Diploma Of Remedial Massage HLT52015
Dry Needling – The Neuromuscular Acupoint System
Dry Needling is an advanced technique commonly used by Remedial Massage Therapists, Myotherapists, Osteopaths, Chiropractors, Physiotherapist and other physically orientated therapists. Though Acupuncture needles are utilised it is not acupuncture. Acupuncture is a complete medical system known as Traditional Chinese Medicine which is governed by meridian theory and utilises both pulse and tongue diagnosis.
Dry Needling is most commonly used by therapists to treat trigger points in muscles, in the integrative neuromuscular acupoint system (INAS) these points are known as symptomatic points as they provide symptomatic relief to muscular dysfunction.
INAS utilises three types of points –
SAs – local points which give symptomatic relief
PAs – Segmental these points are paraspinals – points which may be used to influence pain patterns found in the corresponding dermatomes see figure A dermatome charts
Has – these are holistic points which homeostatic points which are used repeatedly it the INAS protocol, they have an effect of offloading the sympathetic nervous system see figure B
Figure A
Figure B
Twenty-four homeostatic acupoints (HAs).
(Modified from Abrahams P, Hutchings R, Marks S: McMinn’s color atlas of human anatomy, ed 4, London, 1997, Mosby.)
This system has been shown to give predictable, repeatable and reliable results in management of injuries as well as treatment of both acute and chronic pain conditions. A treatment would typically utilize as many HA points as possible as well as the appropriate PAs and SA points as selected as being appropriate by the therapist. Treatment typically takes an hour, less for treatment of acute injuries. The Therapist will place the needles in the appropriate points and leave them in for approximately 15minutes, with the exception of the upper Trapezius points, with these points a Trigger point needling technique is used, the needles are not left in here as there is a danger of pneumothorax injury should the patient move during the treatment. After the needling component of the treatment advanced Remedial Massage techniques are applied again as deemed appropriate by the practitioner in order to address the issues presented by the patient. Patients would typically have 1 treatment per week for 1 month after which the treatment intervals may be spaced out according to the results being achieved. Acute injuries may be treated with shorter intervals during treatments, these sessions are typically shorter 30 minute treatments would commonly be indicated here, cluster needling techniques may be used here to treat the injured site.
See figure C example of cluster needling
Figure C – Cluster Needling of Corked thigh
Needle length varies depending on the area being used in the thoracic area needles no longer then 30mm are used. The longest needles are used for the Inferior Gluteal point in most patients 75mm needles are used, however in some patients 100mm needles are needed. Needles are inserted at various angles oblique 45’, perpendicular 90’, perpendicular-oblique70’ transverse-oblique 20’ and transverse these angles are referring to the skin as the reference point. On the lateral thoracic area only transverse techniques with cupping are used see figure D
Figure D – Cupping with 30mm needles of lateral thoracic region
Dry needling may be utilized to treat almost any muscular skeletal condition, contraindications include skin eruptions or inflammations, skin growths, ganglia, tumors and cancers, patients with blood clotting disorders, patients taking blood thinning medications. As with any treatment infection control measures must be strictly adhered to. Acupuncture needles are sterile single use needles the needle must be held by the handle the shaft of the needle must not be touched, if a needle has been removed form its tube and is dropped this must be discarded. Any open needles must be discarded if not used in the session. The patients skin is prepped for treatment using an alcohol wipe, tea tree oil or another appropriate antibacterial substance. The practitioner must adhere to strict hand washing between patients and again the use of a antibacterial solution on hands is indicated. Needles must be placed in a sharps container when removed from the patient. Single use sterile gloves are indicated to be used in any procedure where contact with blood, body fluids, mucous membranes or non intact skin is indicated.
As this system uses points which down regulate the sympathetic nervous system commonly the patient will feel a deep sense of relaxation post needling treatment. Commonly immediate change in pain perception is evident though this may take several treatments for the patient to achieve lasting pain relief. The number of treatments required usually correlates to the severity and chronicity of the condition. The treatment when combined with Remedial Massage techniques is however superior to either technique in isolation. Patient response to treatment may be predicted by screening prior to treatment using quantitative acupuncture evaluation techniques. Beginning at H1 deep radial point count down H1-2, H1-3 H1-4 (approximately 1 cun apart – Chinese inch) see diagram and record the number of equally tender point on each side
After the upper limb points the lower limb points are located see diagram H4-1 Saphenous H4-2 H4-3 H4-4 again using the same pressure at each point record the tender points
After the number of points have been recorded patients may be classified into 4 groups according to the number of tender evaluation points
0-4 = A patients
5-8 = B patients
9-12 = C patients
12-16 = D patients
A patients are the most responsive to treatment and D patients generally are likely to have a poor response.