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APTA Stance

American Academy of Orthopaedic Manual Physical Therapy approves dry needling as within the scope of 5 PT APTA state affirmations include: AL, CO, DO, GA, KY, LA, MD, MS, MT, NV, NH, NM, NC, OH, OR, SC, 2 TN, TX, VA, WI, WY APTA state declines DN in: 2 ID, NY, PA, SO, UT, HI

Dry Needling
A new practice within physical therapy

Education/Certification
Example Curriculum Includes Trigger
2

Point DN Level 1 Therapy Concepts or GEMt 3-day course-principles Need 200 treatment sessions to progress to Level 2 AND

Trigger

Point DN Level 2 Therapy Concepts or GEMt 3-day course-hands on Become Functional Dry Needling Practitioner

Questions may be directed to Smalvitz@wisc.edu Resources are available upon request

*Many companies offer different ways of becoming certified and most are not accredited ** Some PT programs have added DN into their degree seeking coursework

University of Wisconsin
Department of Rehabilitation

What is Dry Needling (DN)?

Deep vs. Superficial Vs. Intramuscular Electrical Stimulation


For All Types1:
The needle inside its tube is held against the suspected area with the non-needling hand. The needling hand loosens the needle from the tube and taps the needle top causing skin penetration.

Sometimes referred to as intramuscular manual therapy, DN is a skilled intervention done primarily by physical therapists in which a solid filament thin needle is used to penetrate the skin for stimulation of underlying tissue.

DN vs Acupuncture6,8
Dry Needling is founded upon the anatomy of the neuromuscular system Acupuncture is founded upon early concepts on meridian lines and the flow of energy

What Can DN Help?


Myofascial Trigger Points (MTrP) Local and Referred Pain Decreased Range of Motion

Precautions1
1. Needle Phobia 2. Cognitive Impairments 3. Local Skin Lesions 4. Local Lymphedema 5. Severe Hyperalgesia or Allodynia 6. Allergies to Certain Metals 7. Abnormal Bleeding 8. Compromised Immune System 9. First Trimester of Pregnancy 10. Vascular Disease 11. Post-Surgical Joint Capsule Procedures

Decreased Muscle Activation Pattern Myofascial Restriction Peripheral Neuropathy or Radiculopathy Diagnoses include but are not limited to : Achilles Tendonitis Lateral Epicondylitis Frozen Shoulder TMJ Dysfunction Plantar Fasciitis Headaches
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Deep:
Focuses on dysfunctional motor units After insertion, the needle is drawn back and forth without removing it from the skin for desired twitch response. Next, remove the needle and reassess.

How Does It Work? 3


Superficial:
Targets peripheral sensory afferents With no twitch response, needle is inserted and kept in place for 30 seconds. Repeat if necessary for 2minute duration. Taut Band Reduction Increased Blood Flow Release of Endogenous Opioids Effects on Neurotransmitters Gate Control Theory Placebo

Contraindications1
1. Local or Systemic Infections 2. Under the age of 12 (not recommended)

Intramuscular Electrical Stimulation:


Similar theory as TENS Tx parameters not firmly established Negative electrode on MTrP and positive electrode in taut band outside of MTrP Common Uncommon Rare Very Rare

Risks2
Bleeding Inflammation Pain Nerve Irritation Redness Blood Pressure Change Local Infection Pneumothorax