about dry needling and asked if I would take a look at his shoulder and see if he’d be a candidate.
This week we're taking a look the abstract "Treatment of temporomandibular myofascial pain with deep dry needling." As you may know, Temporomandibular dysfunction is often associated with myofascial pain and can be challenging to treat successfully. Choosing to perform dry needling on muscles of mastication surely comes with risks, i.e. increased risk of bleeding, bruising, needing to consider the anxiety that often accompanies this presentation, etc.
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.
By Brett Windsor, PT