Notes from Structure & Function Dry Needling Level I: FOUNDATIONS IN ORTHOPEDIC REHAB AND SPORTS PERFORMANCE

Stuff I liked…

• Integration of eastern thinking and acupuncture, if not explicitly, then certainly implicitly (notably, the idea that overcleaning the sites can kill “good” bacteria and “adverse” reactions to needling such as nausea/disorientation/vomiting may actually be a good thing as a sign of the body trying to recalibrate itself.)
• No resheathing of the needles..needles are cheap, no need to risk an accidental stick
• It was a good anatomy review in general…and a good reminder how much there still is to learn!
• Needle technique isn’t that difficult. Knowing where to stick and needle and where/when to NOT stick a needle is more important
• Helped me think deeper about the SMFA…for example, treating one of Stecco’s fascial points, if you follow the SFMA breakouts from multisegmental rotation, there’s a good chance you’ll wind up in one of these places….then you recheck your work. Good to have a movement baseline
• Did not insist on bottoming out (through feel not end feel)
• Brings the perspective of downregulating/upregulating the nervous system in context of athlete’s competitive schedule (broader perspective than just hunting down trigger points, which has been an unfortunately narrow misinterpretation of DN)
• Deemphasis on trigger point hunting and bottoming out seems to result in less residual soreness

NOTES

• No "dangerous" points; just depends on level of training and education
• Traditional acupuncture is a large umbrella term
• Western medical acupuncture – tries to reverse engineer traditional Chinese medicine
• …then if we can't figure it out we just call TCM stupid
• Think beyond MSK
• Auricular acupuncture – "battlefield acupuncture"
• Twisting the needle -> depletes ACh at endplate…but doesn’t always correlate with decrease in pain
• Problem with trigger point dry needling – can cause lingering soreness
• Stuff in the body that’s important is usually surrounded by fat
• Needling nerves is like a sticky piece of cooked spaghetti
• IMS ->  C fibers -> endogenous opioids
• Not just about sticking the needle in…what do you do with it?
• Superficial DN -> afferent input -> increase motor output
• Short term reactions are similar in superficial versus deep needling
• Goal = maintain and restore the homeostatic balance of the patient
• C fibers = small and slow kid 
• Mast cells determine where the party is going on
• Histamine release = why the needle can be difficult to remove
• Food/adenosine -> vomit/nausea
• Example: athlete had needling for first time, then later went to ER for intense pain/nausea….actual cause was passing kidney stone
• Theoretically, needling during pregnancy could cause spontaneous abortion
• Segmental effect -> overlapping nerve fields/segments can make it difficult to isolate sometimes
• Nociplastic pain = misinterpretation of pain centrally from the periphery
• If you want to achieve systemic effects of pain control but not segmental, treat distally (ie, treat lower body if unable to isolate upper body segment)
• Why can pain be emotional – lateral spinothalamic tract has stops to limbic system
• Pain is manifested in many different ways
• Exploiting the endorphin release from spinal cord can be helpful to get people off opioids
• Can treat local, segmental, systemic -> always be prepared for systemic effects
• Periphery still matters in neuromatrix theory
• Time of day matters for needling
• Dry needling treats nothing but may treat everything
• Needles help an unbalanced system (eastern thought)..Vomit/fatigue can be good!
• General principles – less is more, dosing is key, setting up for success
• The more comorbidities = more conservative approach
• Don’t even have to be in muscle to get result – don’t have to get twitch
• TDN studies get ambiguous results because TrP identification is not reliable
• Physical winding of tissue takes place 4cm away from needle
• Needles allow you to get through layers and reach target tissue
• Why does “pecking” work for OA? Satellite cells differentiate into what they need to be-> new synovial cells formed -? More synovium formed
• For short term results – superficial needling
• There is value at putting needles at the site of pain
• Diameter of needle doesn’t affect outcome measures but does affect comfort
• Dosing…think of it like medication. You can always start low and then increase (volume, thickness, frequency)
• If patient is sweating after 2-3 minutes you’ve already tapped into supraspinal mechanisms
• Documentation language addition – “all needles remained intact’
• Could make the argument that you are killing good bacteria with swabbing
• When people have severe scoliosis, organs are just fighting for space
• Spina bifida – needle would be like sticking a wrench in a light socket
• ALWAYS have the option to NOT needle
• Active infection – can send patients bodies into overdrive if exposed to needle
• If patient on blood thinners – test with small, thin needle superficially
• Pneumothorax 100pct preventable. Know your anatomy
• Drowsiness can be good or bad…depends on context
• Scar tissue does better with unpolished needle
• Why electricity works – fatigue out synergistically dominant muscles
• Surface electrodes still good for co contraction
• Axonal damage treatment – some evidence to support healing at low intensities
• E stim is just a controlled needle manipulation – converts biomechanical stimulus to biochemical
• All stuff gets released all the time but systems can be biased toward different chemicals based on frequency
• Lower Hz – more stuff is released giving better chance that one will work
• Limited evidence on who responds/doesn’t respond to needling…but light skinned/light hair/low BF tend to not respond as well anecdotally
• Go as deep as we need to go---think through feel, not end feel
• Garage end feel analogy – you can stop your car in the garage by stopping it or you can drive it into the back of the garage
• The drama is above the skin…tissue doesn’t care what your letters are (PT, DC, MD, etc)
• Acupuncture+biomechanics+fascia -> lots of similarities…doesn’t matter if you say hola, bonjour, hello…all basically mean the same thing