About Integrated Dry Needling
Integrated Dry Needling is a system of dry needling that involves identifying all of the significant abnormal impulse generating sites in the musculoskeletal system which are contributing to movement dysfunction, pathological processes and pain sensitivity. Whether a site is considered significant is determined by whether out not there is movement dysfunction and tissue irritability on palpation associated with it. The reported site of any pain or discomfort does not in any way direct the treatment or needling techniques used but is viewed as one of the results of tissue and system overload due to movement dysfunction.
The Integrated Dry Needling approach to treating mechanical musculoskeletal pain presentations was developed, in part, to address the many adverse effects of popular trigger point models of dry needling and traditional acupuncture, not the least of those being discomfort, the high incidence of sympathetic overload and the, generally accepted, high level of non response.
The physical therapies tendency to apply treatment modalities at the site of reported pain quickly appeared limited to many practitioners when presented with complex or long term overuse pain presentations,commonly accompanied by a history of non response or poor response to local modalities and manual therapy.
A model promoting pain as due to tissue overload as a result of movement dysfunction rather than the problem itself, provides a more satisfactory approach for the therapist. This approach is devastatingly effect in simple musculoskeletal presentations. When presented with more complex pain presentations involving a highly sensitised central and peripheral nervous system and viscera, having a tool with which to appropriately optimise movement and reduce any contributing tissue irritability, without further traumatising the system, can reduce total load on the system dramatically, optimising movement and relieving pain.
The contribution to a movement “problem” of systemic and autonomic nervous system imbalance is considered but not specifically addressed within the Integrated Dry Needling model. Practitioners can facilitate change in these aspects of an individual with other components of their interaction with a patient. If the practitioner is skilled in on of the traditional paradigms of acupuncture, such as Japanese Meridian Therapy, some further needling input can be provided to more directly address systemic and autonomic imbalance.
Whilst other needling approaches require the production of a muscle twitch or the production of a strong ache, or du qi, techniques used in Integrated Dry Needling developed at the “shallow end” of the sensation pool, initially exploring how little needle stimulation in each presenting tissue environment can produce a measurable change in compensation free range of motion.
There are four basic techniques used and each have specific applications. Broadly, these result in either tissue and neurological down regulation or tissue mobilisation either due to modulation of the neurophysiological drive from maladapted connective tissue structures. In order to be considered effective there must be a resulting increase in range of motion. There is little or no sensation with the majority, but not all, techniques. All are more comfortable than in other dry needling approaches. Up to thirty needles are used in a treatment which may involve, techniques applied anteriorly and posteriorly in all quadrants of the body. A small specific amount of stimulation is provided with each insertion and treatment is stopped at the instant the tissue palpably changes.
Non response is not observed in Integrated Dry Needling, perhaps because the appropriate level of needle stimulation is provided for each individual, whereas for many the “dose” of needle stimulation producing a twitch or an ache may be too great for them to respond.
One of the great advantages of a tool like Integrated Dry Needling is that , in the right hands, movement dysfunction can rapidly be resolved or optimised, and pain treated as a result. The challenge for the movement therapist is beyond dry needling and is to solve the problem of why an individual presented with certain movement dysfunction in the first place and how to ensure their optimised movement profile not only progresses but is maintained.
Targeted changes in the tissue are located during a non provocative examination using a process of light palpation, skilled tissue sensitivity testing,movement analysis and neurodynamic assessment.
The Integrated Dry Needling approach employs more superficial and less vigorous techniques than those used in other approaches .This has obvious benefits for patient and practitioner alike such as reduced discomfort and reduced risk of adverse outcomes.
The incremental addition and varied level of stimulation provided to each patients tissue during a Integrated Dry Needling treatment means the issues of non response and over stimulation are far less a concern.
Both are known issues in other dry needling approaches..
Integrated Dryneedling provides a logical, well reasoned approach to clinical presentations where a degree of central sensitisation may exist and “trigger point” type tissue reactions are absent or difficult to locate and also a way to access acute soft tissue injuries which are contra-indicated in other dry needling approaches.