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There are three primary ways chiropractors can use dry kneeling in their practice.
I’ve been in practice for 16 years and I’ve been doing dry needling for about seven years now. What interests me with dry needling is the faster recovery we get with patients. I often find that we can treat other areas more effectively, such as the glute region where it’s a thick muscle or the quadriceps, or it’s a deep area we want to treat.
Dry needling works well for those areas that are tricky to treat or if we’re dealing with chronic areas like the Trapezius or Levator SCAP or Rhomboid area.
1. Using Dry Needling on Trigger Points
The first way chiropractors can utilize dry needling in their practice is to treat trigger points or myofascial release.
We’re going to treat her quadriceps. We’re going to palpate into the different portions there and feel where she has any knots or tenderness. And then we’re going to insert that needle right into that muscle to cause a twitch response.
That feels like a little twitch for the patient. Often it replicates the patient’s pain. It will be a dull, achy sensation. But it’s a quick, really effective treatment at releasing those trigger points.
And again, why I would choose this over Active Release Technique or Graston is the depth of the issue. At times, I’ll do a combination of all three of them, but I typically find the drying healing works well for those deeper structures. I’ve taken three different dry needling courses and they all have a slightly different take on it.
Some are just putting the needle in and letting it do its thing.
Or you can actually piston the needle back and forth. That’s a little bit more uncomfortable for the patient but you often get more of a twitch response when you put the needle in that way. I’m going to show you what that looks like in the quadriceps. It’s a little bit more comfortable for the patient versus just pistioning back and forth into the muscle.
So now we have two needles into her quadriceps.
We’re going to show you what the stimulation looks like. We’re going to place one portion of the STIM unit onto one needle and the other portion onto on the other needle. We’re now going to turn it up until we get a light contraction. There you go. The muscles twitching right there—and again—it’s like an artificial twitch response. It can help to relax the muscle a little bit deeper. Effectiveness depends on the muscle’s tone.
If someone’s very hypertonic, a lot of times, I will do this to cause it to relax a little bit more. If the patient doesn’t like the piston action, I often use the STIM machine to do that. You could do that for 10 to 15 seconds and then take it off. Then, if you had other areas, you could treat those areas with the STIM.
The interesting thing with dry needling is also when you’re applying the STIM.
For example, if you’re treating the lower leg and you’re treating a specific muscle down there like a flexor group, you can often see the toes moving. That’s also another way to confirm you’re in the right location as well—besides a palpation, of course. But that’s an interesting way to also get that kind of release of that tissue.
You can see those muscles moving and you can concentrate wherever you need the treatment.
2. Treating Radiculopathy with Dry Needling
The second way chiropractors can use dry needling is to treat radiculopathies.
If someone has radiculopathy we will place needles in that segment level where they have their issue. We’ll also apply needles to the area in their extremity that correlates with that segmental level. Once we have those needles in those different areas we’ll hook up a STIM machine to those needles and create a kind of circuit between that whole pathway.
It’s going to help decrease tone in those different areas. It’s also going to help reset the firing pattern in that area. We like to use that in this region a lot.
I want to show you what that’s going to look like with STIM. The nice part is, in this case, I have three different attachments. We can start in the low back if we want to do hamstrings, gastroc, or soleus, we can place those and kind of fire all those different muscles along that pathway.
We find it expedites recovery for radiculopathy. The same thing applies to the upper extremities.
We can do that segmental level up there and treat the muscles it supplies down to the arm. We have needles in her lower back at her L5 S1, then in her hamstring, and then also in her gastroc and soleus.
We’re going to hook up stimulation leads to those different needles and then we can turn that on. Here again we’ll get some contraction and all that different pathway. It can decrease the tone along the entire pathway.
We now have all the leads connected to the needles in her lower back. We’re going to turn on this machine and create a muscle contraction in all three regions.
Patients should let you know when they first feel a little buzz or tingle. What’s great about this area is we can get into the multiplied muscle and, again, help activate that muscle. A lot of times I’ll leave patients with this treatment for 10 to 15 minutes.
This doesn’t replace all your other chiropractic techniques. This is just one thing I found that can help accelerate the healing process for radiculopathies.
3. Dry Needling Areas that Can’t Go through a Full ROM
The third way chiropractors can use dry needling in their practice is for conditions where you can’t put the muscle or the joint through a full range of motion.
We would do this a lot in our office with post-surgical hip replacements, especially if the surgery was performed posteriorly. The surgeon cuts through the glutes.
A lot of times, once they get that hip replaced, that glute muscle is not firing as well as it should. It’s not activating as it should. We’ll treat that and then we’ll apply some STIM to the needles and activate that muscle to help normalize that muscle function over time. What I’m going to demonstrate right now shows what it looks like in the glute medius and glute max.
The nice thing with dry needling is whether you’re treating a post-surgical hip or whether you’re treating just a common glute S.I. joint issue, you can vary needle length to get to the location of your problem. A lot of times, I will use a four-inch needle, and we’re treating the glute area.
This sounds crazy, but a lot of those issues can be very deep in the tissue and you can’t get there with your hands.
Dry needling helps us get to that with less discomfort for the patient, too. They don’t feel the difference between a one-inch needle or a four-inch needle.
They’re roughly about the same thickness. As that muscle releases or you get that twitch, then it will relax and you can insert even deeper. Say, from a post-surgical standpoint, though, they made a posterior approach and cut through the glute muscles. We would apply some stimulation to the needles.
What we’re again looking for is a kind of steady contraction. As that tissue loosens up and begins to function correctly you’ll start to see it normalize—as far as the pattern of the stimulation in certain areas.
In certain areas where there are larger, more powerful muscles, you’re going to get a larger contraction, whereas in smaller spinal muscles, you’re not going to get that same reaction, but you will still get the same effect.
That’s how I use dry needling to treat a post-surgical hip or any hip condition.
The other condition I think chiropractors could utilize dry needling for is with frozen shoulders. So, again, we know how difficult these often are to treat. But we find dry healing works really well. We’ll also combine that with laser therapy and Graston. But to get down to the deep capsular level, dry needling is highly effective.
Again, you can target specific rotator cuff muscles or the different capsule, deltoid, or trap.
I’m going to show you how we would apply it for the capsule. I am just palpating and feeling for the location of the tightness. Go through the deltoid, get down to that capsule level from a posterior standpoint.
Once we can get those muscles to relax then we feel like we can do more A.R.T. or other soft tissue techniques, adjustments-wise, to free up that area. Those are three ways that I think chiropractors can utilize dry needling in their approach.
Dry Needling or Acupuncture
I was finding I was getting such great results with dry needling that I went and took a couple different acupuncture programs.
But there is a big difference between acupuncture and dry needling. Dry needling is a treatment modality for these tight muscles that we want to release whereas acupuncture is a whole healing system.
Acupuncture is an entirely different treatment and carries a different intent with the needle. We’re trying to release soft tissue with the dry needling, whereas acupuncture tries to stimulate acupuncture points to help the patient heal. I think for the average chiropractor, dry needling is a technique you can learn and implement right away in many different conditions.
I hope that illustrates just three ways that you can utilize dry healing in your practice.