New perspectives on dry needling following a medical model: are we screening our patients sufficiently?

ABSTRACT

Myofascial trigger points are not an isolated neuromusculoskeletal phenomenon and have been implicated in systemic, visceral, and metabolic pathology, as a side effect of some medications and in the presence of psychological risk factors. This complexity can complicate adequate screening of patients prior to choosing dry needling as a treatment intervention. Regardless of whether clinicians practice in a direct access setting, they should be cognizant of medical conditions, comorbidities, and risk factors that will influence clinical decisions for dry-needling appropriateness, technique chosen, and potential adverse responses to treatment. Of primary concern are conditions that can either manifest with myalgia and/or myopathy or masquerade as a more common musculoskeletal condition. This clinical commentary reviews system-specific considerations and other common disorders that should be screened for and discusses not only whether dry needling is appropriate but comments on technique and dosage considerations when initiating dry needling.

KEYWORDS:

• Dry needle
• trigger point
• safety
• screening

Disclosure statement

No potential conflict of interest was reported by the authors. The primary author teaches dry needling as a guest faculty member for the North American Institute of Orthopaedic Manual Therapy. Cesar Fernandez-de-las-Penas and Josue Gan are instructors in Trigger Ponit Therapy and Dry Needling for David G. Simons Academy. Jacqueline Doidge is Co-Director and Senior Lecturer for Optimal Dry Needling Solutions.

Additional information

Notes on contributors

Gary Kearns

Gary Kearns is an assistant professor in the Doctor of Physical Therapy Program at Texas Tech University Health Sciences Center. He is a fellow in the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) and his fellowship project entitled Medical Diagnosis of Cubital Tunnel Syndrome Ameliorated with Thrust Manipulation of the Elbow and Carpals was published in the Journal of Manual and Manipulative Therapy in 2012. He graduated with his Doctor of Science (ScD) in Physical Therapy through Texas Tech University Health Sciences Center in 2015. Most recently, he became a board-certified specialist in Orthopedic Physical Therapy (OCS) in 2016.

César Fernández-De-Las-Peñas

César Fernández-de-Las-Peñas is a professor of physical therapy at Universidad Rey Juan Carlos, Madrid, Spain where he is the head division of a clinical research group focusing on pain sciences. Cesar has 18 years clinical experience in private practice and pain clinic, focusing on manual therapy approaches for the management of chronic myofascial pain. He conducted his PhD in biomedical sciences in the Centre for Sensory Motor Interaction (SMI) in Aalborg University, Denmark and a second PhD in Physical Therapy at the Universidad Rey Juan Carlos. His research activities concentrate on biomedical sciences within neuroscience, specifically on pain science and assessment in chronic pain patients and healthy subjects. He has over 400 scientific publications, being leading researcher of approximately 150 of them. Most publications concentrate on neck pain, headaches, carpal tunnel syndrome, lateral epicondylalgia, and the neurophysiological effects of manual therapy. In addition, Cesar is a renowned lecturer worldwide and a distinguished guest speaker in conferences.

Jean-Michel Brismée

Jean-Michel Brismée is a professor in the Doctor of Science Program of Physical Therapy and Doctor of Philosophy Program of Rehabilitation Sciences at Texas Tech University Health Sciences Center. He has authored over 100 scientific papers in refereed journals related to musculoskeletal physical therapy practice

Josué Gan

Josué Gan is a PT working in a private practice in Bern, Switzerland. He is an instructor in trigger points therapy and dry needling for David G. Simons Academy. He is currently finishing his MSc in musculoskeletal at the University of Applied Sciences of Zurich, Switzerland.

Jacqueline Doidge

Jacqueline Doidge has been a physical therapist since 1977, trained in Canada, and studied medical acupuncture and dry needling from 1987 to 1992 in South Africa. She lectured at University of Cape Town in manual therapies and trigger point techniques from 1987 to 1992. She has been in Arizona since 1994 and brought the ODNS dry-needling courses to USA in 2014. Since then, she has taught more than 35 courses in dry needling throughout the USA, Kenya, and the Middle East.