1. Supported in part by Arkansas Blue Cross and Blue Shield
and the Office of the Arkansas Drug Director and in partnership with the Arkansas Academy of Family Physicians (AAFP), the Arkansas Medical Society (AMS), the Arkansas State Medical Board (ASMB), the Arkansas Department of Health (ADH) and its Division of Substance Misuse and Injury Prevention (Prescription Drug Monitoring Program—PDMP)
Continuing Education Credit: TEXT:
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2. Dry Needling by Physical Therapists
Leah Tobey, PT, DPT, Cert. DN
Doctor of Physical Therapy
Certified in Dry Needling
UAMS Orthopaedics

3. Objectives Define Dry Needling in Physical Therapy
Fact or Fiction?  Identify Mechanisms of Pain & Dry Needling Mediated Analgesia
Identify appropriate patient diagnoses

4. How to join our poll questions:
Grab your cell & open a new text
Text the number 22333
In the message line, type LEAHTOBEY999 (not case sensitive)

5. https://www. polleverywhere

6. Dry What…? Dry vs. Wet Needling
Dry: No medication being used during DN
Wet: Lidocaine injection done by MD
Best evidenced-based treatments & Best outcomes =
+ Electrical Stimulation
(Internal TENS unit)

7. What is DN: Dry Needling?
Dry Needling is a pain-relieving treatment technique using thin filiform needles. The needles are inserted into areas of hypersensitivity aka “knots” or taut trigger points and help create an internal, mechanical and chemical change within the tissue and creates a change in a patient’s CNS & disrupts to help relieve pain
What is DN: Dry Needling?

8. DN: Dry Needling Technical Definitions
The American Academy of Orthopedic Manual Physical Therapists (AAOMPT) states:
“Dry Needling (DN) is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions. Research supports DN improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor end plates, and facilitates an accelerated return to active rehabilitation.”
The APTA document Description of Dry Needling in Clinical Practice: An Educational Resource Paper.
"Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. [It] is a technique used to treat dysfunctions in skeletal muscle, fascia, and connective tissue, and to diminish persistent peripheral nociceptive input, and reduce or restore impairments in body structure and function, leading to improved activity and participation."

9. https://www. polleverywhere

10. Caveat
“The integration of symptoms, examination of findings, and the current evidence provide ‘best practice’ physical therapy for neuromusculoskeletal conditions with the addition of dry needling to a multimodal combined approach.”
Dry Needling Institute of American Academy of Manipulative Therapy James Dunning, DPT, MSc Manip Ther, OCS, MCSP, MAACP (UK), FAAOMPT, MMACP (UK).

11. DN Dry Needling Brief History
Dates back to 1940’s with Dr. Janet Travel
Identified muscular trigger points and referral patterns that were elicited with Wet Needling
Discovered Dry Needling offered the same results = Groundbreaking!
Dr. Travel & Dr. David Simon identified most of the trigger points located in the human body. Thus, the first generation of modern Dry Needling was established.

12. DN Dry Needling Benefits
Improve Blood Flow
Possibly induce a healing process to the affected tissues
Intramuscular DN with Electrical Stimulation
Desensitize structures
Hypersensitive tissues can be irritable & the treatment can induce discomfort
Deactivate taut trigger points
Reduce Pain
Decreased pain is felt within 24 hours*
Endogenous opioids + endorphin release, etc. during mm twitch response
Followed by sustained mm relaxation
Restore Function & Motion
Speeds up healing process; improved mobility is immediate in many cases
Tremendously beneficial for quick and tangible results on top of other movement remediations

13. Anatomy
Physiology
Biomechanics
DN Treatment Process
"It's something a PT does in conjunction with determining range of motion, stretching, exercise, posture correction. ”
-Dr. Jan Dommerholt
During a 45’ session: 10 minutes of DN
+ 15 minutes of E-Stim with needles
+ 20 minutes of neuromuscular re-education for ROM, posture, strengthening

14. Osteoarthritis of L knee: The PT might treat 20 minutes of dry needling with E-Stim. Plus other manual therapies: patellar, tibial/fibular joint mobilizations, stretching and strengthening exercises in addition to the DN.
This can jumpstart the healing process with improving blood flow, stimulates collagen,
Frequency: 2-3x/wk x 4-6 weeks

15. Acupuncture Dry Needling Traditional Chinese medicine
Use of acupuncture points located near/on the skin’s surface
Pricking the skin ¼ to 1 inch for treatment of various physical, emotional and mental conditions
Pain relief via balance of the body’s energy/life force, Qi and Meridians (pathways).
Aka Myofascial Trigger Point Dry Needling or IMS: Intramuscular Stimulation
Technique used to treat myofascial, acute and chronic pain via de-activation of trigger points (MTrPs)
Mechano-transduction & chemical changes to CNS
Winding, Wind & Holds, Pistoning, E- Stim
Used in conjunction with manual therapy, exercise, postural education, stretching.
71% correspondence between MTrPs & acupoints

16. Who is appropriate for DN: Dry Needling?
Patients with acute, chronic or myofascial-type pain who need a
“Central Nervous System Reboot” in conjunction with other PT treatments.
Low back pain
Sciatica
Hamstring tendonitis
Hip & Knee OA
Hip bursitis
Achilles tendonitis
Headaches
Neck pain
Cervical radiculopathy
Shoulder pain
RC tendonitis

18. Poll everywhere question: what conditions do you want to know more about related to PT or Dry Needling?

19. References
American Physical Therapy Association Board of Directors. Guidelines: Physical Therapist Scope of Practice (BOD G ). Accessed February 9, Updated 2018.
Guide to Physical Therapist Practice 3.0. Alexandria, VA: American Physical Therapy Association; Accessed February 9, Updated 2018.
American Physical Therapy Association. Physical Therapists & the Performance of Dry Needling. Published January Accessed February 9, Updated 2018.
American Physical Therapy Association. Description of Dry Needling in Clinical Practice. Published February Accessed February 9, 2015.
WebMD.com/painmanagement
Dr. James Dunning, Dr. Raymond Butts. Dry Needling Institute of American Academy of Manipulative Therapy.