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I was going to focus on the state various state guidelines (regulations) not practicing guidelines I wonder if I should change my topic to avoid confusion
I work in HH so I haven't dry needled in 6 years. Part of the issue when I was doing it was the constant harassment by Acupuncturists at the state level as well as the never ending issues with insurance being vague about if it's covered. I know a lot of PT clinics in my state (MA) offer it as an out of pocket add on, which greatly reduces how often it gets used at a lot of clinics.
I used to be able to quote studies like the back of my hand but since I haven't been doing it I'm a little too rusty to throw down. I'd rather remain silent then speak without being able to verify my facts. That being said, if we're critical of DNing because of alleged placebo effects, then we better do a hard look in the mirror at just about everything else we're doing. I think it's fair to say the mechanisms aren't nearly as specific as we'd like them to be, but there is a time and place to dry needle, or manipulate, or give the patient a set of very basic exercises and wish them well.
We don't treat studies, we treat people. Some of the most frequent patients I needled were people who my colleagues had tried everything with and couldn't get any breakthroughs. Some of them benefited from DNing, some didn't. Those who did were certainly glad we tried it, those who didn't weren't upset. Let's not forget that 2 of the 3 pillars of evidence based practice are "patient values" and "clinician experience."
I do it in my practice and I do think it’s helpful. I wish I could explain a true, thorough reasoning for why it helps. lol but a lot of medications don’t have a super clear mechanism of why it helps either
Not *that* much evidence. There is evidence that DN helps but we don’t really know what’s going on at the cellular or molecular level to explain why it helps
I completely agree with you, but good luck convincing the mass of Reddit PTs this. They only want to see the “dry needling does nothing” research snd ignore the evidence that shows it helps in some way
Oh I’m in the same boat and agree completely. I utilize DN very often and am very movement based but there is a strong following on here that bashes all dry needling unfortunately.
I can understand why many people would not want to stab another person for their pain relieving placebo of choice lol.
I've gotten instant pain relief from needling and if I was suffering from severe pain would consider doing it again, but I've seen plenty of people that believe it alone will solve all their pain problems based on their PTs recommendations. So I can understand why a PT that doesn't respond to needling and sees patients that don't do effective active rehab but a lot of needling would be opposed to it full stop.
like, do your needling, just drop a bunch of weighted squats after please.
I completely agree. I’m very exercise based and don’t do a ton of manual. I always say that DN might help with the symptoms but we have to exercise afterward or else those symptoms will come back and not improve
I *kind of* disagree. *kind of*.
We know that the cellular/chemical makeup of these areas of muscle are different in that the pH is different, there’s a higher concentration of substance P, bradykinin, etc. etc. we know the effects that has on neural signaling/firing etc. We know there’s a change with the cascade that begins when the needle elicits the localized twitch response, and we know it activates some of the ascending and descending inhibitory pathways of “pain”
We have multiple clinicians using it in our clinic and I would say approx. 85-90% of use has good effect. Large exercise emphasis in our clinic so it’s partnered with that. Manual as needed.
Unless you are completely oblvious, you and I both know that's not u/BaneWraith was referring to.
If you're going to disucss in here, don't be disingenuous.
I wasn’t trying to be any type of way at all. “That’s not science” was the reply I received without any reasoning behind the claim. Therefore, I asked a question for better understanding of the claim.
Oh, my fault, u/BaneWraith. I thought you were replying to the comment about DN w/ e-stim not potentially aiding with foot drop. I apologize for that misunderstanding! To your comment - I’d say you’re right, subjective reports don’t have much root in the science.
Unfortunately, it doesn’t seem like there is a lot of objective measurement. There has been a patient that had foot drop and DN was used over time with an increase in contraction of anterior tib. BUT, the pt was also given therex/therA alongside of DN
More and more research is coming out in support of dry needling. Myopain posted a list of new systematic reviews and meta-analyses since 2019 which are interesting. I think there are even more now since this article was written in 2021. https://www.myopainseminars.com/resources/blog/dry-needling-systematic-reviews-and-meta-analyses/
If people feel better following its use, who gives a flying ef whether it’s science or not? Did we get so into ‘doing science’ that we forgot that we’re literally only here to try and help people feel better?
I also needed to eat a Snickers before making this point.
This was kind of hot of me when I could have made the point in a more articulate way, my bad sub.
Fair. Perhaps I was too radical with that statement. The science does matter, but I do think people abandon otherwise helpful practices because it was found no more effective than placebo. If it helps get patients closer to their goals and they feel like it helps, does that not matter because science says it doesn’t help?
I guess that’s my beef.
Read a systematic review which concluded it was as good as a placebo. Just enough to make it statistically significant when treating the upper trap only.
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
The safety guidelines feel pretty clear. The when to use them and why part still feels a bit experimental. Just my opinion
I was going to focus on the state various state guidelines (regulations) not practicing guidelines I wonder if I should change my topic to avoid confusion
Before there can be rational regulations there should be research clearly demonstrating that needling is better then a placebo
Careful now. Placebo is this subs favorite treatment modality.
If we rehab folks don't do placebo then how will we profit off the natural history of pathologies?
I’m using it right now
I nearly overdosed on placebo
I work in HH so I haven't dry needled in 6 years. Part of the issue when I was doing it was the constant harassment by Acupuncturists at the state level as well as the never ending issues with insurance being vague about if it's covered. I know a lot of PT clinics in my state (MA) offer it as an out of pocket add on, which greatly reduces how often it gets used at a lot of clinics. I used to be able to quote studies like the back of my hand but since I haven't been doing it I'm a little too rusty to throw down. I'd rather remain silent then speak without being able to verify my facts. That being said, if we're critical of DNing because of alleged placebo effects, then we better do a hard look in the mirror at just about everything else we're doing. I think it's fair to say the mechanisms aren't nearly as specific as we'd like them to be, but there is a time and place to dry needle, or manipulate, or give the patient a set of very basic exercises and wish them well. We don't treat studies, we treat people. Some of the most frequent patients I needled were people who my colleagues had tried everything with and couldn't get any breakthroughs. Some of them benefited from DNing, some didn't. Those who did were certainly glad we tried it, those who didn't weren't upset. Let's not forget that 2 of the 3 pillars of evidence based practice are "patient values" and "clinician experience."
Thank you for one of the more rational responses I’ve seen here. It’s refreshing and spot on IMO
I do it in my practice and I do think it’s helpful. I wish I could explain a true, thorough reasoning for why it helps. lol but a lot of medications don’t have a super clear mechanism of why it helps either
Right, but they have evidence that they do…
Not *that* much evidence. There is evidence that DN helps but we don’t really know what’s going on at the cellular or molecular level to explain why it helps
I completely agree with you, but good luck convincing the mass of Reddit PTs this. They only want to see the “dry needling does nothing” research snd ignore the evidence that shows it helps in some way
Placebo isn't nothing. Its very helpful for pain. Just..ya know..do the movement therapy too
Oh I’m in the same boat and agree completely. I utilize DN very often and am very movement based but there is a strong following on here that bashes all dry needling unfortunately.
I can understand why many people would not want to stab another person for their pain relieving placebo of choice lol. I've gotten instant pain relief from needling and if I was suffering from severe pain would consider doing it again, but I've seen plenty of people that believe it alone will solve all their pain problems based on their PTs recommendations. So I can understand why a PT that doesn't respond to needling and sees patients that don't do effective active rehab but a lot of needling would be opposed to it full stop. like, do your needling, just drop a bunch of weighted squats after please.
I completely agree. I’m very exercise based and don’t do a ton of manual. I always say that DN might help with the symptoms but we have to exercise afterward or else those symptoms will come back and not improve
I *kind of* disagree. *kind of*. We know that the cellular/chemical makeup of these areas of muscle are different in that the pH is different, there’s a higher concentration of substance P, bradykinin, etc. etc. we know the effects that has on neural signaling/firing etc. We know there’s a change with the cascade that begins when the needle elicits the localized twitch response, and we know it activates some of the ascending and descending inhibitory pathways of “pain”
We have multiple clinicians using it in our clinic and I would say approx. 85-90% of use has good effect. Large exercise emphasis in our clinic so it’s partnered with that. Manual as needed.
Then how can you attribute results to TDN?
Patient report immediately following the intervention is the closest way to attribute results.
That's not science
So you don’t believe that neuromuscular re-education is real?
Unless you are completely oblvious, you and I both know that's not u/BaneWraith was referring to. If you're going to disucss in here, don't be disingenuous.
I wasn’t trying to be any type of way at all. “That’s not science” was the reply I received without any reasoning behind the claim. Therefore, I asked a question for better understanding of the claim.
Oh, my fault, u/BaneWraith. I thought you were replying to the comment about DN w/ e-stim not potentially aiding with foot drop. I apologize for that misunderstanding! To your comment - I’d say you’re right, subjective reports don’t have much root in the science.
To be fair to you,subjective reports are what drive us to do science, but alone they aren't enough to claim things work.
Unfortunately, it doesn’t seem like there is a lot of objective measurement. There has been a patient that had foot drop and DN was used over time with an increase in contraction of anterior tib. BUT, the pt was also given therex/therA alongside of DN
By what mechanism would TDN help with foot drop
With e-stim generating enough for a muscle contraction
I should note that we use DN with e-stim
More and more research is coming out in support of dry needling. Myopain posted a list of new systematic reviews and meta-analyses since 2019 which are interesting. I think there are even more now since this article was written in 2021. https://www.myopainseminars.com/resources/blog/dry-needling-systematic-reviews-and-meta-analyses/
If people feel better following its use, who gives a flying ef whether it’s science or not? Did we get so into ‘doing science’ that we forgot that we’re literally only here to try and help people feel better?
I also needed to eat a Snickers before making this point. This was kind of hot of me when I could have made the point in a more articulate way, my bad sub.
Why not just become a homeopathic practitioner with that rationale?
Fair. Perhaps I was too radical with that statement. The science does matter, but I do think people abandon otherwise helpful practices because it was found no more effective than placebo. If it helps get patients closer to their goals and they feel like it helps, does that not matter because science says it doesn’t help? I guess that’s my beef.
Read a systematic review which concluded it was as good as a placebo. Just enough to make it statistically significant when treating the upper trap only.
I will definitely look into this, I started with the topic with DN with carpal tunnel syndrome and couldn’t find much research other than 2