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Five dry needling tips

by David Pope

5 tips for incorporating dry needling into your treatment

Dry needling is becoming a very popular adjunct to Physiotherapy practice, and something I use in my clinical practice every day to speed up my patients’ treatment results. Here are 5 tips for using dry needling in your practice

  1. Needle comfortably. A lot of people break into cold sweats at the thought of dry needling, and if this is your patients, you can back off your needling intensity and still get great results. Be more gentle with your needling, don’t push to get a twitch response, make it a more pleasant experience for your patients. Approaches such as the Dry Needling Plus are by nature a more gentle and comfortable experience, but you can tie this into whichever approach you use.
  2. Teach self down-regulation of muscles, then needle any remaining hyperactive fascicles. I like my patients learning and getting an awareness of how to “let go” of any overactive muscles eg “Butt grippers” may need to learn how to relax their Glute Max and Post Glute Med, or hamstring grippers may need to learn that they don’t need all that resting tone in their lateral hamstrings when they are standing around or lying down. You can teach your patients how to let go of these muscles first, with techniques such as the Release With Awareness taught by LJ Lee on the Discover the Sports Pelvis and Discover the Sports Thorax courses, or the Active Release Technique, or similar techniques. You can then needle any muscle fibres that they may not have the neural patterns to “let go” of yet to speed the process along.
  3. Needle before performing any joint mobilisation. When you identify a stiff joint eg a stiff talo-crural joint, it may be simply compressed by muscle activity around it. Needle the muscles around this joint (eg Tib Ant, Tib Post, Soleus) first, then reassess if the joint is still stiff. You will surprise yourself to find it is often not “stiff” any longer
  4. Needle in functional positions. If you have a muscle that ramps up it’s activity at a certain point in range eg lats increase in activity at 90 shoulder F, take the person into this position, rest their arm on something and needle their lat in this position
  5. Don’t stretch after needling. This may seem counterintuitive, but strong, forceful stretching may irritate the tissues you have needled, rather than settling down overactivity. If you do stretch, do it gently, with awareness, and focusing on relaxing muscle tension.

I hope these tips help you get even better results with your needling.

Remember, you need to attend a dry needling course that meets the legal and insurance requirements in your country to be able to perform needling in your practice, and you need to follow all of your contraindications and precautions.

How do you incorporate dry needling into your clinical practice? Let me know in the comments below

 

  • Great tips Dave, I think it's difficult to make the call that a joint is stiff before reducing muscle tone. Needling is a quick way to make that tone change to reassess joint mobility. I once managed to miraculously unfuse an ankylosing spondylitis patient's SIJ within one session. Bam!

    • David Pope

      Great work Russell, sounds like there might have been a bit of muscular compression of that SIJ rather than the Anky Spond stiffening it up. Bam!

  • Interesting tips Dave. Mega thanks for posting. Keen to know more about #5 on stretching. Are there any recent articles etc on your radar which go into this in more detail?

    • David Pope

      Hi Elaine, I haven't seen any studies on this, it is something I have noticed clinically, and when testing it out using myself as a guinea pig. Pretty easy to overexcite and tighten up your needled muscles again by stretching vigorously afterwards. Some nice gentle ROM and movement retraining work seems to work better in my experience.

      Let me know if you find any studies on it!

  • kanchan shingala

    Great tips Dave! These would surely be helpful. Let me tell you that most of my patients love the gentle dry needling technique. Thank you.

    • David Pope

      Great to hear!

  • Laura Costello

    My daughter is studying in Copenhagen for the semester. She is on the crew team back home and has been medically disqualified due to injury. She was having dry needling at home which was helping. Can you recommend a top notch physiotherapist in Copenhagen for her to see that has been trained in dry needling? Thank you.

    • David Pope

      Hi Laura, no idea of anyone trained in dry needling there. Kristian Thorborg is at the Amager Hospital though, he has been on the podcast for hamstring injuries, and would be worth looking up. Good luck!

  • Jon A

    I've reached the same conclusions about stretching after dry needling while dry needling a partially denervated glut max (unfortunately my own). However, I've found that acupressure seems to work really well immediately after dry needling, even on fascicles that were nowhere near the needle. Interestingly enough, soft tissue mobs don't have the same effect…..for me it needs to be fairly strong acupressure (ie supine on a lacrosse ball).

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