The rehab world is always evolving and going through trends, from using mainly passive modalities such as Ultrasound and TENS to more active approaches with exercise and re training. And now the trend seems to be needling techniques, be it acupuncture, IMS, dry needling or some weekend course you took in someone’s mom’s basement, it’s as if everyone wants to needle, asks to be needled or just plain needles for no reason.
Is there some evidence that shows there is a benefit to needling? Yup there sure is! Is there some evidence that shows that it does squat other than turning people into pin cushions? Yup there sure is! So then whats the point of this post you ask? Simple, to get people thinking about why they needle and do we really need to be needling as much as we do.
Lets start with the question we should always be asking ourselves as we are trying to rehab a client, WHY? Why should I be sticking this sharp metal object into some dysfunctional tissue and possibly fish it around until the tissue twitches and grabs. I’m not going to go into the science (or not so science) of why we needle and the affects we are looking to achieve, rather what is our clinical reasoning of using this treatment. Are we trying to change the neural input/output to the muscles, bring more blood flow, decrease pain or restore muscle function? The answer is probably (hopefully) yes to some or all of the above. But my question is, is using a needling technique the best way to achieve this? How about if the tissue is dysfunctional due to a strength loss or a patients perception of pain or being movement adverse? Is a needle going to help those issues or just further feed into them?
Don’t get me wrong, I use needling in my practice on a daily basis, but I also see too many practitioners that rely on needling as a primary method of treatment. Weak quads resulting in knee pain? Needle it. Sub-Occipital headaches due to weak and overactive sub-occipitals? Needle it. Limited Lumbar ROM due to fear of movement and incorrect pain beliefs. Needle it. Will needling help in all these conditions? Probably. Will needling provide a long term solution and “fix” the problem? Probably not. So in all these examples I think needling is a “fine” technique/tool to use, but isn’t the only tool, nor is probably the best suited as a primary rehab treatment. Strengthening of the quads, cervical re-training and stabilization, patient education would be more effective treatments in these cases.
It sounds simple enough, and most people reading this are thinking “well no shit you can’t just needle and think everything will be fine”. But I’ve seen enough clients that come back time and time again, have had dozens and dozens of “treatments” with IMS or acupuncture and never seems to get to the root cause of their issue. I’ve had plenty of clients tell me they have been given exercises, either they just don’t do them (like most people) or the training load given is either not specific or not high enough. Too many people are given mindless exercises that really serve no purpose, other than to say they were given an exercise, with the standard 2-3 sets of 10 once a day. (spoiler alert – more on this in an upcoming blog)
With that being said the onus also needs to be on the patient. I get plenty of patients looking to just be needled. Usually because they had success with it in the past, or they heard from a friend that all they need is 1 or 2 treatments of IMS or dry needling. When this happens, I usually try to explain the entire treatment plan and where needling fits in that plan, and some get it and buy in. Others will just reply with “ok that makes sense, but can we do the IMS now?” or “I just want needling”. So as rehab professionals we also need to do a better job educating our clients of where needling is best used in regards to an entire treatment plan, not just in isolation of a single treatment.
Do I think needling is a useless treatment technique? Not at all, it can be a very effective tool if used properly and in conjunction with a well thought out treatment plan. If it works it works and if it doesn’t it doesn’t. Don’t just keep needling people for the sake of doing something. Do the strengthening, muscle re-training, patient education and then use needling to “clean up” some issues, or maybe you need to needle first to be able to achieve those goals. But to just needle and assume/hope the rest will fix it self because you needled it?
Maybe just keep needling.
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