Dry Needling for Manual Therapists: Points, Techniques and Treatments, Including Electroacupuncture and Advanced Tendon Techniques

This is a great book for beginner needlers to remind you of the basics!

Awesome book for reference/ refresher. It has each body part labeled and exactly where the needles should go.

This is a good first purchase if your intention is to help patients with dry needling. There seems to be much speculation that such an intention is unethical for anyone but acupuncturists. My inspiration to write this review is primarily a rebuttal to all of the acupuncturists out there who claim this book is unethical and dangerous.I am a graduate of a 4000 hr accredited oriental medical masters degree in the USA I speak from the background of having attended two years of chiropractic college serving as the TA in the dissection lab for a year, completing an accredited US oriental medicine masters degree and then most recently graduating as a doctor of veterinary medicine.First I would like to point out that no profession identifies itself by the tools it uses, but rather by the mission that profession claims to achieve in society. It really doesn't matter whether it is designing houses or manicuring fingernails, you use whatever tools you have to get the job done. Its the job you are trying to get done that defines your profession, not the tools you use. If the truth were otherwise then we would have to say that architects (or accountants and writers for that matter) stopped being architects long ago when they jettisoned pencil, paper and drawing board for computer drafting programs. In a similar vein, by the argument presented here by acupuncturists, use of a computer as a tool can be the trademark of only one profession, and therefore everyone using a computer, regardless of how they define themselves professionally, is attempting to perform computer programming without proper training. This argument makes me wonder about something as a simple as a saw. Do only carpenters have a right to use a saw, or is it only lumberjacks? Should the orthopedic surgeon be denied use of a saw since obviously he wasn't trained as a carpenter and truly can't possibly have the training and experience necessary to use what is essentially a carpenters tool. "Only carpenters should rightfully use saws; anything else is unethical and dangerous." "Only computer programmers should ethically be allowed to use computers." Do these statements sound logical?So lets look at oriental medicine training in the USA. Yes it is typically 3000 to 4000 classroom and clinic hours. Lets be honest though; the vast majority of that time has nothing to do with needling safety and very little if any to do with triggerpoint location or needling, which is what dry needling mostly concerns itself with. Oriental medicine training entails many many of hours studying traditional Chinese medical theory, traditional Chinese medical diagnostics, and herb and herb formula characteristics and their application to various traditionally defined Chinese medicine syndromes. Even acupuncture training is largely about memorizing the location and the effects of the various acupuncture points couched in traditional medical terms. The time spent on needling safety is minimal. I was taught on day one of my acupuncture class how to maintain sterility while opening a needle packet, how to clean the skin with an alcohol swab, how to properly dispose of a used needle in a "sharps container," and I was given a simple warning not to use a needle if I dropped it on the floor! Its hardly rocket science and doesn't require years of apprenticeship from master acupuncturists. The National Clean Needle Exam we all have to take was nothing more than a rehash of these very basic and very logical sterile protocols. Anyone who has ever taken a microbiology lab course could reason it out on their own.So what is the real safety issue here that makes it so unethical for MD's, DC's and PT's to undertake dry needling? Well as I have said, the sterile protocol issue is pretty simple and easily covered in a half hour. Let's face it though, most graduates of a graduate level medical program have been exposed to sterile technique. Here's my experience as a vet student: as a 3rd year vet student I had to scrub in and observe surgery many times, as well as perform surgery. I can tell you that the surgeons and nurses were extremely anal about sterile technique. I was humiliated in front of a whole class when I accidentally touched the sleeve of my gown to the table. In front of everyone I was forced to leave the room, ungown, rescrub and regown while my surgery group stood waiting for ten minutes and all the other groups got on with their business. I imagine MD's have the same level of sterile technique drilled into them. On the other hand, while we were taught sterile technique in acupuncture training, I was also involved with Japanese acupuncture training in school. In these seminars I was taught to hold the shaft of the needle between the ungloved left fingers placed against the point. We were also taught to use the same needle to insert superficially at various points consecutively. I know well trained Japanese-style acupuncturist in my area that saves the clients' silver needles in little envelopes in their file and reuses them on the same patient from week to week with no sterilization! So much for sterile technique and safety among acupuncturists.The other important issue with needling safely is adequate knowledge of anatomy. Having been through anatomy training in chiropractic college and vet school, I can tell you that what passed for anatomical training at my oriental medicine masters program was far inferior. The other two programs required a year of careful cadaver dissection up to 10 hours a week. Acupuncture anatomy training was mainly from books with a cursory look in "lab" at some cadaver prosections done by other people. If I had to pick between MD's, DC's, PT's and acupuncturists, I would trust the acupuncturist the least to know what structures lie underneath the needle.Looking specifically at dry needling, here is a system of inserting filiform needles primarily into triggerpoints with the goal of altering blood flow and biochemical parameters around taut muscle bands that show pathological changes at the cellular level. The approach was founded in the mid- 20th century with MD specialists in physical medicine injecting such points with procaine using a hypodermic needle. Later proponents shifted to inserting fine solid "filiform" needles (so called acupuncture needles) because this was less painful on insertion. However recent clinical experience has shown that fine needle treatments may be less long acting, require multiple follow up treatments and produce greater post-treatment soreness as far as dealing with taut muscular bands. Hypodermic needles may hurt on insertion but procaine injection quickly eliminates the pain, prevents post-treatment soreness, and further, actually dissolves the pathologic muscle fibers so that the triggerpoint cannot recur.Triggerpoint-based dry needling primarily requires two things in order to be done safely and well, anatomic knowledge and good palpation skills. I have covered anatomical knowledge already. As to palpation, all but one of my oriental medicine teachers were educated in Taiwan or mainland China and the lone exception was from India. I was consistently and severely chastised by those teachers for ever palpating an acupuncture point to decide where to needle. I was told this was viewed in China as a sign of incompetence and lack of skill. Most of my patients in student clinic were Chinese as well, so the teachers were probably right that my point palpation caused a bit of insecurity among that patient population, being accustomed as they were to doctors merely inserting needles quickly and succinctly, sometimes even right through the clothing. Since I was studying Chinese medicine, and my teachers were all trained in China, many with advanced degrees far above the level of western practitioners and teachers, I can only assume that their attitude on palpation skills is a standard professional attitude. Yet palpation is the very essential skill needed to safely and effectively perform "dry needling" protocols at a professional level. Quite obviously, from my experience, palpation is not deemed as a necessary skill at all by highly educated doctors at the top levels of Chinese medicine. This really starts to make Dry Needling sound like a completely different undertaking than Acupuncture. MD's board certified in physical medicine spend a great deal of time developing palpation skills pursuant to triggerpoint location and needling. PT's and chiropractors learn palpation as an essential skill in their professions, and when they take dry needling courses, palpation is emphasized. In TCM-oriented acupuncture programs, it most certainly is not.Finally lets go back to the idea that professions cannot be defined by the use of certain tools, but rather are defined by their stated mission and the role they attempt to fulfill in society. Tools are only a means to achieve that mission, and one would expect new tools to be constantly adopted if the profession has any intent whatsoever to continually advance itself. As an example acupuncturists have borrowed from triggerpoint injection in physical medicine. Acupuncturists now can take seminars on injecting acupuncture points with a hypodermic needle, even into the very vulnerable and vascular and neurologically dense neck region. Acupuncturists reason that "a needle is a needle" so their license entitles them to use this technique despite it not having any real historic precedence in ancient China. Chinese medicine as practiced in China doesn't mind borrowing any tool from laser to hypodermic needle or from herb to western pharmaceutical if the combination is effective. In China, the practice of Chinese medicine isn't restricted by an artificial firewall that insists the tools define the trade. It seems this attitude has bled over into the west with acupuncturists readily willing to borrow tools from other medical professions (cold lasers, hypodermic needles, electrostimulation). Yet at the same time acupuncturists in the West insist that it is unethical for other medical professionals to adopt tools from the acupuncture profession.Dry needling has very closely defined intentions defined by biochemical and pathological histologic findings, and the intent is simply to reverse that pathologic process in taut muscle fibers. Acupuncture on the other hand has a quite nebulous intent with most practitioners saying that their mission is to "regulate and balance qi." We often refer to qi in a way that suggests to our clients that qi is some form of bio-energetic entity that flows around the body a lot like electricity would. Yet, in China, educated doctors don't talk or think this way, or even define qi in such a narrowly defined way. Doctors in hospitals in China do not refer to or think of qi as some sort of electron-like flow of a specific energy stream, but rather they define qi as "function and vitality."So we have "dry needling" on the one hand espousing a pretty narrowly defined and well-documented intention, and we have acupuncture, whose definition varies as much as the practitioners that practice it. One would be hard pressed however to find an acupuncturist who defined their mission as "correcting pathological histologic changes in muscle tissue," or one that would even assert that this was some sort of disguised code language that referred to the exact same thing that acupuncturist strive to do. Most acupuncturists in fact would be insulted by that as a description of what their training, intentions and mission were all about.So, in conclusion, we are left with multiple professions with different missions and intents fighting over the use of a tool, with one profession claiming it defines their profession and only their profession, and with other professions insisting that 40mm of thin wire attached to a handle isn't sufficient to define any profession any more than a saw or a pencil or a computer can define a profession. Now, there is always the claim that certain tools are inherently unsafe and their use should be limited to only those with adequate knowledge and caution. In all fairness, I believe that just about anyone with an advanced medical degree that includes in-depth study of anatomy and exposure to microbiological principles of sterile technique ought to be able to handle dry needling. If all they lack is training on how to open a sterile needle package and swab a point with alcohol before needling, I think they can handle it. Claiming that you need 4000 hours of training simply to safely insert a filiform needle is like an MD claiming you need to graduate from medical school in order to safely open a pill bottle and administer the dose written on the label. We've all experience that sort of haughtiness from medical professionals. As acupuncturists, lets not fall into that same boorish behavior. Let's be proud of what it is we actually do uniquely as practitioners of oriental medicine, which is to diagnose and treat disease based on traditional Chinese medicine parameters with an intent to increase the vitality of the whole person. Diet therapy, needles, herbs, western supplements and cold lasers or even just a plain old therapeutic talk session are all just tools we currently utilize in the act of fulfilling our valuable role in society. If what is important to us as acupuncturist is that we get to be the only practitioners ethically sticking needles in people, then we aren't laying claim to a very high goal for ourselves in society.Anyway, as an acupuncturist, speaking to you PT's, MD's, DC's and veterinarians out there that think dry needling could help your patients. By all means, go for it! Buy this book, take a class, draw on all that you already know and help your patients the best you can.

excellent material easy to comprehend

This is a very basic dry needling reference text. It actually has fewer trigger point identified than most trigger point references have identified. While a basic review of early trigger point theory is used as its foundation it lacks adequate coverage of neurophysiological aspects of Chan Gunn's theories and approach, the thoroughness of Jan Dommerholt approach, or the expanded neurophysiological approaches of Edo Zylstra or Yun-tao Ma. I also take issue with the presentation of a political turf argument presented by Wisconsin acupuncturists with out presenting the full opposite argument including the independent study conducted to survey needed education for PTs to apply dry needling.

After attending training courses hosted by the authors of this book, and being trained to an advanced level of medical acupuncture I am now using Medical Acupuncture within clinics daily. This book is a PERFECT reference and go to clinic guide, detailing even more needling techniques. The diagrams and pictures are clear cut and easy to follow, and the theory is easy to read with up to date references. This book is a must for manual therapist!After reading other reviews of this book, it is clear people haven't read this book and merely flicked through. The authors run highly professional accredited courses in the UK, Europe and Singapore which are fully insurable. It is insulting suggesting that practitioners like myself should not be using dry needling, we have spent a number of years studying and training to get to this level of profession, knowing exactly what is within my remit. If I had any doubt about the safety of performing dry needling, then there is no way I would do it.There are risks with ANY practitioners out there who are not competent at what they do and do not keep up to date with training. Just like any book you can buy on manual therapy there are dangers of practising without the appropraite hands on training, and any practitioner I know, would not attempt dry needling without the appropriate training.Like I said previously this is a fantastic guide to dry needling and is a must read for all practioners!

I'm a UK based therapist and I have completed training to advanced level with the authors of this book. I can vouch for the high level of screening of students when applying for their course, the exceptionally high level of training during their courses and this book is an excellent reference book to accompany ANY training in dry needling undertaken here in the UK. From the reviews I have read so far, it would appear that no one has read the book in it s entirety. The authors are highly trained In their profession and fully accredited to deliver such training.To suggest that someone with my level of qualifications is not qualified enough to provide dry needling is insulting. I have spent MANY years and thousands of pounds to get to the level I am at. I am not cavalier nor ignorant in my treatment protocols and fully follow my training in dry needling to the letter. There are risks obviously and I have knowledge of TCM qualified practitioners causing injury during acupuncture treatments so it is obscene to suggest that only TCM practitioners are safe. Read the book in its entirety please, just perusing or flicking through the pages is not a robust way to review this text.This book is a must read for all practioners who perform this modality.