doris

I understand your concern to not make it worse but with the IDN approach you have several approaches to take. I would first start needling in the calf down the common fibular and tibial nerve distributions.  I am not sure if you are advanced trained or not but that way you can get effect on the neuroma proximally and not have to disturb the neuroma locally which sounds like is your concern.  As he does fine with that move distally toward the great toe and use 1/2" needles moving down the digital nerves in the foot.  This is slow progressive way to get anti-inflammatory effects safely.  

Hope that helps

Frank

I see a lot of different TMD at my clinic and I would look at the following.  

First, what is the upper cervical like?  If the upper cervical has poor mobility needle greater occipital, sub occipitalis, C2 and C3 paravertebrals and greater auricular homeostatic.  If there is a lot of upper trap tightness too get spinal accessory homeostatic because the upper traps insert at the base of the skull.  Follow this up with a lot of upper cervical ROM, and retraction exercises.

Second look at how his jaw is opening, a lot of times there is severe lack of protrusion which limits the necessary anterior translation the TMJ needs while opening.  This will be limited when upper cervical is in more extension (forward head posture).  If he is lacking protrusion severely needle the suprahyoids.  Needling the masseter is always helpful in addition.  In the advance course they teach needling the medial pterygoid which would be helpful for this patient as well.  

If it looks like there is trigeminal nerve damage from radiation make sure you are doing a lot of opening exercises with end available range isometrics to help restore this strength.  

This patient may need additional manual therapy internally as well to get the areas that you are not able to dry needle.  

Hope this helps!

Dan Price

That’s a great question in one. I don’t think we’ve gotten yet. I’ll start by saying, I am not the authority to give you permission to or not to dry needle in another country but what I will give you are things to consider.

I believe needling in general is controlled at the federal level in Mexico, so that would be a little bit more complex to get a simple. Yes, I can

I would check with your liability insurance provider to make sure they will cover you in another country. Now I’m sure there’s additional coverages with the team. I’m just thinking about you specifically

I’m not exactly sure which state you’re in so you may be covered under the physicians license, but I refer back to the question. Can the physician practice in a different country?

My apologies I’ve given you only additional questions, but unfortunately, I do not have a definitive answer for you. Please let us know what you find out so we can all benefit from your efforts!

Frank