My Dry Needling Blog: Them's Fightin' Words!
I graduated from my Master's of Physical Therapy program in January 2000. I have been a licensed Physical Therapist ever since. Okay, I realize, already, you have a question. What is a physical therapist? Not many people can offer a good definition because the definition is vague at best. I believe most commonly we can be described in terms of helping to restore and improve physical function in a person's (or quite possibly dogs & horses) life. I was introduced to physical therapy after having a knee surgery. I spent 6 months, 2-3 x per week, at the PT office working on knee range of motion, strengthening, and return to sport. I went from having no muscle strength in my quadriceps and painfully limited knee range of motion to being fitted for a sports brace and getting back on the ski slopes in 7-9 months. Improved function, yes! Techniques used by PT, varied. It was a combination of hands-on, modalities, exercise, humor, education, and caring. It made me want to become a physical therapist. A physical therapist's job is to help improve physical function. The setting may be early intervention (birth-3 yrs), pediatric, school-based, sports, rehabilitation, orthopedic, adult, neurologic, respiratory, hospital based, geriatric, home care, skilled nursing facility based, in-patient, or out-patient. Given the variability in what types of clients we take care of, we become proficient as we go. We learn along the way with on the job training, continuing education courses, and situational experience. I believe this to be true with most any profession and professional degree.
Personally, I started my PT career in early intervention and school-based pediatric care. Treatments were hands-on, neuro, orthopedic, and sensory based. I took continuing education courses focused on pediatrics, manual and sensory techniques, neurodevelopmental techniques, school-based techniques, pediatric equipment needs, play therapy, splinting, and gait training. Later, when I switched to treating a (usually) geriatric client base in the home, I focused on taking continuing education classes geared toward that population. And yes, when I started working with an adult orthopedic client base, I started taking courses geared toward that population (manual therapy, taping, McKenzie, Maitland, Mulligan, myofascial release, dry needling, manipulations, mobilizations, core strength, Pilates, yoga). The options for continuing education seem boundless. Everyone is out there developing new techniques, branding them, and selling them. You as the learner get to decide what coursework makes sense and hopefully take some information away and apply it successfully to your client treatments. Funny, how that works. Stay current, learn new techniques, help your client base.
In 2009 I took my first dry needling course. It was a course teaching how to use thin needles to relax the neuromuscular system. It was based on Dr. Janet Travell's work in the 1940's on trigger points and myofascial pain syndromes. For me, it made a lot of sense to use the technique of dry needling on the client base that I was seeing at the time, mainly adults with work related injuries. Admittedly, I was nervous going back into the clinic to start using my newly acquired techniques. I cautiously and slowly began using the thin needles to start speeding up the healing process and cut down on overall treatment times. It appeared effective. I continued to use the needles and log my patient caseload as required prior to taking Level 2 dry needling. I was thankful for this technique as it meant I did not have to use my hands as much to dig into muscle spasms. I go through bouts of rheumatoid arthritis and my hands and fingers become painful at times. This technique is effective and saves my hands from some hard work. At the time, I did not realize what a 'hotbed topic' this course of study would prove to be. I just knew that it was helping me do my job more efficiently and effectively. I was able to quickly reduce pain and improve function in many of my clients. That's my main objective as a physical therapist. I was still using all of my evaluation skills, clinical decision making skills, palpation skills, and manual therapy skills but I was speeding up the process with thin needles.
Jump to 2018. I am still using needles in the same capacity, to speed up healing, decrease pain, and improve function. Through the years I have taken Functional Dry Needling Level 1, Functional Dry Needling Level 2, Advanced Functional Dry Needling Level 3, and Functional Therapeutics through Kinetacore in Brighton, CO. I use dry needling everyday in my practice at PinPoint Wellness in Lafayette, CO. I incorporate dry needling with my other techniques I have learned along the way through continuing education. I still use my hands on every patient. I still make clinical decisions based on what the client tells me, what I feel, and what the impairment is. I add the needles to speed the process of recovery, decrease pain, and improve function. I use a combination of soft tissue mobilizations, spinal mobilizations, joint mobilizations, passive range of motion, manual traction, myofascial release, dry needling, cold laser, kinesio-taping, electric stimulation, exercise prescription, and education with my clients, everyday. So for as broad a profession as being a physical therapist is, I have found a way to narrow in on neuromuscular pain and dysfunction. Years of study, years of continuing education, years of clinical practice.
So what do I hope to shed light on? Why am I angry? The general disrespect, insults, and debasement of my profession by the acupuncture profession. They too, use needles to treat tight muscles and a wide array of other ailments. They are vocal and litigious across the nation, claiming that we have infringed on a technique that they use. I will not begin to describe the theory of acupuncture and treatment methods, as it will only come back to me with criticism and scathing remarks. You, the reader, can Google acupuncture to learn more.
It appears, after all of these years of using dry needling in Colorado, the disrespect from the acupuncture community is not fading away. Over the past 6 years I have declined joining business networking groups because the acupuncturist in the groups would not let me talk about dry needling as a part of my profession. I have been told by acupuncture students to 'leave the needles to the acupuncturists.' Students! People that have not been in clinical scenarios nor have had any work experience. I have treated an acupuncturist fresh out of acupuncture school who told me she did not learn how to use the needles in the same way that physical therapists do. She reported that she would have to go for further continuing education to learn the deeper techniques. In my daily contact with clients, not one has ever confused my treatment (neuromusculoskeletal assessment, hands-on techniques, mobilizations, muscle energy techniques, dry needling, and education) with that of an acupuncturist.
The kicker that is prompting me to take action and publicize how we are treated by the acupuncture community happened last week. I know Facebook is usually rife with arguments and disrespect, but this one, since it effects my profession, still has me shaking my head in disbelief and anger. A member of the Colorado Acupuncture Association's Board of Directors put out some special gems. On 10/9/18 she declared: "PTs just revamp the whole medicine and call it dry needling in what's perhaps the greatest scope of medicine practice creep ever. They spent $100,000 just last year in just CO on just the topic of DN alone to lobby the effort. They are all over the place misinforming and misrepresenting and also puncturing lungs and arteries and nerves. No one is overseeing their weekend classes and they are encouraged to needle their patients after 1 weekend which includes about 7 hours of practice............Truthfully, the PT profession is impressive if not bold. Side note - a doctor of PT (after the undergrad etc like the rest of us) has 3 years of schooling - it's the easiest and shortest doctorate to achieve in the medical profession. 'Dry Needling' is orthopedic/sports/trigger point acupuncture and there are different kinds of acupuncture from Chinese, Samuri, 5 element, Japanese, lineage, sport, ear, etc. Acupuncture is a full robust medical paradigm in its own right. Here's what dry needling is: In the 70's a group of MDs were injecting lidocaine in trigger points. They wondered how much of the effect was the drug vs the trigger point twitch from the empty (dry) hypodermic needle so they experimented by 'dry needling' - meaning they did the needle thing but didn't inject. PTs however can't get their grub hands on hypodermics and somehow still got their hands on acupuncture needles and are calling acupuncture dry needling to circumvent a whole slew of laws and regulations. And education."
According to the acupuncture community we PT's are evil, unsafe, and uneducated while we are flippantly puncturing lungs, arteries, and nerves with our grub hands. Can't you just feel the love. I've heard many acupuncturists say that PT's should go get an acupuncture degree if they want to use needles. I say huh? Why would I do that? I have my education in physical therapy, that's who I am. I've been doing physical therapy for almost 20 years. I've been dry needling since 2009. I do not wish to study Eastern Medicine, herbals, moxibustion, blocked Qi and meridians.
I wish to continue to resolve neuro/musculoskeletal problems with my experience, hands-on treatment, modalities, dry needling and anything else I learn along the way. I wish to be respected (maybe just tolerated) by the acupuncture community. I wish that I did not feel bullied everyday by the acupuncture community. I wish we could collaborate and refer to each other. I wish we could appreciate each other's expertise. No one provider or technique can solve every issue. My goals will continue to be to help my clients avoid pain medications, steroid and stem cell injections, and surgery.
So, when I walked into my first dry needling class, I just thought it would be a cool thing to learn. Since 2009, I have continued on the dry needling path, taking classes, and honing my skills and techniques. Have I felt beaten up for being a physical therapist wielding needles? Yes. Have I helped clients feel better? Yes, everyday. Do I wish PT's could promote themselves and their techniques without criticism? Yes. Do I feel like dry needling is here to stay? Yes, I certainly hope so. I know PT's are still winning the rights to dry needle in many U.S. states. I know some states will never allow it because they won't combat the acupuncture associations. Would I do this all again? Yes, most definitely.
***For more information about dry needling (by physical therapists) please visit: www.dryneedlingconnect.com***
When you have pain, sciatica, shoulder pain, back pain, neck pain, TMJ, headaches, bursitis, plantar fasciitis, tendonitis, sprains/strains, epicondylitis, whiplash, knee pain, hip pain.......Visit a physical therapist!!!