Forum Replies Created
Hi Jackie, I do not have any specific evidence to share with you. I can share my personal experience treating my own daughter’s osgood schlatter’s knees over the past 5 years. I use 0.18 x15mm needles. I haven’t needled at the growth plate areas themselves, so I am sorry not to be able to answer your exact question. I use the homeostatics in the symptomatic area (saphenous, common fibular, tibial, and sometimes lateral popliteal and sural if she will let me). The discomfort reduces for a time after needling. In addition, she gets symptom relief from K-tape offloading (and she thinks she looks cool!), and dynamic cupping following the tibial, fibular, sural and saphenous nerve distributions throughout the entire leg. She likes vibration therapies to the posterior knee, but doesn’t tolerate the vibration therapies to the anterior knee or tibial. I use arnica lotion as the lubricant for the dynamic cupping. Although she hopes to be grow to 5 feet 5 inches tall or more, I am hoping her current 5ft 3 in is closer to her final height just so the poor kid can start existing without swollen knees and maybe get back to tolerating kneeling and the occasional bump to the shin. Sonya Worth PT
When in doubt anywhere in the spine, be certain of your palpation of bony landmarks (spinous processes and transverse processes), shorten the needle if there is any doubt about the integrity of the lamina in the area you plan to treat.
I have no experience dry needling patients with co-existing leukemia diagnoses. Consider discussing your plan of care with the patient’s haem/oncologist and PCP.
The 20560 and 20561 codes are untimed codes.
I have had some success calming the neurogenic inflammation using dry needling following the neurology and also needling between the metatarsals at the affected region. If the neuroma is well organized I would not expect needling to resolve the neuroma .
I would advise you to be thorough with your palpation of each and every spinous process and transverse process to be absolutely certain you are needling in the gutter created by the spinous process and the transverse process therefore giving you the lamina as a bony backdrop for the needle. Use the 1:1 rule, or shorten the needle to a 15 mm (half inch) needle if you are in any doubt.
Hi James and Nick
I would approach an acute injury just as Nick did. Start with superficial needling in the area of injury , add homeostatics in the region, gradually increase dosage. Of course, this would be in the context of a full orthopedic examination and plan of care.
Since eliquis is a blood thinner, dry needling would be a “precaution” not an absolute contra indication. I personally always check with the physician who prescribes any blood thinners prior to dry needling their patient. Usually this provides an opportunity for a connection with the provider and education about PT and dry needling if necessary.
Looks like the case study pdf is too large to attach here.
Here is the reference:
Bell, L., Stout, N. L., & Geiser, M. B. (2019). Dry Needling for Chronic Breast/Chest Wall Pain After Breast Cancer Treatment. Rehabilitation Oncology, 37(3), E14-E16.
I can share the full text file if you have difficulty accessing it.
Hi! I have not. I have had some good results needling old surgical scars in the periphery, especially when adding e-stim. I do have a colleague who reports some improvements in post mastectomy axillary scarring/cording with careful dry needling under the supervision of an oncologist and lymphedema therapist. I am also attaching a published case study treating chest wall tightness with dry needling and e stim. Although this does not answer your question, it is all I have to offer. Be careful in the presence of any limb or chest wall lymphedema. Sonya Worth
It turns out the file size is too large to upload here.
This is the full reference:
Rha, D. W., Park, G. Y., Kim, Y. K., Kim, M. T., & Lee, S. C. (2013). Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clinical rehabilitation, 27(2), 113-122.
You can access this through “google scholar” easily. There is no charge to download the publication from research gate.
I apologise for this slow response. Attached is a pdf of the PRP article I referred to.
I recommend posterior cutaneous needling in the lumbar (homeostatic, segmental, and symptomatic) and sacral (segmental and symptomatic) regions, distal neeedling in the femoral and sciatic nerve distributions (homeostatic), and symptomatic needling wherever indicated by the patient’s presentation.
I would imagine superficial abdominal needling would be worth exploring, along with superior cluneals, SIJ region.
If you have taken our Advanced Course, exploring the obturator nerve distribution may be helpful depending on the patient’s symptoms.
Good luck! Let us know how this works out.
Yes, in VT I have called the case worker prior to starting the episode of care, or prior to adding dry needling to the episode of care. The case worker has been happy to cover dry needling in these cases.
The APTA description of dry needling in clinical practice document recommends caution when needling patients in the first trimester of pregnancy.
Park et al The safety of acupuncture during pregnancy: a systematic review. Acupuncture Medicine. 2014; 32:257-66. and, Carr, D. The safety of obstetric acupuncture: forbidden points revisited. Acupuncture Medicine. 2015; 33:413-419. Both state that acupuncture at forbidden points: does not increase the risk of adverse pregnancy outcome in controlled clinical trials; is not associated with increased rates of adverse pregnancy outcome in observational studies, and does not induce miscarriage or labour..
Thus, your patient at 36 weeks pregnant may benefit from a trial of dry needling for her sciatic nerve pain, provided there are no other contra indications or precautions to dry needling.
If you do find any more specific references to dry needling (or acupuncture) for sciatic nerve pain during pregnancy, do share them with us.
Also consider sharing your patient’s response with the forum as a case study.