Dry needle puncture , also known as trigger dry myofascial trigger point , is a technique in alternative medicine similar to acupuncture. This involves the use of either a solid filiform needle or a hollow-core hypodermic needle for muscle pain therapy, including pain associated with myofascial pain syndrome. Dry needle puncture is sometimes also known as intramuscular stimulation (STI).
While much research has been done to test the efficacy of the dry puncture as a treatment for muscle pain, there is still no scientific consensus as to whether or not it is effective. Some results suggest that it is an effective treatment for some types of muscle pain, while other studies have shown no benefit compared to placebo. There is not enough high-quality study of techniques to draw clear conclusions about its efficacy.
Chinese-style tendinomuscular acupuncture relies on a careful palpation of the so-called "Ah Shi" points, which often correspond to trigger points and/or motor points in myofascial tissue. Chinese-style tendinomuscular acupuncture tends to use the lower needle (thicker) required to puncture the contraction node with a high degree of precision. On the other hand, lighter acupuncture styles, such as Japanese style, and many American styles, may tend toward a more shallow gauge syringe. Most acupuncture styles, especially those with lighter techniques, require detailed knowledge, not only anatomy but also network and channel connections. Thus, while some forms of acupuncture are not at all the same as dry punctures, the term dry puncture can refer specifically to what is now called Myofascial Acupuncture, Tendinomuscular Acupuncture, or some version of Acupuncture Sports.
Video Dry needling
Origin
The origin of the term "dry puncture" is associated with Janet G. Travell. In his book,
The use of syringes for dry needles is described by Chang-Zern Hong in his research paper on "Lidocaine Injection Versus Dry Needling to Myofascial Trigger Point". In his research, he describes the procedure for trigger points or MTrP injections and dry needles using a 27-gauge hypodermic needle 1 / 4 -in long (Hong, 1994). Both Travell and Hong use syringes for dry needles. Hong, like Travell, does not use acupuncture needles for dry puncture.
Although a dry needle needle initially only uses a syringe because of concern that the solid needle does not have the power or tactile feedback given the needle and the needle can be deflected by a "solid contraction node", the concern has proven to be unfounded and many health practitioners are stabbing dry needles have found that acupuncture needles not only provide better tactile feedback but also penetrate "solid muscular nodes" better and more manageable and cause less discomfort for patients. For that reason, both the use of hypodermic needles and the use of acupuncture needles are now accepted in the practice of dry needle needles. Often practitioners who use syringes also provide injection treatment of trigger points to the patient and therefore find the use of a hypodermic needle is a better option. As their use becomes more common, some practitioners need a dry acupuncture needle without acupuncture in the sphere of their practice, beginning to refer to this needle with their technical design terms as "solid filiform needles" as opposed to the FDA appointment of "acupuncture needles".
The "solid filiform needle" used in dry stabbing is regulated by the FDA as a Class II medical device described in the code entitled "Sec 8805580 Acupuncture Needles" as "a tool intended to penetrate the skin in acupuncture practice". In accordance with the Food and Drug Act of 1906 and subsequent amendments to the act, the FDA's definition applies to how the needle can be marketed and does not mean that acupuncture is the only medical procedure in which this needle can be used. Dry needle needles using such needles contrast with the use of hypodermic hollow needles to inject substances such as saline, botox or corticosteroid solution to the same point. In a small number of studies, the use of solid needles has been found to be as effective as substance injection in cases such as pain reliefs in muscle and connective tissue.
The Founder of Integral Systemic Dry Needling (ISDN), Yun-Tao Ma, has been the spearhead of the "dry needling" movement in the United States. Ma states, "Although ISDN is derived from traditional Chinese methods, it has evolved from an ancient empirical approach to modern medical art rooted in evidence-based thought and practice." Ma then opposed herself by stating, "The dry needlestick technique is a modern Western medical modality not related to traditional Chinese acupuncture in any way, dry needle has its own theoretical concepts, terminology, needling techniques and clinical applications." Ma is well aware of the self-contradiction and the legal consequences of a dry needle rooted in acupuncture and Chinese medicine has since erased all information in his bios on his education in Chinese Medicine and became a Licensed Acupuncturist in the United States.
The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) menyatakan:
Dry needle puncture is a neurophysiological evidence-based care technique that requires effective manual assessment of the neuromuscular system. Physical therapists are trained to use dry punctures together with manual physical therapy interventions. Research supports that dry needle needle improves pain control, reduces muscle tension, normalizes biochemistry and electrical dysfunction of the motor end plate, and facilitates acceleration back into active rehabilitation.
The above statement is sufficiently clear about the functional, physiological and medical aspects of treatment. The Manual of Dry Needling Color Edition (2) Technique (Volume 1) is the basic reference text for therapists trained in the method of dry needling procedures in accordance with the norms of their respective country practices. The basic steps given in this book can make the therapist practice using the dry needling technique for the subject under different clinical conditions. The text focuses not only on the steps that need to be done but also focus on what a therapist should not do while performing the procedure. At work, we have taken all the guidelines provided by OSHA for blood-borne diseases and WHO guidelines on workplaces and hand hygiene.
Dry needle puncture for the treatment of myofascial trigger point (muscular) is based on a similar, but not exclusive, theory on traditional acupuncture; acupuncture and dry needle needle trigger point, which is a direct and palpable source of patient pain. However, dry piercing theory only begins to describe the complex sensory reference patterns that have been documented as "channels" or "meridians" in Chinese Medicine. Dry needle puncture, its treatment techniques and desired effect, will be most directly proportional to the use of 'a-shi' points in acupuncture. What further differentiates the dry stick from traditional acupuncture is that it does not use a variety of traditional Chinese Medicine theories used to treat not only pain but other non-musculoskeletal problems that are often the cause of pain. The difference between the trigger point and the acupuncture point for pain relief is unclear. As reported by Melzack, et al., There is a high degree of correspondence (71% based on their analysis) between published trigger sites and classic acupuncture points for pain relief. The debatable difference between dry needle and acupuncture has become controversial because it deals with the problem of the scope of various professions.
Maps Dry needling
Technique
In the treatment of trigger points for people with myofascial pain syndrome, dry needling is an invasive procedure in which a filiform needle is inserted into the skin and muscles directly at the myofascial trigger point. The myofascial trigger point consists of several contraction nodes, which are related to the production and maintenance of the pain cycle. Deep dry needles to treat trigger points were first introduced by Czech physician Karel Lewit in 1979. Lewit has noticed that the success of the injection into trigger points in relieving pain seems unrelated to the analgesics used.
The right dry puncture of the myofascial trigger point will generate a local twitch response (LTR), which is an involuntary spinal cord reflex in which muscle fibers are in tight muscle ties. LTR shows the exact placement of the needle at the trigger point. Dry needle puncture that gives rise to LTR improves treatment outcomes, and can work by activating endogenous opioids. The activation of endogenous opioids is for the analgesic effect using Pain Gate Control Theory. Inserting the needle itself can cause considerable pain, even if done by an unconventional trained practitioner. No studies to date that report the reliability of the trigger point diagnosis and physical diagnosis can not be recommended as a reliable test for the diagnosis of the trigger point.
Benefits
Currently there is no standard form of dry puncture, no evidence indicating its efficacy, and no medical pathway provides the theoretical basis for why a dry puncture should be efficacious. Much of the research published on dry needle needle has no strong evidence; neither randomized studies, containing small sample sizes, had high rates of drop out, used active intervention in the control group, did not follow the acceptable minimum criteria for diagnosing myofascial trigger points, nor did it clearly state that myofascial trigger points were a single cause for pain. For example, in a systematic review of needle therapy in the management of myofascial trigger points, only 8 of 23 trials depicting criteria are acceptable at a minimum to diagnose the trigger point. Finding the trigger point for a dry needle needle is the basis for performing a dry needle needle and should, therefore, be documented in any study that performs this technique. In the same review, two studies tested efficacy beyond the placebo from dry puncture in the treatment of myofascial trigger point pain, but, in one, the dropout rate was 48% and not blind or random, and other studies used potentially active intervention in the control group. Others conclude that a dry needle needle can reduce pain, thus improving mood, function, and disability. This study used a dry needle at the trigger point to reduce pain in patients with chronic myofascial pain.
Another systematic review concluded that the dry powder for the treatment of myofascial pain syndrome in the lower back appears to be a useful adjunct to standard therapy, but stated clear recommendations can not be made because the published study is small and of poor quality. A 2007 meta-analysis that examined the dry puncture of myofascial trigger points concluded that the stabbing effect did not differ significantly with placebo control, although trends in the results could be compatible with the treatment effect. One study (Lorenzo et al., 2004) showed a short-term reduction in shoulder pain in stroke patients who received needles with standard rehabilitation compared to those who only received standard care, but this open-label and time-varying study restricted the use of the study. Again the small sample size and poor quality of research are highlighted. The systematic review and meta-analysis 2013 released by JOSPT on "the effectiveness of dry needles for upper myofascial pain" recommends the use of dry needles, compared with sham or placebo, to relieve pain immediately after treatment and at 4 weeks in patients with myofascial pain syndrome top quarters. However, the authors caution that "the limited number of studies conducted to date, combined with the methodological shortcomings in many studies, encourages caution in interpreting the results of the meta-analyzes performed".
A 2014 review of dry needle syringes found insufficient high-quality evidence for the use of direct dry needles for short-term and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. The same review found strong evidence that validates clinical diagnostic criteria for identification of trigger points or poor diagnoses and that high-quality research suggests that manual checks for trigger point identification and localization are invalid and unreliable among checkers. A systematic review and meta-analysis 2017 found very little evidence supporting the use of dry trigger point needle to treat pain and upper shoulder dysfunction.
Controversy
Many physical therapists and chiropractors have asserted that they do not practice acupuncture when the piercing is dry. They claim that much of the basic physiological and biomechanical knowledge that uses dry needling is taught as part of their core physical therapy and chiropractic education and that special dry needle skill is additional to that knowledge and is not exclusive to acupuncture. However, the originators and supporters of dry needles recognize that certain aspects of this technique are inspired by acupuncture although they also recognize that the medical basis for it is Western Medicine purely in nature and therefore unauthorized part of acupuncture and is a medical part that separate. process. Many acupuncturists argue that a dry needle appears to be an acupuncture technique that requires minimal training that has been repeated with a new name ("dry puncture"). Whether acupuncture is considered acupuncture depends on the definition of acupuncture, and it is said that the trigger point does not match the acupuncture points or meridians. They fit the definition for the ad hoc category of acupoints 'a-shi'. It is important to note that this category of points is not necessarily different from other formal categories of acupoints. In 1983, Janet Travell et al. describes the location of the trigger point as 92% in correspondence with known acupuncture points. In 2006, Peter T. Dorsher, an acupuncture expert at the Mayo Clinic, concluded that both points systems have approvals of more than 90%. In 2009, Dorsher and Fleckenstein concluded that strong consistency (up to 91%) of the distribution of pain patterns referred to trigger regions for acupuncture meridians provides evidence that trigger points are likely to represent the same physiological phenomena as acupuncture points in the treatment of pain disorders. An article on Acupuncture Today (May 2011, p.Ã, 3, "Scope and Standards for Acupuncture: Puncture Needles?") Further strengthens the correspondence of 92% of the trigger point to acupuncture points. In 2011, the Academy of Acupuncture and Oriental Medicine Council (CCAOM) published a position paper describing a dry puncture as an acupuncture technique.
The North Carolina Acupuncture Board of Licensing has published a position statement asserting that a dry needle needle is acupuncture and thus covered by Acupuncture Acupuncture Act of North Carolina, and not within the scope of Practice Physical Therapist practice, and Physical Therapist not among the professions exempt from law. The Attorney General requested an opinion by the Council of North Carolina Acupuncture Accountants that he gave on December 1, 2011 saying that "In our opinion, the Physical Therapy Tester Assembly may determine that a dry needle needle is within the scope of physical therapeutic practice if it carries out the drafting under the Procedures Act Administrative and adopt a rule linking a dry needle with the definition of physical therapy practice according to law. "But that's a matter of opinion and not a legal matter. The North Carolina Rules Review Committee of the legislature found that the North Carolina Physical Therapy Board has no legal authority for the proposed rule. The Board of Physical Therapy then decided that they have the right to declare a dry puncture in scope as well. "The council believes physical therapists can continue to perform dry punctures as long as they have the necessary education and training required by NCGS Ã,§ 90-270.24 (4) , but there are no regulations to set specific requirements for dry stabbing. "
In May 2011, the Oregon Chiropractic Supervisory Board decided to allow "dry stabbing" into the sphere of chiropractic practice with 24 hours of training. In July 2011 the Oregon State Court of Appeal issued an order, preventing the bone expert from practicing a dry needle needle until the case was heard in court. The document issued by the court stated that "dry puncture" is "substantially the same" as acupuncture and that "the respondent has not explained how 24 hours of training, without any clinical component, provides sufficient training for chiropractors to protect patients." In September 2011, the Oregon Board of Chiropractic Examiners and the Oregon Attorney General appealed the order on the grounds that they felt the commissioner who issued the order was wrong in his statement. On November 10, 2011, the Oregon State Court of Appeal issued a Denying Commandment for Review. The impact of the verdict is that the entire Court of Appeal will now determine whether the delay is appropriate. This stay is relevant only in Oregon State.
In January 2014, The Oregon Court of Appeals ruled that the Oregon Chiropractic Supervisory Authority did not have the legal authority to include dry punctures in practice for chiropractors in the country. The verdict does not mention whether a chiropractor has the medical expertise to use a dry needle or whether the training provided is sufficient. Awaiting further discussion on training requirements, Oregon Physical Therapy Nurse Board has advised all Oregon physical therapists to practice a dry needle needle. They did not change their decision that a dry puncture is within the scope of practice for Oregon Physicians.
The American Medical Association adopted a policy in 2016 that said other physical and non-physician therapists who practiced dry pies should - at least - have standards similar to those for ongoing training, certification, and continuing education for acupuncture. AMA board member, Russell W. H. Kridel, M.D. states "loose regulation and standards that do not exist around this invasive practice.For patient safety, practitioners must meet the standards required for acupuncturists and licensed physicians."
See also
- Acupuncture
- Myofascial Discharge
- Trigger point
References
Source of the article : Wikipedia
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