1. Beyond Stretching and Ultrasound; Current Treatments for Musculoskeletal Injuries Julie Paolino PT MS ATC MCTA CIDN

2. WHERE TO START …. Traditional physical therapy consists of stretching, exercise, massage, heat or ice But there is more!

3. NEWER INTERVENTIONS Dry Needling & Therapeutic Taping

4. DRY NEEDLING

5. AAOMPT POSITION STATEMENT “It is the Position of the AAOMPT Executive Committee that dry needling is within the scope of physical therapist practice.” (AAOMPT. Position statement: Dry Needling. American Academy of Orthopaedic Manual Physical Therapists, October 17, 2009.)

6. WHAT IS DRY NEEDLING AND HOW IS IT EFFECTIVE?

7. NOT acupuncture! Acupuncture Treating disturbances of “Energy Flow” Needles are inserted in pre-determined areas in meridians WHAT DRY NEEDLING IS NOT!

8. 2,000 hours education and training in ancient Chinese medicine Knowledge of meridians which is not related to modern medical knowledge Professional license exam 4-5 years of PT education Knowledge – anatomy, PNS, physiology, pathology, kinesiology and manual therapy Clinical training = 25-50 hours of specialty training depending on model DRY NEEDLING VS ACUPUNCTURE Dry Needling Traditional Meridian Acupuncture Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

9. WHY WE DRY NEEDLE? To decrease pain (local vs referred) To Improve function To DESENSITIZE the patient’s nervous system (Chronic pain)

10. What does it do? EFFECTS OF DRY NEEDLING

11. NEEDLING EFFECTS: Creates a lesion which activates physiological mechanisms of remodeling of injured and inflamed soft tissues in and around the needling site Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

12. NEEDLING EFFECTS: Electrical stimulation: Rhythmic vibration local and systemic effects Non-specific pathophysiologic effects: Restores tissue homeostasis thus joint biomechanics are improved Precise location of particular points: Traditional acupoint or trigger points - ??? Needling the sensitized or inflamed area Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

13. Clinical Limitations DRY NEEDLING

14. CLINICAL LIMITATIONS Requires the process of homeostasis in order to promote self- healing Therefore, if a patient’s self-healing potential is impaired, the response to needling may be limited!! Most effective: soft-tissue pains thru localized symptoms Less effective: non-soft tissue pain symptoms Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

15. AFTER CARE Manual Soft Tissue Mobilization Joint Mobilization Therapeutic Exercise/Stretching Corrective Exercise Ice or Heat Light activity encouraged

16. IS THERE EVIDENCE TO SUPPORT INTRAMUSCULAR DRY NEEDLING?

17. DUNNING, J. ET AL. DRY NEEDLING: A LITERATURE REVIEW WITH IMPLICATIONS FOR CLINICAL PRACTICE GUIDELINES. PHYSICAL THERAPY REVIEWS 2014 VOL.19 (4) Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) However, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature Acupuncture’ literature supports the use of ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials

18. IDN: LITERATURE SUMMARY Superficial and deep needling more effective than placebo, or no treatment Inclusion of paraspinal points clinically significant versus local needling in isolation Needling non-local trigger points reduces pain in primary TrP sites Studies support immediate and short term results but need high quality, long term trials Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

19. Traditional taping techniques would restrict and limit movements THERAPEUTIC TAPING

20. 3 DIFFERENT TYPES Mulligan : Mobilzation with Movement ROCK Taping / FMT Kinesiotaping

21. MULLIGAN MOBILIZATION WITH MOVEMENT Dev by New Zealand physio 1985 Tape utilized to reposition “joint” promote mobility increase ROM

22. ROCKTAPE AND FMT Fascial Movement Taping Dr. Steven Capobianco Greg van den Dries FMT goal is to foster proper movement through treatment acute injuries use in chronic cases for prevention and performance improvement and training Simple and effective approach Stretches along length, but not width Recoil effect

23. KINESIOTAPING Dr. Kenzo Kase, DC Developed in 1979 Exposure 1988 Seoul Olympics, Introduced to US in 1995 Effects: Skin, Fascia, Circulatory/ lymphatic, Muscle, Joint. Uses: ~Mechanical correction ~Fascial correction ~Space correction ~Ligament / Tendon correction ~Functional correction ~Lymphatic correction

24. Mechanical Decompression of the skin EFFECTS OF THE TAPE

25. Sensory motor stimulation Sensory cortex Afferent signals to the brain EFFECTS OF THE TAPE

26. Pain GATE theory Support for injured muscles or joints Allowing a full, healthy range of movement EFFECTS OF THE TAPE: DECREASE PAIN

27. APPLICATION

28. GENERAL INFORMATION Health history and Test patches Prior experience w/ taping 15 min test patch to assess tolerance Sensitive Skin and Allergies There is no latex Allergic reactive rare Irritation created if stretch is placed at the anchors

29. GENERAL INFORMATION Sensitive zones Posterior knee Neck (anterior and posterior triangles) Armpit Anterior elbow Hands/Feet**

30. Compromised skin Infants Elderly Pregnant patients (especially 3 rd trimester) Prone to skin allergies Sensitive skin Open wounds Skin infections, Cellulitis Active cancer DVT Kidney disease CHF GENERAL INFORMATION ContraindicationsPrecautions

31. Ability to wear for up to 5 days (3 days K tape) Waterproof, latex free and hypoallergenic Do not heat tape! Remove if adverse symptoms occur ROCK TAPE

32. Step One: Eccentrically Load Area Step Two: Stabilize Area Step Three: Decompression Strip(s) ROCKTAPE

33. KINESIOTAPE To Inhibit a muscle ~Distal  Proximal (I to O) ~Inhibit: Acute injuries, muscle spasm ~15% to 25% Tension To Facilitate a muscle ~Proximal  Distal (O to I) ~Chronic conditions, weak ~15% to 50% Tension

34. KINESIOTAPE TAPE TENSION Paper off tension: 10-15% Light 15-20% Moderate 25-50% Severe 50-75% Full 75-100% 0%: NO TENSION ON ENDS (ANCHOR)

35. KINESIOTAPE STRIPS I strip: Applied directly over area to be treated Y Strip: Anchor and two tails: Surround muscle to be treated. X Strip: Can be used for muscles that cross 2 joints, Star for contusion, muscle sprain / Tear. Stretch middle 1/3 rd of “X” placed over muscle belly. Fan Strip: Lymphatic issues. ~Anchor in areas of lymphatic system. Cut 3-4” long strips. Place through area of swelling with Nil to paper off tension. ~Criss-cross fans through Rx area, anchor on each side of joint

36. EFFECTS OF TAPE: DECREASE PAIN Support for injured muscles or joints Allowing a full, healthy range of movement

37. EFFECTS OF TAPE: DECREASE EDEMA Enhanced blood flow Decreases pressure on pain receptors Improved lymphatic drainage will help minimize swelling and bruising

39. LYMPHATIC CORRECTION

40. THE TRAINING ROOM To support sport-specific fascial chains Better engage and coordinate movements Increase efficiency Reduce fatigue Ankle Sprain/Prevention

41. NOTHING IN THE UNIVERSE IS STATIC. EVERYTHING MOVES. T HE HUMAN BODY IS NO EXCEPTION.

42. Questions?