Ep. 83 - LiveWell Talk On...Dry Needling
Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital
Guest: Nick Warneke, PT, DPT, CMTPT, sr. physical therapist, St. Luke's Therapy Plus
Dr. Dustin Arnold (00:09):
This is LiveWell Talk On...Dry Needling. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. UnityPoint Health St. Luke's Hospital Therapy Plus is marking its 25th year of service. One of the ways they are honoring this anniversary is by looking at how far they've come with new techniques, technologies, and therapies. One of the newer treatments is called dry needling. Joining us to talk about what it is today is Nick Warneke, St. Luke's Therapy Plus senior physical therapist. Thanks for joining me this morning. Is there a such thing as a junior physical therapist?
Nick Warneke (00:39):
No, there's not actually. Okay. Did you stick around long enough and you just get old?
Dr. Dustin Arnold (00:43):
Okay. Just want to get that out there right away. You know, Nick, I remember when you went off to get the training about this and I have some knowledge of this situation, but what is dry needling?
Nick Warneke (00:56):
So dry needling, I guess we step back a little bit. You have to know what we're treating to talk a little bit about what dry needling actually is. So we're going to talk a little bit about trigger points. If anybody's ever had a cramp in their calf, they know exactly how uncomfortable and how painful that is. A trigger point is really a small scale cramp. So instead of the whole muscle contracting and being really painful, it's just a small bundle of muscle fibers, but it still generates a lot of pain. So the trigger points are those things that you find oftentimes in your neck and your shoulders, those knots, or those tight bands and dry needling. We use a technique where we just take a small filament needle and we insert it into the muscle to help facilitate that thing to just relax a little bit.
Dr. Dustin Arnold (01:37):
Yeah. I remember, I think there was a study in the late eighties, maybe early nineties, where they found that they injected the corticosteroid versus just making the puncture with a needle and they had the same outcomes and that kind of started this. And I like to describe it as, it's kind of a control, ALT, delete for when your computer locks up, the it's kind of for the muscle. I always loved the patient that has like piercings everywhere, tattoos, head to toe. And then the first thing they say to me is I'm scared of needles. You know, I love that patient, but people are afraid of needles. It's a real phobia. What can you do? How big are the needles?
Dr. Dustin Arnold (02:21):
What are some of the complications? What should a patient be afraid of?
New Speaker (02:24):
Sure. Well, it's one thing that I'm not super excited about needles myself. I wasn't very excited to go get the training in the first place, but getting certified in dry needling, I was poked from my face to my feet and I promise you that if I can handle it, anybody can handle it. The needles are really thin. So they look like there I think 30 gauge. And you know, the, the practitioner in me doesn't know like needle gauge sizes. It's a third of a millimeter in diameter. It's really tiny. It looks like a little piece of hair, frankly. So it is kind of uncomfortable. I won't pull any punches. Dry needling is a little bit painful, but most people don't feel that needle prick, like they're going to go get their blood drawn.
Dr. Dustin Arnold (03:02):
30 gauge is pretty small. I mean, as someone as myself that takes insulin, 30 gauge is relatively small.
Nick Warneke (03:17):
Most of the time, people do not feel that needle insertion. Every time we do that needling process, what happens when we get the needle into the muscle is there's a spinal cord reflex that kicks in. And that, trigger point will contract. And that feels like a little cramp. That's the uncomfortable part about dry needling. It's really brief. It lasts for a second or two, and then it goes away. Um, but I think the folks that come in that imagine they're going to be just pricked and pricked and pricked and pricked in it. That's, that's not what happens.
Dr. Dustin Arnold (03:43):
We've had Dr. Lorenzini on about acupuncture as a previous podcast. What is the difference between dry needling and acupuncture?
Nick Warneke (03:53):
The primary difference and I'm no expert on acupuncture either, but I would say just to over-generalize a little bit, most acupuncturists have a, like an Eastern medicine or a different target. So we are trying to needle trigger points. We're trying to get trigger points to relax, and we're not needling along meridians or ashy points or things like that that I'm not super familiar with. So the theory is a little bit different. I think another big difference is kind of the process. Most people that I talked to that have experience with acupuncture, the needles lift in the skin for a really long time. It's not uncommon to have several needles in one area.
Nick Warneke (04:33):
And, you know, the clinician will walk away for a few minutes and try to just let the patient relax. And we're not doing that in draining length. I had set one needle at a time for treating one localized spot and it's, it's less than a minute.
Dr. Dustin Arnold (04:45):
The needle that you use, that's a single use and it's disposed.
Nick Warneke (04:50):
Or they're certainly single use. We're not reusing any needles or anything like that.
Dr. Dustin Arnold (04:56):
Nick Warneke (04:58):
Complications are really low. There are the two big things that I see any kind of regularity with soreness. Everybody gets sore. I think 95% of people that I talked to that I've needled tell me they get sore. And the 5% that tell me, they don't, I think are liars, but, it should be really mild. It's going to feel like you've gone and done some exercise and you have that typical, you know, muscle soreness that lasts usually for 24 to 48 hours.
Nick Warneke (05:20):
Most people will still wake up the next day feeling kind of sore and it gradually will improve by the next day. The other complication I see is sometimes bruising. So they say 5% of the time people will, will find a bruise. 5% is one in every 20 pokes give or take. And I generally don't poke people that many times in one visit. So rarely do we notice any bruising.
Dr. Dustin Arnold (05:42):
Well, that's leads to the next question. How many times do you, so I come in, I got neck spasm, let's say trapezius mid up back. How many pokes would I get?
Nick Warneke (05:53):
So the first time I, I treat anybody with dry needling in a clinic. We're, we're going to go really light on the first day, regardless one it's, uh, you know, it's, it's just a process to see how you tolerate it and what your response is like.
Nick Warneke (06:06):
So I will probably pick the two or three or four spots that I feel will help you the most. And that's it. So generally it takes less than five minutes. It's just a small part of everything else that we're doing. In terms of your treatment plan, beyond that, if you have a positive response and you tolerate the needling process, we can always do more, but rarely would I probably needle anybody more than eight or 10 times in one visit.
New Speaker (06:30):
I think that's important to stress that it's one element of a treatment plan, not the treatment plan, right?
Nick Warneke (06:39):
Yes, I'm still a physical therapist. I think some people look at me like I'm just the weird needling guy but I'm still a physical therapist.
Nick Warneke (06:49):
It's just a small part of the process though. Just like if we were to use like a TENS treatment or any other kind of modality, dry needling is an option to help get people, some pain relief so that, you know, the strengthening and the flexibility stuff that we also work on is more effective. That's the idea.
Dr. Dustin Arnold (07:07):
Myself as a team physician for football, what's the experience with sports medicine?
Nick Warneke (07:11):
I think it can have really outstanding outcomes. Typically. I wouldn't recommend dry needling on somebody just in the acute phase of an injury. Oftentimes those issues with muscle tone will kind of resolve on their own or with some other conservative treatments like stretching or ice or heat. But anything that's longer lasting that stretching is not effective for, absolutely dry needling can be really helpful.
Dr. Dustin Arnold (07:36):
So I'll keep that in the back of my mind. So if I'm a patient, I just, ask my physician to refer me to physical therapy for my particular ailment. Let's just say back pain. And then you would determine if dry needling is appropriate for that patient. Not necessarily as a physician, I don't have to say, okay. Because we set it up that you would make that decision and I'd be the physical therapist to see and treat correct. Correct. So I just need to get a referral for my visit.
Nick Warneke (08:06):
That's it. And the biggest reason that we need the referral for is just to be able to send it to your health insurance, right. That's why we get referrals for everything else already. We just want to make sure that dry needling is a part of the process. It's new enough that there are some physicians out there that really don't know much about it.
Nick Warneke (08:21):
So we like to tell your doctor, Hey, this is going to be part of our plan. Are you okay with that? So we asked for a referral that's specific for dry needling. But after that, the first day you come in your therapist, we'll do a little screening. So there are some reasons that we would not want to dry needle, some contraindications we'll go through all that stuff on the first visit and make sure that you're a good candidate. And then that's all it takes
Dr. Dustin Arnold (09:29):
Well, this has been great information. Thanks for joining me. Thank you so much for joining us today, Nick,