July 3, 2019 at 4:18 pm #28500drrabornptMember
Hi all…I have a college aged, female patient who has POTS and she has a pretty clear lumbar radiculitis and is quite sensitive in predictable homeostatic points in the low back and into her legs, more so on one side. Do any of you have insight into using dry needling with a patient who has POTS? I want to implement this with her and believe it would help. I have some reservation as CNS stress/stimulation could be an issue with POTS. But I don’t see this as a contraindication. Thoughts?
July 15, 2019 at 9:23 am #28697larafreidlineParticipant
I agree you do have to pay attention to the neurological responses. I have used IDN with one of my patients with POTS for neck and low back pain. Results were very mild after several treatments so decided not to continue IDN. Good luck.
August 9, 2019 at 9:59 pm #29300drrabornptMember
I appreciate the info! I did needle her this week and preliminary results are mixed. Her back felt pretty good. LE needling points were pretty hypersensitive, especially on the radicular side. I believe i used 8 needles for her initial dose targeting L5, superior cluneal, ITB, and sural n. She said the next day her back felt great but her legs were sore. Only problem with our assessment is she was significantly more active than she was used to the two days prior. I thought she may have been more sore in her legs had we not needled her. I’ll need another round or 2 and may needle higher up the chain as advised to see how she responds. It is sensible to use needling to tap into the process of central inhibition in her case. Thanks all!
July 18, 2019 at 10:50 am #28891NickParticipant
I use it regularly with my POTS patients. I like to think of it as if someone was sympathetically upregulated. From an orthostatic standpoint make sure to do initial needling sessions laying down to avoid any vagal, parasympathetic response. You may also consider more superficial needles and starting with a lighter initial dosage until you get a feel for their response to needling.
In addition to treating the pain complaint I may add in needling areas in the upper cervical spine, trigeminal n. distribution, and thoracic (through the levels of the sympathetic chain ganglia T1-L2). I also recently have noticed myself focusing more on the TL junction area in this population. Perhaps the guarding is a function of the psoas origin, diaphragm attachment, location of the kidneys and adrenal glands, or location of the cysterna chyli anteriorly. In any case I often notice significant muscle tone in this area.
Let us know how it goes!
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