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Acupuncture & Dry Needling: Reaching those who can't reach a clinic


Service provision has expanded to include needling techniques into community practice, so far with promising results.


Acupuncture:


Cases seen in the community cases tend to be complex, and typically involve chronic pain combined with some sort of mobility restriction. This usually means acupuncture is usually indicated over dry needling (or combined with it at least), with additional considerations around suitable positioning, not just to accommodate needle placement but patient ability to get into a postural set, and also maintain it. Many cases, cannot manage onto a portable plinth (even with this set lower or with the use of portable steps), so supported forward positioning or using their own bed can be preferable. As seen in the case below, the bed was initially used, and towels put down. While clinics set up's usually involve wipeable laminate flooring and plinths (in case of some blood from needling), sometimes the equivalent set up is just not possible when working in people's homes.


Express consent was given from the case below, and shows needle placement and positioning from behind for treatment of chronic pain of the lower back, posterior right buttock and hip area. The top knee was supported in front, in a bent position with a pillow underneath, and the patient encouraged to keep rolled forward at the pelvis (to maintain lower back needle clearance from the bed).



A distal needle point was chosen in the hand, rather than foot/lower leg as a precaution owing to medical history in childhood of osteomyelitis, and skin grafts taken for this. Particular attention to needle placement in the hand was given for clearance of blood vessels in the area.


Although acupuncture for chronic pain, should ideally be for around 40 minutes, sometimes cases struggle to maintain even a supported position for a more sustained length of time. The positioning above was managed for 20 minutes.


However, in spite of this Physiotherapy was able to continue, involving outdoor mobility practice. The distance achieved at the usual pace using a four wheeled walker under supervision was about 75% of that routinely managed. However, significantly - further mobility work was undertaken without the usual strong pain medication of Oramorph taken prior to rehabilitation work, and instead managed with only with a bit of additional Voltorol (anti-inflammatory pain relief) gel over the hip area following the acupuncture.


Dry Needling


Routine musculoskeletal practices are additionally seen in community private practice. Private community services sometimes market as provision of Physiotherapy in the comfort of patients own homes. However, these cases (which could attend clinic set up's) can additionally benefit from the extended treatment times many private in-reach services set as standard (rather than seeking community input purely as some sort of door to door luxury option). For me, extended treatment times, make it much more easier as a practitioner to offer needling techniques (and go through the necessary consent forms with patients) additional to delivering the other treatment modalities I want to use.

Express consent was given from this community case involving pain and reduced knee bend following recent return to playing rounds of golf. Following assessment, a clinical impression of medial compartment irritation (likely irritation of some of the main knee joint cartilage) was formed additional to associated muscle guarding of the small Popliteus muscle which lies at the back of the knee, and calf musculature. Dry needling into the Popliteus and calf musculature was used as an adjunct treatment, additional to manual therapies, exercise and advice. After treatment sessions, the movement range of the knee increased and resting (musculoskeletal) tone of the muscles was reduced on palpation. The patient was placed on open review following 4 sessions after reporting a return to golf and near full symptoms resolution.


While there are a number of needling technique training providers, I chose to complete training through Breeze Academy who are based in the North East of England but provide teaching in locations covering a wide geographical spread, including dual qualification in acupuncture and dry needling, additional to separate needling speciality courses.







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