Dry needling appears to be the new "technique" that orthopaedic therapists are trying to learn. It's different, there is a demand, and there are reports of success. With this, unfortunately, comes expensive classes. Is the potential benefit worth the expense? Now, with all these factors comes a certain level of controversy. In fact, there are some out there that almost appear to have alerts set up for whenever a dry needling post comes up, so that they can lecture about its "ineffectiveness" and lack of evidence.
Understandably, one of the most important critiques of dry needling as an intervention is the lack of high quality evidence to support it. While this is true, there are several reasons why we shouldn't suddenly abandon the potentially useful intervention altogether. For one, part of the lack of research is secondary to inconsistencies in technique and the studies. I'm aware of 3 programs locally and know that all three have different methods of dry needling. Secondly, research is only one of the three pillars of evidence based practice. The other two include patient preference and clinical experience. If a patient reports prior success with dry needling, it may prove beneficial to include in your plan of care. The clinical experience can be seen with changes being made in a specific asterisk sign from the one intervention of dry needling. While I will not argue the specific mechanism, it likely works through acting as a novel stimulus to the nervous system to alter threat levels.
To build off that I want to give you a quote about how we should interpret research and implement the findings into practice:
“However, the authors caution against interpreting EBP to mean that good practice should consist of only application of those tests and measures or interventions currently backed by good-quality research evidence...Likewise, when tests/measures and/or various interventions are proven to be faulty or ineffective through good quality research, it is reasonable to argue that they should not be used in practice. However, if there is no relevant evidence available, or if the evidence that is available is of questionable quality, clinicians must rely on other theoretical knowledge and practice experience, integrated within a sound clinical reasoning process, to determine appropriateness of tests/measures and interventions that have not yet been adequately researched (Christensen et al, 2011).”
With the push for physical therapy to be more research-driven, many have put the potential highest quality of evidence on a pedestal. Many have forgotten that much of what we do as physical therapists has not been studied or the studies lack true isolation of variables. Because of these limitations, we must remember to not be so close-minded as to eliminate potentially useful interventions. As many of you know, pain is more of a perception and we must impact the nervous system and the patient's beliefs to truly alter their experience. There are some patients who will have excellent responses to dry needling. Let's not limit those patients' potential improvement simply because research is lacking.
-Dr. Chris Fox, PT, DPT, OCS
Christensen N, Jones MA, Edwards I. Clinical Reasoning and Evidenced-based Practice. Current Concepts of Orthopaedic Physical Therapy, 3rd Ed. La Crosse, WI. 2011.
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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