dry needling

How Physical Therapy Dry Needling Transformed my Practice After 17 Years

I have been practicing physical therapy for 17 years. I love to learn and I am always on the look out for the most current and effective ways to manage my patients’ pain. When I discovered dry needling, and later became certified in it, I was able to improve my skills as a PT and transform my career.

My story

I graduated from PT school in 2000 with a Master’s degree from Saint Louis University. I have practiced in several different settings, including pediatrics, nursing homes, home care, acute care, and outpatient orthopedics. Orthopedics has always been my love and has been where I’ve spent most of these last 17 years.

Regardless of the setting, one constant in the world of physical therapy is change. I can recall handwriting my daily SOAP note in 1 of 3 columns on a single sheet of paper. Abbreviations were necessary in order to best describe what you were trying to say. Check boxes were common so that you would not have to rewrite the exercise from the day prior. It was much simpler then my current 7 page electronic document that includes every detail from the exact direction and grade of my mobilization to my comprehensive plan that matches the outlined certification period.

In addition to complex documentation changes (always the first thing on my mind…ugh), the entire examination and intervention thought process has been revolutionized.

I am now a Doctor of Physical Therapy, thanks to Rehab Essentials transitional DPT program. I have been a DPT for 4 years now and my eyes and ears have opened up to the formality of all of the transformations my profession has gone through. I also witnessed these changes each time I observed a younger colleague perform tests and measures that I was unfamiliar with.

Since I love to learn, I was elated to be exposed to new techniques (and I’m naturally a bit competitive, so I had to stay ahead). I attended several continuing education courses to make sure I remained current and was not considered “old school”. My practice slowly evolved and I was feeling quite proud of the work I was doing and the treatment I was providing.

Physical therapy and my dry needling transformation

Over the years, I have become acutely aware of my strengths and weaknesses. I knew that my kinesthetic understanding of the human body and how it functions co-dependently is something I can be proud of. However, I questioned how I could effectively supplement my exercise offerings with more advanced manual skills that take less time and better promote patient buy in.

I learned several options throughout my continuing education journey, including soft tissue and joint mobilization, muscle energy techniques, IASTM, and functional movement patterns combined with manual trigger point release. These all have their place and they are definitely helpful tools in my toolbox.

However, I could never really “get that knot out” in my chronically tight patients and often wished I had the background, setting, and hands of a massage therapist. In addition, the constraint of the insurance companies put pressure on me to get my patients better faster.

A colleague of mine discovered a potential way to do just that. She became certified in dry needling a few years ago and although I was intrigued, I never thought it was something I could see myself doing. I referred a few patients to her and witnessed immediate changes in range of motion and reductions in pain that I never saw with other interventions. At the same time, however, I observed battling insurance companies and limited coverage for this unique treatment approach. My interest faded and quite honestly I couldn’t see myself comfortably poking needles in someone.

Fast forward a few years to about one year ago. Another colleague of mine became certified in dry needling. I listened to her inservice and witnessed the same great results. She did not describe insurance battles and appeared very excited about her new approach. I was at a point in my career where I desperately needed a new technique. Something to refresh my practice and create some excitement. I signed up for the Myopain Seminars course in March of 2017 and became certified in dry needling.

I immediately put this into practice when I returned to the clinic. I needled at least 1-2 people per day and observed outstanding results.

The very first client I needled was a gentleman in his 50s with a 10 year history of chronic back pain. He walked in with his torso flexed forward, his gait guarded, and a depressed demeanor. During my evaluation, I determined that his psoas muscles were tight (among other things). Also, he had become very deconditioned since he quit running due to pain. He was now taking on a sedentary lifestyle that included alcohol abuse. He was one of those challenging “hot messes” and I wasn’t convinced that PT was enough to get him better.

I chose to pull out the needles and try to “unlock” his lower body by needling his quadratus and then his psoas. I was very nervous as the needles for these muscles are quite long and it is considered a “blind approach” because you can’t palpate these muscles directly. He experienced incredible cramping during the procedure and left the clinic feeling like something changed, but he couldn’t quite describe it.

Two days later, I observed this same man working with the PTA. He was standing upright and performing strengthening exercises with a smile on his face. I couldn’t believe it! He said the needling was amazing and significantly reduced his pain. I was thrilled! This was exactly the reason I needed a refresh! This reminded me why I signed up to be a PT!

The honeymoon

I felt like I was on a honeymoon with my needles and continued to use them as a regular part of my practice. I consistently experienced incredible results, some more dramatic then others. I became increasingly thrilled and acutely aware of the background information I learned when becoming certified in dry needling. The premise of dry needling is based off of the concept of referred pain patterns.

Dr. Janet Travell is the original guru of this concept and is the co-author of Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1 & 2.

Janet Travell

On January 26, 1961, US President John F. Kennedy appointed Dr. Janet Travell as his personal doctor. She was the first woman to hold the post.

I knew that Dr. Travell’s name was familiar and I knew I learned about referred pain patterns in school. I also knew that several of my younger colleagues used this terminology and incorporated it into their care. However, this was not part of my regular practice. I was amazed to discover what I had been missing all of these years – another possibility to explain a person’s pain! Those “knots”, or trigger points, that I’ve always worked on removing play a larger role than I had initially realized.

I’ve prided myself in consistently looking above and below the area of pain in order to fully understand and identify compensatory patterns. I confidently understood how weakness or tightness in one area could lead to dysfunction and pain in another. I’ve been successful in treating this way. However, there are definitely times when the pain description is vague and I’m stumped or when I have exhausted all other methods and nothing seems to work.

Often times, I blamed the patient for non-compliance knowing that if they would simply be consistent with their exercises, their joints would operate in a more neutral manner and suffer less strain. The education on referred pain patterns has opened my mind to exactly what those nasty muscle knots have the power of doing.

I can ask my patients to stretch and I can lengthen their tissues. However, if this is my only focus, then I am not fully restoring their tissues and not addressing the true source of their pain.

Anne H. Campbell, PT, MS, OCS, CMTPT, FAAOMPT from Myopain Seminars uses an excellent analogy to understand the role the muscle knot plays in the length of the tissue. She said to think of the muscle knot as a knot in a rope. If you keep pulling on the ends of the rope, you may lengthen it slightly, but you are not removing the knot. The knot is simply getting tighter. This helped me understand the importance of soft tissue work when restoring muscle function.

Dry needling is a very effective and quick method to accomplish this. However, it is not for everyone. It can be uncomfortable and can also be a source of fear for some patients. Although I am still very excited to use my needles on several of my patients, I do appreciate the value of the other tools I can offer. Like everything in PT, what works for some does not work for everyone.

Have an open mind

I’ve always understood the merit of patient education and realized the significant importance it has in dry needling. This is very different from everything else PT offers. It is invasive, yet it directly gets to the source of pain. Also, the majority of patients have never heard of it. I did some additional research and put together a helpful blog post that addresses 8 popular questions about dry needling. I use this information with every client.

Once their fears are abated and they are armed with information, the majority of people are comforted and open to the idea of dry needling.

Although the honeymoon is over, my needles are still my favorite tools. I have them available and offer them to almost every client. I’ve seen their power. One advantage of being the “experienced clinician” is that I am getting older and I’ve had more time to feel some of my patients’ ailments. I’ve suffered from back pain and currently have shoulder pain. I’ve felt the benefits of needling my own infraspinatus as a means of improving my shoulder pain (my colleague needled me – there is no way I could do that to myself!).

Dry needling isn’t a magical cure, but it has been one of the most effective interventions for restoring my shoulder mechanics and enabling me to better tolerate my exercises, therefore making them even more effective. I’m grateful for my career and everything I have learned. Who says you can’t teach an old dog new tricks?

Images

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About Elizabeth Wergin

Elizabeth Wergin
I am a PT, a mom of 2 girls and a blogger on mindful healthy living. I graduated in 2000 from Saint Louis University with a masters degree in physical therapy. I then received my doctorate in PT in 2013 from the University of Montana. I have been practicing mostly in orthopedics over the course of the last 17 years. My passions include healthy living, gardening, cooking, staying fit and learning about anything related to all of the above.

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