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Hi Joanne-
I don’t mean to not answer your question, but I would ask, what are you trying to accomplish by dry needling her? What is her pain generator, if her MRI and xrays are negative. Where do you think the pain is coming from? I would caution against DN if you are unsure where the pain is coming from or don’t have a specific goal that you think DN can directly impact.
Food for thought. Let me know if you have other details. I just would caution against needling bc nothing else has worked.
May not be the answer you are looking for, but I hope helpful.
Suehi Sarah-
I would use 1/2″ needles as long as you are below the iliac crest, around the area of hematoma. So sort of “Circle” the area if you will. you can add needles in the center as well…again…1/2″. leave in for 30 minutes at a time, every other day. Should see some immediate changes.Keep us posted!
Suehey Jen!
I usually use a fishing tackle box! That is an easy way to cart things around. I know people use rolling carts as well that they can roll into and out of the rooms with ease.As far as your start up goes…Meyer has a few starter kits that I set up for them, depending on what you wanted. Might be a good place to start. I would say
0.25 gauge
2 boxes 1/2″
4 boxes 1″
4 boxes 2″
4 boxes 3″
1 box 5″either the A1 or the Sierin brands. or both. The needles are quite different (Sierin really polished) so see what you like, depending on how much needle manipulation you do.
Hope that starts to help?
SueChris were you added? I know it is just getting up and running. Not sure if I have been added yet. lol!
SueHi Sarah! I would not directly needle the cyst. Doing what you are doing (all the muscles around the area) are a great call. Keep doing that!
Good luck and keep us posted!
SueHi Andrew!
What I have done in the past is place a 1″ needle about 1-2 fingers width into the syndesmosis from the malleoli up as high as they are painful. You can certainly add some stim (2Hz) to the top and bottom needle as well. And then any other contributing factors in the LE or foot and ankle you think would be helpful.Hope that gets you started! Looking forward to anyone else’s thoughts.
SueHi Sarah!
Glad the patients are getting moderate results. Are you placing several 1/2″ needles in the area of swelling for 20- 30 minutes? OR just 1-2 needles for a few minutes? You could increase your time for sure. Another option is to treat up the fascial chain…intermedius just lateral to the mid recutrs femoris…psoas…anterior tib..and between 1st and 2nd metatarsal in the foot. That is where I would personally head next. Total anecdote. Not evidence based. but what I would suggest clinically. hope that helps. Keep me posted!
SueDan-
This is a question that goes beyond DN. Several states do not have reciprocity and you should have a license to practice at all, let alone to perform DN. However, many ATs/ PTs travel with teams and cover their team despite where they are, and despite the state laws. This is a huge issue across the board, which is why things like the PT Licensure Compacture act http://www.fsbpt.org/FreeResources/PhysicalTherapyLicensurecompact.aspx and the Sports Medicine Licensure Clarity Act https://www.nata.org/sports-medicine-licensure-clarity-act are being worked on. http://cqrcengage.com/nata/app/bill/931768So- again- this issue goes beyond DN. I know I am not specifically answering your question but hope the above information provides clarity for treating your athletes/ patients across state lines in general.
Sue
Jennifer- while it would not be impossible to have symptoms that far out, I would say egotism 12 hours after. Would be rare. But…. certainly possible. We really are not sure how long different checmical changes occur so I would hesitate to say it is coincidence. Local, systemic and segmena effects are all right there, so needling the neck can be powerful.
It should be a very transient symptom though and should be cleared up by now. How is the patient doing? I would be cautious moving forward.
This is a great question Mark. I have not used that marker as a clinical onjective, nor have I seen it in the literature. Let me know if you find something in a lit review and will be curious to see if your colleagues have used this at all.
Hi Amanda-
I am hoping some of your colleagues jump in here who have more experience than I do with this diagnosis. I really don’t have much.My suggestion would be to start proximal…at the lumbar spine…or on the opposite extremity. Even doing some mirror box stuff while needling can be helpful (so I have heard) to change the sensory input into the brain.
I think avoiding the direct area is a good approach.
Hoping someone else chimes in with more detail or suggestions.
Keep us posted!
SueHi Rachel-
I double checked with our resident LPH and Pelvic Floor teacher Tonya Bunner. She stated:She is definitely affecting the pudendal nerve. If that is what she is
targeting than great! If not then she either needs to go more lateral
towards the trochanter with her needle or just leave the QF alone. If
she is targeting sciatic nerve then she needs to go up to piriformis or
greater sciatic foramen which would be a better choice.So I guess i would say- if you are aiming for pudental nerve…then you have got it! If not…see recs above. Hope that helps?
SueHi Ruben!
I am attaching a couple resources for you regarding needling post op. I will look for more as well. Hope these are helpful and please share anything you have found as well!
SueHi Joanne!
Great question! As you said, Cali has no board for ATs. therefore, no one governs them. They need to look to the BOC for practice guidelines and rules/ regulations. The BOC never trumps state law, rules or regulations, but in their absence, they need to be used for guidance for practice.The BOC allows dry needling if the MD has given approval for supervision and the AT has taken continuing education (which is not defined).
Please see the BOC Dry Needling Fact Sheet for more information!
Hope that helps!
Suehttp://doi.wiley.com/10.1111/j.1532-5415.2007.01314.x
Efficacy of Periosteal Stimulation Therapy for the Treatment of Osteoarthritis-Associated Chronic Knee Pain: An Initial Controlled Clinical Trial: PERIOSTEAL STIMULATION THERAPY FOR KNEE OA. Weiner et al, 2007
Also Dr James Dunning is coming out with a multi center trial that I have not seen yet but should be published soon.
Hope that helps!
SueHi Katie!
Sorry for the delay!Do you think it is just a cutaneous nerve or is it a peripheral nerve? If more peripheral, you could follow the nerve up towards the knee or even needle the dermatome that corresponds where her symptoms are (advanced class thoughts). Also, cupping with a silicone cup may be helpful in scar management, if there is any entrapment there. I will start cupping around 12 weeks if the scar seems stable and like it won’t open. Be mindful.
Those are my initial thoughts. Hoping someone else chimes in!
SueBrad!!
I am so sorry! Family emergency has taken me away from the computer this week. All is ok now!!
But this is a great question!! Let me gather some info and I will get back to you ASAP.
Sue
Way to rally North Carolina PT’s!!
Advocates for North Carolina physical therapists (PTs) have scored a victory by way of a superior court, which dismissed a lawsuit brought by the North Carolina Acupuncture Licensing Board (NCALB) against the North Carolina Board of Physical Therapy Examiners (NCBPTE), several PTs, and a physical therapy practice over the issue of dry needling by PTs.
Hi Todd! When you say “nodule” do you mean a thickened portion of the achilles from a chronic tendionopathy or peritendonitis? If so, I agree with you…can’t think of a reason to stay away from it.
If it is a cyst, then I would think twice. We just don’t know what is in it, and not sure if I would want to “open” anything that could spread infection.
If it is retrocalcaneal bursitis, I would try some 1/2″ needles around the edges of it and see if it helps.
Hope that helps overall! Anyone else? Thoughts or experiences?
All-
This is getting more and more messy. It is a shame that this is where time, energy and resources are being driven, all to perform an activity that is lawful under the North Carolina Practice Act.North Carolinians….keep us updated.
From Bart Bishop: In our clinics, we don’t try at all to get needling covered by insurance, rather we charge $20 per session on top of the copay and other charges billed to the insurance. It is $75/session if they come for nothing other than needling.
Dr. Ma’s response:
Yes. Needle 24 homeostatic points and cupping on muscles: back, shoulder , legs, Very effective to have symptoms relief.
So those of you who have not taken Dr. Ma’s Fundamental Course, you will not know the HA points. But we did go over some of them ( we just didn’t call them HA points). They are in his book. DO NOT do any of the points we didn’t go over. The ones in the t-spine and in the c-spine/ head and pec are dangerous and need special instruction or even different placement than what is on the chart. But the ones in the upper and lower extremities would be great.
Also- the amazing cupping! What a bonus!
