Getting Started with Myofascial Trigger Point Dry Needling
By David B. Fishkin, DC, MPH
Myofascial Trigger Point Dry Needling is the most powerful clinical tool for the treatment of soft tissue subluxation. The soft tissue subluxation (STS) is to be differentiated from the synovial joint-based subluxation treated by the chiropractic adjustment.Just as loss of motion and fixation is integral to the concept of synovial joint subluxation, so too is dry needling integral to treatment of the soft tissue system, albeit a different path. Just as we use the adjustment to clear the fixation and impedance in the osseous system so is the dry needling technique equivalent in its power to clear the soft tissue fixation, its pathomechanics and biochemical imbalance.
In the soft tissue scenario you have macro trauma, micro trauma, acute and chronic catalysts just as in the synovial/osseous system that lead to a sequelae of biochemical/biomechanical events. These events can foment spasming, locking and shortening of soft tissue elements that can no longer respond to internal cues and many external attempts to restore function to a normal physiologic state. The theories proposed by Simons and Travel serve as the underpinning of understanding that what has been coined a trigger point is only the extreme pathologic manifestation of the soft tissue subluxation which occupies a broader area under the continuum of soft tissue dysfunction.
We can now explain clearly that the soft tissue becomes subluxated, locked and fixated just as the synovial system does.
Reducing nervous system dysfunction via the soft tissue system is as critical as relieving it via the joint system. The work of Simons and Travel has contributed greatly to the understanding of this mechanism of muscle and soft tissue fixation. And other authors such and C. C. Gunn M.D. and Andrew Fischer, M.D. not only validate the chiropractic model but lend further support for nervous system dysfunction in the peripheral system throughout the soft tissues. And yet other authors such as Helene Langvine have written extensively about the broad communication of the fascial system and its effects on the body. Dry needling is a critical tool in treating these problems.
Direct and Effective
The approach of using fine solid needles to unlock and release the soft tissue structures is more direct and effective than other techniques available today. The difference I and those that I have trained have seen very positive clinical outcomes. Patients who walk in antalgic walk out greatly improved and chronic patients that previously were unresponsive now respond completely or stabilize. This is occurring at the front lines of practice and we have a number of case studies from the referred literature that I have posted on my website.
Sadly, only the doctors in sixteen states Maryland, Delaware, Virginia, North Carolina, South Carolina, Alabama, Connecticut, Florida, Utah, Illinois, Colorado, New Mexico, Rhode Island, New Hampshire, Oregon and Texas are currently permitted to take advantage of this fantastic approach.
Political and Legal Issues
In some cases because the state law does not permit penetration of the skin for any reason and in other states where it should otherwise be permitted, intra and inter professional politics are restraining the spread of this great clinical tool. That story will be told in a future article in DC.
MFTrPDN can be performed only by those doctors who are legally authorized to provide this service under their state law. This cutting edge technique will work with all approaches, whether you like to treat patients on a symptomatic basis or corrective basis. This technique supports YOUR approach to patient care and is suited to those doctors who seek excellent clinical outcomes and management of challenging acute and chronic patients.
For the well-care doctor who desires to pre-emptively strike against the development of global dysfunction, this approach will support that goal. It will also improve your community profile as a primary care holistic doctor. Offering this service will broaden your appeal to patients who may not currently be seeking you out and as well as improving your service to current patients.
For the sports-oriented doctor there is no greater tool to keep the soft tissue system of your athletes at peak performance. You will learn that early detection and treatment of soft tissue dysfunction will lead to fewer injuries and better performance for your athletes. This technique can be brought to the field as easily as you bring your hands.
For the restorative and corrective oriented practice there is no better method to help achieve and maintain your goal than having this technique in your clinical toolbox. It will be much easier to retrain structural plasticity with the help of a cooperative soft tissue system. Rather than wrestle the structure against resistant soft tissue, you can ease the structure to its desired goal. Adjustments will occur with greater comfort and will hold longer.
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