Podcasts about Dry needling

Dr. Abbie Ross, PT, NCS and Dr. Danielle Tolman, PT are joined by Edo Zylstra, PT, DPT, OCS to discuss the the potential of Dry Needling in the treatment approach of patients with Vestibular Dysfunction and Migraine.About Edo Zylstra, PT, DPT, OCSDr. Zylstra has over 20 years of experience in orthopedics, pre-/post- surgical care, sports performance, wellness training, chronic pain treatment, and injury prevention. He works with patients of all ages and across all activity levels. He evaluates and treats from a whole-body approach. His treatment combines knowledge and understanding of anatomy and function within the context of full body structure, function, and movement patterns. He works to restore compromised mobility, strength, stability, and movement patterning. This is achieved through various manual techniques, active modalities, progressive exercise, and education. Outside of the clinic, Dr. Zylstra brings his knowledge and expertise to continuing education course, and educates clinicians on dry needling techniques.Where to find Edo:https://www.kcarephysio.com/Hosted by:

EP487. In this episode of The Mom Room, Renee gives an update on her hip recovery journey and shares how amazing dry needling has been for her pain relief. She also opens up about her struggles with energy levels when she's not taking the birth control pill, revealing just how much of an impact it has on her daily life. Renee dives into the details of her new favourite protein powder and explains how plant-based options were leaving her feeling bloated. Plus, she gives her honest review of the Netflix series Adolescence and responds to all the fun comments on her reel where questioned whether romance novels should be less accessible and have ratings. Tune in for an episode full of personal insights, recommendations, and lots of real talk! Don't forget to rate and review the show if you love it, and join the conversation on Instagram! Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Jim Shepherd // #TechniqueThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling lead faculty Jim Shepherd discusses several techniques and strategies to help troubleshoot getting your needle through tough tissue and to the desired target

No episódio de hoje do Podcast Movimento em Foco, recebemos novamente Lucas Tonicelli, fisioterapeuta e osteopata, para um bate-papo completo sobre liberação miofascial! Vamos desmistificar esse conceito, discutir sua eficácia, técnicas mais utilizadas, polêmicas sobre a pistolinha vibratória, ventosas e muito mais!

Dr. Ellison Melrose // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling lead faculty Ellison Melrose discusses the order of operations within a clinical session, addressing the common questions therapists have regarding which tools to use first and the best sequence for treatment. She emphasizes the importance of reassessing both subjective and objective signs at the beginning of each session as part of the symptom behavior model. Ellison outlines three key factors to consider when selecting treatment tools: the goal of the treatment, the patient's preference, and the physical therapist's preference. Listeners will gain insights into optimizing their clinical sessions by thoughtfully choosing their approach based on these considerations. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling.

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling division lead Paul Killoren discusses the important considerations when choosing dry needling education. As the founder of iDryNeedle and the division lead at the Institute of Clinical Excellence, Paul shares his extensive experience in the field, having taught dry needling for over a decade. He addresses common questions and concerns about training options, emphasizing the need for unbiased evaluation of different educational programs. Whether you're a student physical therapist or a professional in a newly accepting state, this episode provides valuable insights into navigating the diverse landscape of dry needling education. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling.

Have you ever been referred for dry needling but were too scared? Are you curious about how dry needling and acupuncture really work… and if they're worth trying? In todays episode, I'm sharing everything you need to know about these powerful treatments and how they can help relieve pain, improve mobility, and even prevent future injuries. Dry needling has been a game-changer for me and my patients, when I was struggling with TMJ, it was the ONLY thing that fixed my jaw pain. So I'm sitting down with you to dive deep into why it works, how to find the right practitioner, and what you can do to get the most out of your sessions. You'll learn: The difference between dry needling and acupuncture, and which one is right for you How muscle knots cause pain and dysfunction + and dry needling releases them What to expect in a dry needling appointment Why the number of needles will impact the success of your recovery Simple tips to help ease muscles at home … and SO much more. Order the RelaxaPulse Portable Vibrating Massage Roller here. Watch the YouTube Version of the Podcast here. Ready to take a step in the right direction and look after future you? Check out the products that will keep your body in Synx here - www.synxbody.com And if you want to see more of the behind the scenes OR you loved the episode let us know over at @synxbody and @rachael.ferguson 

Wir starten das Jahr 2025 mit einem kurzweiligen Format - Overrated/ Underrated. Und zwar zu verschiedenen Themen, zu denen wir immer wieder gefragt werden: Was haltet ihr von den Programmen von David Grey? Blood Flow Restriction Training? Barfußschuhe? Haltungstrainer? Dry Needling? Dubai Schokolade? Hier geben wir unseren Senf dazu! Viel Spaß beim Hören! Infos und Anmeldung zu den Seminaren: https://myomechanics.de/seminare/ Anmeldung zum kostenfreien Online Seminar "Schmerzanalyse bei Rückenschmerzen": https://www.felixkade.de/schmerzanalyse-online-seminar/

The importance of chiropractic care and advanced therapies in sports medicine for enhancing performance and preventing injuries. Techniques like dry needling and spinal decompression are highlighted as essential tools for addressing muscle dysfunction, soft tissue recovery, and acute disc injuries. By targeting trigger points and improving blood flow to injured areas, these treatments help athletes—both professional and amateur—recover faster and perform at their best. Proper biomechanics and injury prevention, especially in teenage athletes, are also a major focus, as imbalances during growth can lead to long-term joint and knee issues.Innovative therapies such as hyperbaric oxygen therapy, ozone injections, and peptides are discussed for their ability to promote healing, reduce inflammation, and oxygenate tissues that lack sufficient blood flow. These treatments, combined with education on movement and form, are vital for optimizing recovery and performance. By addressing injuries early and incorporating these cutting-edge therapies, athletes of all levels can minimize downtime, prevent chronic issues, and maximize their physical potential.Highlights of the Podcast00:12 - Introduction to Dr. Camille Reagan02:22 - Working with Professional Athletes03:35 - Dry Needling as a Game-Changer07:51 - Spinal Decompression for Acute Disks12:15 - Teenagers & Injury Prevention16:40 - Chiropractic and Proper Form21:30 - Concussions in Athletes28:00 - Advanced Therapies: Hyperbaric Oxygen & Peptides34:55 - Ozone Therapy for Joint Healing40:34 - Advice on Chiropractic Care

In this episode, Dr. Becky, Skyterra's Physical Therapist, guides us into the world of dry needling—a specialized technique that provides fast relief from pain by targeting muscle trigger points. Discover what sets dry needling apart from acupuncture, how it works, and why it's an effective tool for alleviating stubborn pain and tension. Dr. Becky explains why people come to her for relief, describes the unique experience of dry needling, and shares how just a few sessions can help manage persistent pain, whether it's from poor posture, overuse, or muscle tightness.

Working definition: Athletic dry needling vs non-athletic dry needling. There is not a difference between the wording.  We aim to take and make dry needling practical and easy to use. We filmed professional-quality videos that are included in the course. What got you started in Dry Needling? I took 12 CEUs per year for 10 years What is your favorite application? The cervical seems to give the biggest outcomes I love when people are stumped or out of options and willing to try anything Weirdest needle Needling has a systemic effect Pelvic floor dry needling There are a lot of barriers to entry for the secondary school AT.   How do you walk through those? Get the waiver specific to dry needling. Use a lot less needles Include stim and needles to reduce the number of needles needed. Typically I use 16 -20 needles Young kids, I use less than 10. If someone is scared of needles, can they do this course? We get this often. I try to get them to try a few and see We have only had one person no-show on the next day due to the fear of needles When would you apply E-stim to needling? Allows you to dose needling - essentially make it more or less intense. Best used for pain mitigation If they are hesitant Find out their objections You can have anything in the world you want if you help enough people get what they want. - Zig Zigler Call to action: use SportsMedicineBroadcast.com/DryNeedling for your exclusive discount Contact Us Scott Dixon - AthleticDryNeedling@gmail.com Scott - 904-853-1921 Jeremy Jackson -

We're diving into a fascinating study on the effects of dry needling and spinal manipulation in treating nonspecific chronic low back pain. This episode is a must-listen if you're curious about combining these treatments to enhance patient outcomes. We'll explore the study's findings, discuss the global prevalence of low back pain, and highlight the significant benefits of integrating dry needling with chiropractic adjustments.Episode Notes: Comparison of the effects of dry needling and spinal manipulative therapy versus spinal manipulative therapy alone on functional disability and endurance in patients with nonspecific chronic low back painThe Best Objective Assessment of the Cervical Spine- Provide reliable assessments and exercises for Neuromuscular Control, Proprioception, Range of Motion, and Sensorimotor-Integration. Learn more at NeckCare.comTurncloud EHR- Minimalist design, without being sparse. Practical, yet elegant. Turncloud's design was to find the most efficient path in a day in the life of a chiropractic office. Connect with their team at www.turncloud.com Patient Pilot by The Smart Chiropractor is the fastest, easiest to generate weekly patient reactivations on autopilot…without spending any money on advertising. Click here to schedule a call with our team.Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

Dr. Ellison Melrose // #TechniqueThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling faculty member Ellison Melrose dives into the topic of abdominal dry needling, focusing specifically on chronic abdominal wall pain. They discuss how this condition often arises from entrapment of the anterior abdominal nerves, frequently seen in postpartum women and individuals experiencing chronic pelvic pain syndromes. The episode covers the techniques for needling the rectus abdominis, including how to orient to the tissue and choose the appropriate needle length. Dr. Melrose introduces the use of electrical stimulation (e-stim) to enhance muscle response during the procedure, explaining the importance of localizing muscle spindle interactions. The episode provides a practical demonstration, including preparation techniques and exercises to visualize the abdominal muscles. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling.

This week Joe brings back his wildly popular "overrated/underrated" segment! Specific topics discussed include: 1) Floating Heel Exercises 2) Dry Needling 3) Peloton 4) Odd Object Lifting 5) Single Set of Push-ups to Failure 6) Walter Payton 7) Original Met-Rx & Myoplex vs Today's Brands 8) Lengthened Partials 9) Fasting 10) Turkish Get-Ups 11) Revival of the Running Back/Running Game in NFL Football 12) Youtube Fitness 13) Reverse Grip Bench Press 14) 15+ Rep Sets 15) Crumbl Cookies 16) Getting 8 Hours of Quality Sleep 17) Over-Easy Egg on a Burger 18) Having Great Grades in School 19) LMNT/Electrolyte Powders *For a full list of Show Notes + Timestamps goto www.IndustrialStrengthShow.com. IMPORTANT LINKS The DeFranco Whey Dinosaur Training  Team Forever Strong [1-Week FREE Trial] Magic Spoon [code: JOED] BON CHARGE [code: JOED]

This week Joe brings back his wildly popular "overrated/underrated" segment! Specific topics discussed include: 1) Floating Heel Exercises 2) Dry Needling 3) Peloton 4) Odd Object Lifting 5) Single Set of Push-ups to Failure 6) Walter Payton 7) Original Met-Rx & Myoplex vs Today's Brands 8) Lengthened Partials 9) Fasting 10) Turkish Get-Ups 11) Revival of the Running Back/Running Game in NFL Football 12) Youtube Fitness 13) Reverse Grip Bench Press 14) 15+ Rep Sets 15) Crumbl Cookies 16) Getting 8 Hours of Quality Sleep 17) Over-Easy Egg on a Burger 18) Having Great Grades in School 19) LMNT/Electrolyte Powders *For a full list of Show Notes + Timestamps goto www.IndustrialStrengthShow.com. IMPORTANT LINKS The DeFranco Whey Dinosaur Training  Team Forever Strong [1-Week FREE Trial] Magic Spoon [code: JOED] BON CHARGE [code: JOED]

Hi Beauties! On this week's episode of Beauty Bytes with Dr. Kay: Secrets of a Plastic Surgeon, I am excited to join Dr. Michael Belkowski, founder of Biolight, to discuss the benefits of red light therapy. Michael has his physical therapy practice in Montana where he specializes in a variety of treatments. Similar to his specialty of Dry Needling, he came across Red Light Therapy which focuses on reducing inflammation and improving circulation. Most importantly, we discuss how it stimulates our mitochondria, which determines our overall health and longevity. He created Biolight because he wanted to make a product that was more affordable and still good quality compared to the other products that were already out there. Benefits of Red Light Therapy include hair health, skin health, athletic performance, brain/nerve health, anxiety and depression reduction, bone & joint pain & much more! 

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling division lead Paul Killoren shares research on the efficacy of ultrasound-guided dry needling compared to landmark-based dry needling for safety & clinical efficiency. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling.

How to Optimize Your Body Mechanics in Manual Therapy with Dr. Ti PenceIn today's episode we wrap up our two part series titled "Body Mechanics and Beyond: Crafting a Sustainable Manual Therapy Practice" with Dr. Ti Pence.  In Part 1 we learned about the importance of alignment and conservative force generation techniques when performing joint manipulation. We also talked about the key "red flag mistakes" that can quickly lead to overuse injuries resulting in 'above the belt soreness' and can develop into career-ending injuries over time.Today, Dr. Pence will teach us his 90-90-90 rule for shoulder, elbow and wrist positioning.  We will also learn the optimal way to configure your treatment space for maximum efficiency and comfort and why it is important to be able to  generate force through fluid, balanced movements. Key Themes in Today's Episode: Common mistakes in performing manipulations and techniques leading to injuriesHow to use proper form to prevent injuries and role of relaxation and palpation in generating speedWhy you should avoid Mediocrity and the need for Specialization in Chiropractic CareWhy you should mastering specific techniques and counter techniquesHow to Prevent Injuries and Optimizing Force Generation in Chiropractic ManipulationTrusting sensory input and honest feedback rather than relying solely on assumptions when performing techniquesLeave us a review or submit a Question for Dr. Pence here: https://tinyurl.com/podcast88-reviewsQADownload the Accompanying PDF Guide today's Episode Here: https://tinyurl.com/podcast88-PDFLearn more about new certification in Rehab, Clinical Nutrition, Dry Needling, Acupuncture and more here: https://tinyurl.com/podcast88-certs

If you're a healthcare provider in the physical medicine space, your body is one "tool of the trade" that you use more than any other in your practice.  Whether you're performing joint manipulations, soft tissue treatments, needling or using any variety of treatment modalities, your physical ability to perform is the common denominator.And while there is no shortage of courses that can teach you about various techniques and treatments, there is very little attention given to the biomechanics and ergonomics involved with preserving the physical health of the provider administering care.In this two part series with Dr. Ti Pence, titled Body Mechanics and Beyond: Crafting a Sustainable Manual Therapy Practice, we will discuss the importance of alignment and conservative force generation techniques when performing joint manipulation.  Key Themes in Today's Episode: Important "red flag" mistakes that can quickly lead to overuse injuriesHow to avoid the most common injuries within the first five years of practiceTechniques and positioning that place unnecessary strain on the body The practical and somewhat unconventional rule to measure the effectiveness of body mechanicsLeave us a review or submit a Question for Dr. Pence here: https://tinyurl.com/podcast87-reviewsQADownload the Accompanying PDF Guide today's Episode Here: https://tinyurl.com/podcast87-PDFLearn more about new certification in Rehab, Clinical Nutrition, Dry Needling, Acupuncture and more here: https://tinyurl.com/podcast87-certs

“What do you mean you're going to poke me with needles?” You might ask this question if your medical professional believes that needles might help expedite your healing and recovery process from an injury. Typically people associate needles only with acupuncture. However, other medical professions use needles in different ways for different benefits.Today our guest is Dr. Timothy Garrison. He is a Partner and Physical Therapist with several credentials behind his name including: DPT, CMTPT, FMS, AIB-VR, Body Q, Vest Cert. LV. 1. On today's show he walks us through the basics of dry needling and how it relates to the practice of physical therapy. He dives into his own physical recovery with needle techniques and how he helps his patients every day. Tim has treated both surgical and non-surgical patients, with the goal of restoring maximum function so patients can return to their normal lives and activities. Tim takes pride in treating each patient individually, taking into consideration their lifestyle  and prior level of function when creating a physical therapy treatment plan.Tim Garrison has been practicing physical therapy in Maryland and California for over 21 years. After undergraduate Tim went on to get his Doctorate Degree in Physical Therapy from University of Maryland Eastern Shore. Tim has treated a wide array of orthopedic conditions by working predominantly in an orthopedic and vestibular medicine setting. He has been specializing in vestibular care and concussions and has multiple certifications .Tim has a special interest in running and treating the injured runner as well as shoe wear. Tim has completed one full marathon in 2017 exactly 2 years after his second ankle surgery for a severe injury. When not working, Tim enjoys spending time with his two sons snowboarding and also participates in adult soccer, running training, and is passionate about running races for charity.Connect with him:www.fyzical.com/south-frederick-mdTim.garrison@fyzical.com

The Intersection of Dry Needling and Acupuncture in Clinical Practice with Dr. Gary Estadt, Pt. 2In this episode, Dr. Gary Estadt walks us through real-world applications and success stories that showcase the quick and profound effects of needling on complex conditions like frozen shoulder, peripheral neuropathy, and even phantom limb pain. We also chat more about the importance of patient education and how to discuss the use of these treatments with patients who may have a fear of needles.Key Themes in Today's Episode: Acupuncture's physiological impact on the autonomic, cardiovascular, endocrine, and immune systems.The current status of insurance reimbursement for needling procedures and how to effectively code for dry needling servicesEducational Recommendations for PractitionersHow a dual approach to needling can significantly improve your ability to treat a myriad of conditions effectivelyThis Episode Sponsored by: Southeast Professional Education GroupJoin us for our next FAKTR webinar on Thursday, August 22nd. Click the link below to register for free: https://tinyurl.com/podcast86-AugWebinarDownload the Accompanying PDF for today's Episode Here: https://tinyurl.com/podcast86-PDFTell us which cities we should add to our 2025 live course line-up! Send us a DM on Instagram at https://www.instagram.com/faktreducation

The Intersection of Dry Needling and Acupuncture in Clinical Practice with Dr. Gary Estadt, Pt. 1Needling techniques, can be some of the most effective treatments in a healthcare providers arsenal.And while both use solid filiform needles and target specific points in the body, they differ in their historical background, philosophy, and terminology.In Part 1 of this two episode series, we'll learn about the fascinating history of needling that goes back over 5,000 years, with insights into the incredible case of Otzi the Iceman.We will also discuss the critical differences and surprising similarities among dry needling, Western medical acupuncture, and traditional Chinese acupuncture.Key Themes in Today's Episode: Differences and Similarities Between Dry Needling and AcupunctureHistorical Context and Evolution of Needling PracticesMechanisms and Physiological Effects of Needling TechniquesEducational Recommendations for PractitionersHow a dual approach to needling can significantly improve your ability to treat a myriad of conditions effectivelyThis Episode Sponsored by: Southeast Professional Education GroupJoin us for our next FAKTR webinar on Thursday, July 31st. Click the link below to register for free:https://tinyurl.com/podcast84-JulywebinarLINKS:Join our Email List: https://faktrperformance.com/join-the-list-5776

After attending a Dry Needling course and getting some fantastic extra clinical pearls this one really stuck out to me. It was extremely interesting to think about utilizing lumbar adjustments as rehab, through the stretch reflex of muscles. We aren't downplaying rehab at all and think it is really important but I had never thought of this concept as something that worked in this way. So I did my best to recap it. Thoughts? www.clinicallypressed.org #complicatedsimple #resultsthatgiveback --- Support this podcast: https://podcasters.spotify.com/pod/show/clinicallypressedco/support

The best way to learn dry needling.  Plus S'mores, Minions, and 12 month vs 10 month contracts!  Defintely worth a listen! healthyroster.com The official sponsor of Candid Athletic Training! athletictrainerinsuranceplus.com GET $$$ Off with Candid Membership!!!!! www.smarttoolsplus.com 10% OFF with Promo: CANDID10 https://athleticdryneedling.com/ get $100 off a course with a Candid Memberhsip!!!! https://chinookseedery.com/ The best sunflower seeds out there!  Discounts for Candid members! https://performancerunning.com/ 10% off in stock fully priced products using the code Candid10 or get 25% off with a Candid membership (some restriction apply)

Herman is weer thuis na een lange rit in de auto. En daar kon ie vandaag op de rustdag weer even goed van bijkomen. Martijn had het even wat pittiger, want hij kreeg vier naalden in zijn reet gestopt. Dry Needling het dat. En vooralsnog zijn de effecten er! Niet te vroeg juichen natuurlijk. PODCAST TIPS VOOR OP DEZE RUSTDAGDe Kopgroep (elke dag over de Tour)De Dienst (over en van de AIVD)De Bourgondiërs (prachtige geschiedenispodcast van Bart van Loo)Monsters in het Bos (de favo van Herman)Napleiten (over de Nederlandse rechtspraak De Wielerredactie (van maatje Steven Dalebout, doorwrochte wielerachtergrond)Support this show http://supporter.acast.com/tweewielers. Hosted on Acast. See acast.com/privacy for more information.

Dr. Ellison Melrose // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling Division faculty member Ellison Melrose discusses the benefits of utilizing dry needling as a treatment for sexual dysfunction in women. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our Extremity Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION ELLISON MELROSEGood morning PT on ICE Daily Show I am coming to you live from Durango, Colorado this morning in my truck so excuse the background, but we are here to talk about First of all, my name is Dr. Ellison Melrose. I am lead faculty with the dry needling division of ICE. I am coming to you today to talk about dry needling in the pelvic health space, particularly for sexual dysfunction in females or in women. And I wanted to highlight two common diagnoses we have, which is vulvodynia and vaginismus. So let's dive right into that. First, I want to highlight in 2018, there was a joint report done by both the International Urogynecology Association and International Continence Society that overviewed sexual function and dysfunction. They did a deep dive into things like the proper screening, what proper history or physical subjective objective exam would look like. And then they had a huge section on the prevalence of pelvic floor dysfunction in folks that had sexual dysfunction as well. So that's what I wanted to highlight today. We, in the pelvic floor practice or pelvic floor space, we see it often where pelvic floor dysfunction and sexual dysfunction is highly linked and correlated. what I, what this report, um, highlighted is that there's actually 37 different diagnoses of sexual dysfunction that can be attributed to some form of pelvic floor dysfunction. And that's a lot, right? So, um, there granted, I mean, if you look at all of the, the nitty gritty diagnoses, um, we may be thinking maybe we're over medicalizing this, patient population a little bit with specific diagnoses, but it highlights the fact that there's so many people out there that have pelvic floor dysfunction that is contributing to a form of sexual dysfunction. 45% of women that have urinary incontinence will complain of sexual dysfunction at some point in their life. Of that 45%, 34% of that is hyposexual desire disorder. Um, and 44% of those are a brand of sexual pain disorder, which is either dyspareunia or a non-coital, so a genital pain that's not associated with intimacy. And that's what I wanted to highlight. Two most common diagnosis that we see in the clinic that can be challenging for us as pelvic floor PTs often are both vulvodynia and vaginismus. And we'll kind of get into potentially why these can be challenging diagnoses for us. DRY NEEDLING FOR VULVODYNIA Um, but for vulvodynia, the clinical definition of this is anyone that has had pain in or around the vulva region for at least three months without a clear ideology of symptoms. So they don't have, They've had negative cultures, so they don't have either fungal or bacterial infection going on here. And so there's this idiopathic pain presentation in the vulva region. And then vaginismus is a recurrent or a persistent muscle spasm of the pelvic floor, which inhibits any form or enables penetration and there's different forms of vaginismus and different diagnosis underneath that umbrella of vaginismus. And we can kind of dive into that when we talk about vaginismus specifically. I wanted to highlight these two diagnoses particularly because without a proper diagnosis, oftentimes the internal assessment can either be very challenging or it can be very non-therapeutic and actually traumatizing to some of these folks. So if we don't have a particular subjective exam that allows us to understand what is going on with our patients, the whole pelvic floor assessment may be not therapeutic. So for both of these diagnoses, everything starts in the subjective exam. Let's start with vulvodynia. So vulvodynia, oftentimes folks may have symptoms similar to that of a yeast infection or a UTI that then kind of snowballs from there. They may have actually had recurrent yeast infections or UTIs in the past and are familiar with those symptoms, but, and so they do their normal treatment with that, which a lot of times is either over-the-counter medication or they might phone up their OBGYN and say, well, let's get some of these either antifungals or antibiotics on board ahead of time while we wait for the culture. Well, culture comes back negative and the symptoms are still persisting. Sometimes they may get taken away with some of the medication a little bit, but the symptoms overall typically will persist past that. Um, and for folks that have this at this point, it is no longer a, um, you know, bacterial or yeast causing these symptoms. There is a brand of neuropathic pain going So a lot of times they have either had this for quite a long time, at least three months, they've seen other providers that have either provided a medical treatment or something that has been ineffective. And so symptoms have continued. When we think about neuropathic pain and the chronicity and the persistent pain or the chronic pain side of things here, this actually heightened symptoms typically. Um, other subjective things that you might see in these folks is that they may have, um, some sensitivity to, uh, like touch in, in the vulva region, right? So wearing specific type of clothing may be uncomfortable where they may have other brands of, uh, nerve related symptoms like itching or burning. Um, which oftentimes are two symptoms that we think about for either a yeast infection or ATI. And so that's why they get mismanaged in their medical treatment. So it all starts in the subjective exam. And while an internal assessment in these folks isn't out of the question, it can definitely be helpful. It doesn't always, it's not the most efficient way to go about treating this pain presentation. when we think about neuropathic pain, we need to think about, okay, why is this nerve so irritated? And a lot of times in vulvodynia, they see that there is either a irritation of the nerve. Sometimes there can even be, you know, some, some changes in the myelin sheath of these nerves. So there's actual nerve damage associated with it. Depending on maybe what the original cause of the, nerve irritation was. And so when we dive into, we've highlighted their subjective complaints, we know what's going on here, where do we go from there, the internal assessment may be valuable in order to see is this maybe a hypertonicity issue. So if we have tight pelvic floor musculature, can we teach them to relax their pelvic floor and allow for improved blood flow to the pudendal nerve that could be contributing to some of these symptoms. So there is a lot, there is value in that. And I believe that there is, um, oftentimes in the pelvic health space, we are so used to, um, you know, trying to treat, the patient's symptoms ourselves, whereas we can teach our patients to help themselves with learning how to relax their pelvic floor. So there is a benefit in the vulvodynia patient population to utilize the internal assessment. But when we think about efficiency, so how can we treat a neuropathic pain presentation the most efficiently in our in our clinical setting? I am in the dry needling space, and so we use dry needling a ton outside of the pelvic floor world for treating various different brands of pain, one of which is neuropathic pain. So dry needling can be a super efficient tool to improve, to talk to the nervous system and do a nervous system reset to the nerve in question, which oftentimes is the lupudendal nerve. So dry needling is a very efficient tool in order to improve those neuropathic symptoms. With that being said, everything we do physically, manually, we need to highlight that this is a persistent pain diagnosis at this point. And so we need to be utilizing our pain neuroscience education. um, educating these folks about, um, what, what happens to our nervous system when we have had pain for a long period of time. Um, and, and that pain doesn't necessarily equal damage at this point or else everything that we do with our, our manual skills or dry needling, uh, will only get us so far. Right. So, um, vulvodynia again a lot of times these patients come in to us with chronic symptoms so they've been going at this for a very long time they've had typically a medical mismanagement where they've been having some medications on board that weren't helping their symptoms they have a lot of sensitized nervous system and so we want to make sure that we are using the most clinically efficient tool to treat these symptoms. Oftentimes as well, you might actually get some reproduction of symptoms with dry needling when we're approximating the pudendal nerve or getting close to that pudendal nerve, which can be helpful in almost diagnosing, right? So using our tools to help with localizing their symptoms. So that is how we would use dry needling in a case for vulvodynia and in a patient population where we would still likely be able to utilize the internal assessment. DRY NEEDLING FOR VAGINISMUS Now let's pivot to vaginismus. Let's talk a little bit more about different diagnoses under the umbrella of vaginismus and then how we would and why we would use dry needling in this patient population. So, Vaginismus, there's two different diagnoses and underneath that we have two other subdivisions. So we have both primary and secondary vaginismus. So again, a reminder vaginismus is either a persistent muscle spasm of the pelvic floor. It's either persistent or it's associated with something and we'll get into that. Primary means that this has been forever. So this has always been an issue. Um, sometimes there may be a congenital malformation of the genital track on board with this patient population as well. Um, and if that is the case, even things like typically their first, um, like, uh, association with any form of penetration, uh, is oftentimes a, when they get their menstrual cycle. So, um, having a tampon and they're unable to actually insert a tampon into their vagina. Um, from there, then they, they often with this congenital, um, malformation or having it be a primary diagnosis is they, they often are treated fairly medicalized in that state and, and they may require some form of surgical procedure to, widen the vaginal canal. So that's primary vaginismus. Secondary vaginismus is acquired. So it wasn't always an issue, but it could be acquired from a form of trauma. So either an emotional or a physical trauma that then caused muscles in the pelvic floor to spasm. And this can be either global. So what I mean by global is that it's every time anything is enters the vaginal canal, there is a muscle spasm associated with that or it's situational, meaning that things like inserting a tampon may be possible, but physical intimacy with, um, or sexual intimacy is not possible. So there's no, uh, penetration available during, uh, sexual intimacy. Um, so those are the different kind of clinical or, diagnosis we find under the umbrella of vaginismus. Oftentimes in pelvic floor PT, we will see, um, a lot more probably of the secondary vaginismus in that they've, you know, they've never had, they hadn't always had issues, but then something caused or something triggered an issue, which causes the pelvic floor muscles to, um, to spasm, right? And that could be a traumatic birth of vaginal delivery. It could be a sexual trauma. So a, um, yeah, a sexual assault or something of the sort. It could be a, uh, traumatic pelvic exam by their OBGYN, uh, which we've, I see a ton in the clinic and, um, so it could be, a natural physical trauma with that. And then it could also be heightened with a, um, an emotional trauma as well. So a lot of times, I mean, this is a very intimate part of our body. And so there's a lot of times a very, uh, pertinent, uh, or very prevalent emotional, well, um, 70%, I would say probably about 70% of your initial evaluation evaluation, is going to be a subjective exam. Understanding the why behind these patient symptoms is crucial to dictate the course of your treatment or even the course of your assessment in that initial evaluation, right? Like, are we going to be doing an internal assessment on these folks? And a lot of times, probably, probably not, right? So what does day one look like or our initial evaluation look like with folks that have vaginismus? and how and what does our course of treatment look like for them. So typically education goes a long way with folks that have had either a physical or an emotional trauma that has caused muscle spasms here, right? So teaching folks about the anatomy of the pelvic floor musculature uh, why they feel like there's a brick wall when they try to insert a tampon. Right. Um, how, uh, what a Kegel is. Right. So anytime people have any association with the pelvic floor, they are often just think, Oh, I should be doing Kegels. Right. Um, and teaching them what, what a Kegel or what a pelvic floor muscular muscle contraction is and educating like the benefits of relaxing the pelvic floor. And this is just all done through education. So no even physical touch or assessment has been done at this point, but just educating folks around the anatomy of the pelvic floor. Anatomy and physiology of the pelvic floor can go a long way here. We also want to educate about vaginismus itself. So vaginismus is another brand of chronic pain, right? So these folks have typically had pain for an extended period of time, Um, there's not a diagnostic criteria for, for duration of symptoms like there is for vulvodynia. Um, but there is a pain cycle on board here, right? So it all starts in the brain. So it, it either the, the brain perceives an emotional trauma due to either a physical trauma or, or purely emotional that registers discomfort or, or fear associated with, uh, penetration either from a previous, uh, you know, exam with a speculum from a previous sexual encounter, um, from a trauma traumatic birth, right? So the brain remembers those things, which is then going to be causing, it causes muscle guarding. So public for guards, the tight muscles in the public for cause the penetration to be painful. or impossible at sometimes. And then this difficulty in pain reinforces that alarm, the amygdala alarm that's going on up in the brain, right? That reinforces that this is a threat, right? The nervous system then remembers this pain, and so every time our brain is their, their brain is thinking about, you know, either having to go to the OBGYN or having a sexual encounter, anything like that. Um, it is going to remember that and we are going to get the same physical symptoms as the, the tight muscles, um, which is often going to lead to, you know, decrease blood flow to the nervous system, which is going to cause potentially, you know, perceived as pain by these folks. And so they're going to avoid those, uh, you know, avoid whatever is causing this pain cycle, right? And those folks, which ultimately, especially if this is a sexual nature is going to, um, reduce the desire to either have sexual intimacy with their partner or, um, and it's, it's going to reduce that, that overall desire, which is then going to, again, any thought of that intimacy is going to be threatening. So discussing that, that pain cycle with these patients can be very therapeutic and, and helpful in that this isn't their fault, you know? So the nervous system, I like to say it's smart, but dumb, right? It remembers things and not always for the right reasons. And so education about anatomy, physiology, about the vaginismus pain cycle, can take up a majority of your initial assessment with these folks. I also like to do, again, a guided pelvic floor relaxation series with my folks, even if we're not doing an internal assessment. So on day one, these folks, we may not be getting into an internal assessment. We may never get into an internal assessment, but we do want to teach them how to um, feel their pelvic floor muscles and, and learn how to relax them. And so sometimes, um, I will educate them on how to do some self biofeedback either with tactile cueing, um, just medial to their ischial tuberosities sitting on, um, you know, a yoga ball or something like that, where we have some, uh, tactile cueing to the, um, perineal region or the pelvic floor area. Um, and, and teaching them about, again, the anatomy and that when, We're breathing. We're trying to make some of these muscles move. Increasing movement in these tissues is going to increase blood flow to the tissues, which is going to reduce irritation to the nervous system. So teaching them how to relax their pelvic floor without even doing any physical touch yourself can also be helpful. This is a patient population where after we kind of break down and help them understand the why, I like to highlight other tools we have in our toolbox as physical therapists, right? A lot of times when these folks, um, come to pelvic floor PT, they, they've done their research. So they know often that pelvic floor PT equals an internal assessment, which they've had done by their OBGYN and it's maybe been traumatic in the past or Um, they know any form of penetration is, is traumatic. And so, um, right out the gate, I'll say, you know what, that is a tool we have in our toolbox. The internal assessment's a tool. It is gold standard for assessing how the pelvic floor muscles function, but is not everything that we do here at pelvic floor PT. And I introduced dry needling. And I know that seems like for folks that have, don't have vaginismus or don't have trauma associated with penetration, they're like, Isn't dry needling more of a threat than an internal assessment? And for folks that have vaginismus, oftentimes it's not, right? So dry needling the pelvic floor muscles can be an amazing tool as we don't necessarily need to do an internal assessment. on these folks, we know there's likely not going to be anything therapeutic initially with that initial internal assessment. So if we can utilize dry needling in the earlier stages of our pelvic floor PT with these folks, it can be an amazing tool to talk to the nervous system, you know, put a break in that pain cycle associated with the muscle spasms or the tight pelvic floor musculature. It's a beautiful kind of what I like to say control or delete to the nervous system and so it can really help with Retraining that cycle of you know, these muscles Have more control other than just muscle spasm, right? and so if we can take some of the the heightened neuropath or the heightened symptoms down with a tool like dry needling, it may allow us to either ourselves or them do a form of stretching or manual therapy where they can improve the tissue's mobility as well, right? SUMMARY So I could probably talk about this stuff all day. I've already been on here for almost 25 minutes, so I'm going to stop it here, but I want to kind of summarize everything we talked about today. Um, I, we kind of went into a recent report done in 2018 that dove into some pelvic floor dysfunction in, um, sexual function and sexual dysfunction. And we dove into two specific diagnoses today. We looked at vulvodynia and vaginismus clinically and how we can utilize things like dry needling for either treatment or even, um, diving into a little bit of some diagnostic, uh, with, utilize with dry needling as well. Um, and so, uh, while we're, you know, dry needling, the pelvic floor is a fairly unique, um, skill. Uh, there's a lot we can do with dry needling outside of the pelvic floor as well for these folks. And so, um, for those that are in this space, I highly recommend taking our lower body dry needling course if you haven't already, We go into needling for the lumbar spine, the glutes, muscles that surround the sciatic nerve. And so again, taking those principles and utilizing them in the pelvic floor space can be really helpful as well. So we have some courses upcoming this fall. We have, let me pull it up right here. We have a lower body course, I believe in Scottsdale, Arizona, in the beginning of September. We, for those that have taken lower body or upper body, we have two advanced courses coming to you this August. So we have our, our juggling summit up in Seattle and the second weekend in August. And then we have one down in Longmont, Colorado at the second to last weekend in August, um, right before Labor Day. Uh, we have a ton of lower body courses coming to you this fall. So hop onto ptlnice.com and check out what courses we have, um, coming to you. Um, if you guys don't see something in your area, feel free to reach out to us and, um, we can look at getting something booked near you as well. Well, hopefully you guys have a great rest of your Tuesday and enjoy the holiday this week. Bye. OUTROHey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

In this week's episode, Physiotherapist Brent Stevenson breaks down the important question: why do we hurt?  After a horrific eye injury that led him to write his first book, Brent has helped many relieve pain and feel more comfortable in their bodies.  We discuss how to tap into the nervous system, the issue with repressed emotions, why strength is a skill, and more!   Time Stamps:   (5:36) Eye Injury To Writing A Book (15:37) Tapping Into The Nervous System (19:44) Dry Needling (25:44) Repressing Emotions (39:09) Lifting Heavy In Your 50's (43:17) Strength Is a Skill (57:09) Where To Find Brent -------------------- Brent's Website: http://whythingshurt.com/  Envision Physio's Website: http://www.envisionphysio.com/ Brent's Instagram: http://instagram.com/whythingshurt/ Brent's Youtube: http://youtube.com/envisionphysio Brent's Facebook: http://facebook.com/whythingshurt Book by Brent Stevenson: Why We Hurt: Understanding How To Be Comfortable In Your Own Body -------------------- Instagram: https://www.instagram.com/carolcovinofitness/ -------------------- My YouTube Channel: http://youtube.com/@carolcovinofitness -------------------- Finding Purpose in the Pause Book: https://www.amazon.com/dp/B0BZQKKZC8  

Matt and Allie are back in Dry Ridge with Physical Therapist Zoe and her patient Scooter Arnold. Hear about Arnold's injury, experience with chronic pain in his shoulder and neck even after getting multiple rounds of epidural injections. He was tired of not finding something that made him feel better, and decided to join his family members in trying Oxford PT.  Scooter describes his dry needling sessions with Zoe and how it has positively effected his life and progress in strengthening.Did you know that you don't need a doctor's prescription to receive physical therapy? The laws of Direct Access allow you to receive physical therapy without a referral and still use your insurance benefits! Learn more on how Direct Access can help YOU! Our website: https://www.oxfordphysicaltherapy.com/

The effectiveness of dry needling in patients with chronic low back pain: a prospective, randomized, single-blinded study. Rajfur J, Rajfur K, Kosowski Ł, et al. Sci Rep. 2022;12(1):15803. doi:10.1038/s41598-022-19980-1 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux

In this witty and informative episode of Join The Docs, Professor Jonathan Sackier and Doctor Nigel Guest delve into the world of Achilles tendonitis. They kick off the show by tracing the condition back to its mythological roots: when Achilles was dipped in the River Styx, if his mum had done a better job, The Docs might be out of a job! “I didn't think I was going to play ever again.” The Docs welcome a true sporting legend, Glenn Hoddle, sharing his personal battle with tendonitis. Hoddle, known for his magical touch on the football pitch, discusses how tendonitis affected his career. With his trademark wit, he recounted the days when his tendons were more bothersome than a referee on match day. A Tottenham Hotspur legend, Glenn also played for other clubs including Monaco, then went into management at Swindon, Southampton, Wolves, his beloved Spurs and, some “other” London club and also managed the England national team. Now a TV football pundit, Glenn is delighted to join The Docs to tell his story and help others.The Docs then dissect the tendon itself, a topic that leads Jonathan to challenge Nigel's perspectives on human anatomy. Talk of diagnosis  waxes and wanes from fact to a comedy routine with the duo describing  various tests and treatment, with the  role of cold vodka carefully considered.  They segue into treatments, covering how RICE (Rest, Ice, Compression, Elevation) has changed to  PEACE & LOVE…..And if that makes no sense, listen to Join the Docs!"But wait, there's more! If you call within the next ten minutes, we'll throw in a free set of crutches!" Surgical options discussion turns into a mock infomercial, with Dr. Guest pretending to sell the idea of surgery as if it were a set of steak knives. Do you really have to warm-up before every bit of exercise?  Professor Sackier shares a personal anecdote about the time he mistook a dance-off as a suitable warm-up and ended up doing the "robot" for a week straight due to stiffness. Doctor Guest chimes in with his own tale of using interpretive dance to explain tendonitis to a confused group of medical students. The conversation takes a turn to the role of general health in preventing tendonitis, with Dr. Guest suggesting that eating carrots might not help your tendons, but at least you'll see them better.How did that happen? Sharing personal experiences turns into a comedy of errors as they recount their most memorable tendonitis cases, including the time Dr. Guest diagnosed a case of "guitar hero wrist" and Prof. Sackier treated a "selfie elbow."Ring, ring! The evolution of sports medicine is likened to the evolution of the mobile phone, with The Docs joking that tendon treatments used to be as big and clunky as a 1980s cell phone. The Docs wrap up the episode with tongue-in-cheek advice on tendon care, including a suggestion to avoid activities that involve chasing mythological creatures. —--DISCLAIMER: The views and opinions expressed on Join the Docs are those of Dr. Nigel Guest, Jonathan Sackier and other people on our show. Be aware that Join the Docs is not intended to be medical advice, it is for information and entertainment purposes only - please, always take any health concerns to your doctor or other healthcare provider. We respect the privacy of patients and never identify individuals unless they have consented. We may change details, dates, place names and so on to protect privacy. Listening to Join the Docs, interacting on our social media, emailing or writing to us does not establish a doctor patient relationship.To Contact Us: For a deeper dive on this episode's issue, merchandise and exclusive content, head to www.jointhedocs.comFollow us on youtube.com/JoinTheDocs Follow us on instgram.com/JoinTheDocsFollow us on tiktok.com/JoinTheDocsFollow us on: facebok.com/JoinTheDocsFollow us on: x.com/JoinTheDocs

Dave Coombs-Dry Needling (5/14/24) by 96.5 WKLH

Heard of Dry Needling? DocJen and Dr. Dom give you the rundown on what Dry Needling is, the effect it has on the body physiologically, and who might need it! They discuss the limitations of measurement bias in research, the benefits of dry-needling, how long it lasts, and what it means to have expectations and beliefs about dry-needling, also considering the role of supervision and emotions. Let's dive into all things dry needling and what the systematic reviews say about Dry Needling! ⁠⁠⁠VivoBarefoot Discount: Save your kids feet! Your feet have the components they need to support themselves! That's why we love ⁠⁠⁠⁠VivoBarefoot⁠⁠⁠⁠ because the shoes themselves help us gain mobility and strength in our feet. Live that barefoot life in style, choose VivoBarefoot and use code ⁠⁠⁠⁠TOB at checkout to get 15% off⁠⁠⁠⁠! Your foot and body will thank you (affiliate link)! **Vivo offers a 100-day trial period. If you are not completely satisfied, you can send the shoes back and get a refund. Needed Discount: Prenatal supplements? Male prenatal vitamins for sperm support. No unnecessary fillers at the highest quality of nutrients and it's all sustainably sourced! With 7x more choline, 6x vitamin B3, 20x more vitamin B6, use code OPTIMAL for 20% off. What You Will Learn in this PT Pearl: 2:40 - What is Dry Needling? 5:30 - Dry needling - how is it used? 8:05 - Limitation of measurement bias 11:55 - Dry needling benefit 14:12 - How long does the benefit last? 15:20 - Expectations and beliefs of dry needling 19:13 - What the research says! Systematic reviews! 22:40 - Emotion ,Supervision, and Pain?  To Watch the PT Pearl on YouTube, click here: ⁠⁠⁠https://www.youtube.com/watch⁠⁠⁠ For the full show notes, visit the full website at: ⁠⁠https://jen.health/podcast/356 Thank you so much for checking out this episode of The Optimal Body Podcast. If you haven't done so already, please take a minute to ⁠⁠⁠subscribe⁠⁠⁠ and leave a quick rating and review of the show! --- Send in a voice message: https://podcasters.spotify.com/pod/show/tobpodcast/message

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com 

In this podcast episode, Dr. Leanne Bisset, a musculoskeletal physiotherapist and associate professor at Griffith University, shares valuable insights on lateral epicondylalgia, also known as lateral elbow tendinopathy. She discusses the anatomy and function of the affected muscles, highlighting the importance of stability in wrist movements and the role of the extensor carpi radialis brevis. Dr. Bisset emphasizes the shift in terminology from epicondylitis to tendinopathy, debunking misconceptions around inflammation in the condition and providing a comprehensive overview of diagnostic considerations, risk factors, and red flags to look for during assessment. Furthermore, Dr. Bisset delves into the management of lateral elbow tendinopathy, emphasizing the significance of tailored exercise programs focusing on isometric loading initially, progressing to incorporate global upper limb strengthening for comprehensive rehabilitation. She also addresses the limited efficacy of modalities like shockwave therapy and the potential benefits of orthoses in pain management. Dr. Bisset's evidence-based approach underscores the importance of patient education, individualized treatment plans, and monitoring pain responses to optimize outcomes in the management of lateral epicondylalgia.   Guest Dr. Leanne Bisset is a musculoskeletal physiotherapist and an associate professor at Griffith University at the gold coast, Australia. She has published over 100 papers on a variety of topics and has done extensive research on lateral epicondylalgia.   Chapters 00:00 Intro 00:44 Definition of lateral elbow tendinopathy 05:39 Why Inflammation is inaccurate 11:49 Risk factors 13:46 The typical patient 17:34 Red Flags 27:30 Diagnostic tests 29:49 Leanne's Diagnostic Approach 32:27 Treatment 38:15 Details on Isometric Loading 49:29 Other treatments 54:02 Treatment Progressions 58:45 How much pain to allow 01:01:28 Shockwave and Dry Needling 01:03:56 Elbow Braces 01:05:50 Contact Info 01:06:58 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

The more I discuss with colleagues and experts how to provide the patient with great care and how to avoid the commoditization trap that insurance companies have doctors firmly trapped in, the more the idea of add-on services keeps revealing itself as a great option. Whether you are in-network with insurance or are a cash practice, some services are not covered by insurance or should be charged at a separate cash rate from your traditional chiropractic care. Some of those add-on services include but are not limited to, Shock Wave Therapy, Dry Needling, Laser Therapy, Physical Training, Supplementation, and more. In this episode, I interview Dr. David Rudnick about how he provides world-class care in his sports chiropractic clinic and has escaped insurance companies' commoditization trap. The good news is that you don't have to be a hard-sell clinic. You can provide add-on services without pressuring your patients into spending money they don't want to. You can reach Dr. Rudnick at davidrudnickdc@gmail.com.

Dr. Ellison Melrose // #TechniqueThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling lead faculty Ellison Melrose discusses using dry needling for recovery, including e-stim parameters using the ES-160 unit. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling. EPISODE TRANSCRIPTION ELLISON MELROSE Welcome to the PT on Ice daily show. My name is Dr. Ellison Melrose. I am lead faculty with the dry needling division of ICE. I am here to talk to you guys today about recovery, so dry needling for recovery. We are coming off of Ice Sampler Weekend, and we had two pretty intense workouts this weekend, and we're feeling it, I think. So we are pretty sore in the quads, so what I wanted to demonstrate today was a recovery method for primarily the quads. We're gonna go over recovery mechanisms, how to choose the muscles when you're thinking about setting up a recovery circuit, and the e-stim parameters that you want for dry kneeling for recovery. So there are three main mechanisms of action when we're thinking about recovery. The first is pumping, so hemodynamics. We're getting big muscles to pump. There are some muscles that are better pumps and better sponges, so they do a better job at the fluid dynamics. The second mechanism is washing out cellular debris from in that intracellular space. So thinking a little bit more microscopic than just vasohemodynamics or moving fluid. We're thinking cellularly. So we know that active recovery and facilitated recovery can do both of those things. What's nice about dry needling when we're thinking about recovery is that we're not putting any mechanical stress on the tissues, loading like we would with active recovery. Third, we have an autonomic nervous system response. DRY NEEDLING FOR HEMODYNAMICS So one thing that they saw throughout the research is that dry, or e-stim, facilitated recovery with e-stim, there is a longer base of dilation effect after we removed the e-stem from the tissue. And so what they postulated from that is that we have an autonomic nervous system response, so we have increased vasodilation, which is just going to improve our body's natural ability to pump fluid. When we're thinking about choosing muscles, again, as I mentioned earlier, there are some muscles that have better capacity to pump, but also absorb fluid and that is based off what we call O2 flux capacity. We're not going to dive super deep into that today, but pretty much what it means is that there's increased capillary density in those tissues and so they act as better sponges and better pumps. When we look at the lower quarter, there are two main muscles that are going to be pretty good or have higher O2 flux capacity. One is the medial gastroc and the other is the quadriceps. CHOOSING THE RIGHT MUSCLES FOR RECOVERY Another way to think about what muscles to choose are thinking about following the venous system. So again, we're trying to improve hemodynamics. So we want to follow the venous and lymphatic system to encourage that fluid to work its way back up towards the heart. And so thinking about a lot of the bigger venous structures, the lymphatic tissues run immediately. So when I'm thinking about setting up an entire lower quarter circuit. Sometimes, depending again on why I'm choosing these, we may be doing medial gastroc, medial quad, adductor magnus is a huge pump for the lower quarter. And then working into the glutes as well. And then, last but not least, is we have sport-specific muscle fatigue. So when thinking about, a great example I like to use is in CrossFit. After a really grip-heavy workout, we may be just specifically treating the forearm flexors, so the muscles that we're using to grip, right? In this case, we did a lot of thrusters on Sunday, so we are gonna be doing a quad recovery session for Sam today. We're just going to demonstrate bassus lateralis. When we look at e-stim parameters, so we want things to be a pump. So we need to have the intensity at a motor response. We also need it to be a non-fatiguing stimulus. So if our goal is recovery, we are thinking we want it to be non-fatiguing. So we're going to keep the frequency low. we are limiting pistoning. So we do not want to piston the tissue. Every single time we move a needle around in the muscle, we are creating a little bit more micro trauma to that tissue. And that is the opposite of what we want to do when we're thinking about facilitating recovery. So I'm going to get two needles set up in the vastus lateralis here, and we'll kind of go through the e-stim settings and, um, dive in a little bit deeper there. So for the, the needling technique, ready cleaned her skin here. We are going to be using a needle for the vastus lateralis that we feel like we have the most access to that tissue. So when thinking about choosing needle length for a larger muscle, we want to be using a longer needle where I'm going to be threading through the muscle here as I can have access to more muscle tissue. where I'd be going towards the femur. I am floating the needle in. I am not pistoning. If we get a twitch response, great. I'm not necessarily looking for a twitch response. Because we want a motor response with the e-stim parameters, we do want to be localizing our tip of the needle at a muscle spindle interaction, which is what elicits the twitch response. So what we're going to be doing instead of pistoning is a little bit of live redirecting of the needle under e-stem. We'll talk about that. So I'm just going to choose two big portions in the vastus lateralis here and thread across the tissue to have access to more. Oh, nice little twitch there. Because I did find a twitch, I'm going to leave my needle there as again, that is going to be the closest to that muscle spindle interaction where we can have better motor response. Then I'm going to choose a spot up a little bit more proximal, threading across the tissue. Perfect. Okay. So no twitch response there. Again, not necessary. We're not going to be pistoning to find that motor response. E-STIM PARAMETERS FOR RECOVERY So, I'm just going to be setting up a circuit here. And we are looking for, I'm gonna just pull these cords out of the way so we don't have that blocking our visual here. We are using the ES-160 today. All right, so e-stim parameters.. Low frequency, so we're thinking below 5 hertz. We want a motor response. Duration. So the longer the duration, the better. So when we're thinking about this, the research looked at 10 minutes versus 20 minutes, and they had almost double the biochemical clearance with 20 minutes compared to 10 minutes. And so we are thinking we want to set these up for longer duration, so thinking greater than 20 minutes here. We're not gonna be doing that for the podcast this morning, but we will set up that circuit and look for that motor response. So I'm gonna be increasing the intensity. Sam, let me know if it's strong, but still tolerable. Okay, we're looking for that motor response. And if we're not getting that motor response, we are going to do a little bit of live redirecting. So I have switched the, and parameters to just constant, you can do alternating frequency, but it's not necessary in the recovery session. So really whatever's the most tolerable for the patient is what we're going to want to do. So I'm increasing my intensity until we get a nice, strong muscle pump. DRY NEEDLING FOR RECOVERY So, this is what we're looking for when we're thinking about creating that muscle pump. Again, non-fatiguing, so we're thinking lower frequency, longer duration. Our muscles that we're choosing are either based off of following the venous system, looking at the O2 flux capacity in the muscle tissue, or sport-specific fatigue. Our mechanisms here, again, we're creating a pump. It's just a pump, it's really that simple, right? We're pumping fluid throughout the system. We're clear at a cellular level. We're clearing some of the, we're washing out the cellular debris. And then we are also facilitating vasodilation through the autonomic nervous system. If you have any more questions about this, feel free to check us out on the road. So we have a couple courses coming up on the third weekend in May. So the 17th and 18th is, you can check us out on the road. I'll be down in Virginia Beach. And then we hit, I'll be back in Florida, so maybe Florida first weekend in June and Longmont, Colorado on the 20th, the weekend of the 20th of June. So feel free to check us out on the road and have a great rest of your Thursday. See ya. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

On this episode, my pelvic floor therapist, Dr. Betty, joins me to discuss pelvic floor therapy and pelvic floor heath as well as how she uses dry needling in her practice. Dr. Betty is the founder and owner of Reborn Pelvic Health & Wellness. She is extremely passionate about changing the standard of care before, during and after pregnancy, because POSTPARTUM IS FOREVER!Dr. Betty is a world-class pelvic health expert and has built a center of excellence in Utah for pelvic floor physical therapy. She is a physical therapist by trait and has helped 1000s of people throughout her 10+ year career function, feel and move better. She received her doctorate in physical therapy from the University of Wisconsin-Madision in 2012.Knowing first-hand how difficult it can be to navigate this stage of life, having two children of her own, she wanted to help others get back to living their lives to the fullest without shame or embarrassment about their pelvic health. Unfortunently, more often than not, pelvic dysfunction can lead to postpartum mood disorders, secondary to an inability to get back to activity because of unexpected physical changes, pain, discomfort, leaking, and/or painful intimacy. What if we worked more upstream? What if we worked on preventing dysfunction from happening in the first place? And what if we provided true prehab and rehab to our birthing people? And that was where Reborn was derived out of.As a doctor of physical therapy, she believes one-on-one care is the best. Because many people do not have access to pelvic rehab, she created The Optimal Vagina: Beyond Kegels to reach more people. You can now start your journey and optimize your vagina in your own home online.She specializes in treating return to exercise postpartum with endurance sports and athletes. She is also passionate about finding the “why” behind your symptoms, optimizing your body and empowering you to become the expert of your own body so that you can live life to the fullest.When not at work you can find Dr. Betty hanging out with her husband, two daughters, and two fur-babies (dogs). She also spends her time enjoying endurance sports like, marathon training, triathlon training, lifting weights, hiking, and cross country skiing. www.RebornPHW.com @rebornpelvichealthandwellness on IG Receive $50 off your evaluation --- Support this podcast: https://podcasters.spotify.com/pod/show/taylorkulik/support

Often, patients and referring providers are asking clinics if they offer dry needling. Providers and patients are looking for non-pharmacological ways to reduce pain and enhance function.  In many cases, therapists want to offer it but need more education before spending hours and money on additional training. This course will give you an overview of dry needling, weigh the potential benefits/mechanisms of effectiveness, and help you decide if it is right for your practice. To view accreditation information and access completion requirements to receive a certificate for completing this course, please Click here The content of this Summit podcast is provided only for educational and training purposes for licensed physical therapists and occupational therapists. This content should not be used as medical advice to treat any medical condition in either yourself or others.  

Shoot us a text message! Join hosts Parker, Mike, and Seid in an enlightening episode of the Tri Hard Podcast as they delve into a range of topics crucial to every triathlete's journey. The episode kicks off with a detailed discussion of their recent training weeks, sharing insights into their workouts, challenges, and progress towards their goals.Transitioning to nutrition essentials, the team explores the topic of bonking during workouts, shedding light on the causes, symptoms, and strategies to prevent this common issue. Dive into valuable tips and fueling techniques to optimize performance and avoid energy depletion during training sessions.In the realm of product reviews, the hosts share their experiences with new gel products, offering feedback on taste, effectiveness, and suitability for endurance activities. Discover potential fueling options to enhance your training and racing performance.Wrapping up the episode, Parker, Mike, and Seid engage in a discussion on overtraining - a critical topic for athletes aiming to strike a balance between pushing limits and avoiding burnout. Gain insights into recognizing signs of overtraining, implementing recovery strategies, and maintaining optimal performance levels.Tune in for an informative episode packed with training insights, nutrition guidance, product reviews, and essential tips on managing training intensity to maximize your triathlon journey.Website: www.parkerkerthtriathlonnvdm.com My Email: parker@nvdmcoaching.com Seid Instagram: https://www.instagram.com/xlseidlx/ Mike Instagram https://www.instagram.com/michaeldmayjr/ Parker Instagram: https://www.instagram.com/ Youtube Channels: https://www.youtube.com/channel/UC8AySUd_LUSiT3nX8XlDFlQ https://www.youtube.com/channel/UCtFVpHhoCOvUkoTvNIa4xrg Nerdy Nuts:https://nerdynuts.com?sca_ref=2280300.5hSTcFZlsbCode FASTFOODIES10Raw:https://raw.rfrl.co/vrox8Revive:https://revivesups.com/?r=nllk8&utm_campaign=bc&utm_source=nllk8Code NVDMThe Feed:http://thefeed.cc/parkerkerthForm Goggles:www.formswim.com/discount/ParkerNVDM?utm_source=partnership&utm_medium=affiliate&utm_campaign=partner_ParkerNVDMCode: ParkerNVDMFuller Oats:https://eatfullerfood.com/?ref=pqxvptb8Code:PARKERKERTHMobo Board:https://www.moboboard.com/shop/mobo-boardCode:NVDM10Support the Show.

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R2P Sports Residency Research Article Review by Dr. Seth Hawks, DPT.

In this episode of Freedom Talks, host Joe Ogden, talks with Spencer Tredo, Physical Therapist at the Freedom PT Services Grafton location. They discuss how Spencer got started in PT and all of the different settings he has worked in. Learn about the holistic and functional health approach that Spencer takes when he treats patients.

In The RACK Podcast...Powered by ProForm Physical Therapy. In this Episode Chad and Nick meet up with another local physical therapist by the name of Kathleen Beede. Kathleen owns Eagle Physical Therapy Holistic Health & Performance in Dover, NH. Dr. Kathleen is a like minded physical therapist and has a very similar model to ours as well as also incorporates a holistic approach in her physical therapy practice. In addition to being an amazing PT, Dr. Kathleen has her Certification in Sports and Orthopedic Manual Therapy and Dry Needling. She is also currently enrolled in a fellowship program through the Institute of Athlete Regeneration (FAAOMPT). We dive into Dr. Kathleen's journey to becoming a physical therapist as well as talk about her clinic Eagle Physical Therapy. Dr. Kathleen is also a big advocate of biohacking techniques to further improve the overall health and wellness of her patients and clients. She is also one of those PT's that actually lifts lol...So make sure to listen to the end as she provides some great tips that you can implement into your life today! For more information about Dr. Kathleen Beede and her clinic Eagle Physical Therapy, visit her instagram at the_eaglept or her website ! ___________________________________________For more episodes, make sure to subscribe and tune in to our podcast. For other resources on our training, physical therapy and health/wellness tips, check out our Website, YouTube Channel, Instagram and of course our Facebook Page!Make sure to subscribe to our Newsletter to get all the updates about what we got going on here at ProForm.

Welcoming back my friend for the 3rd time on the podcast, we catch up on the expansion of her business and family and get into some of the treatments being offered at her office in Stoneham, MA. Stefanie brings an intimate knowledge of health & fitness to her treatment style, with her 15 years of Personal Training experience. Stefanie has grown to love running after completing 15 Marathons! In 2014, she decided to create a High-End, Concierge company called Boston Health & Wellness, that would collaborate her skills & bring convenience to her clients in their own home. She provided in-home Physical Therapy, Personal Training, Yoga, Massage, & Run Coaching.  In 2020, she decided that she wanted to expand her business model since not everyone can afford Out-of-Pocket care. She knew she needed a Physical Location that DID ACCEPT ALL HEALTH INSURANCES. Even during a pandemic, she knew her timing was correct and she had to take the leap of faith and open an office. Stefanie opened Boston Health & Wellness in November of 2020 which provides Physical Therapy, Telehealth PT, Personal Training, Yoga, Pilates, Massage, Dry Needling, Cupping, Run Coaching, Adult Fitness, and Injury Prevention. Home - Boston Health & Wellness - Stoneham MA (bostonhealthwellness.com)  

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling division leader Paul Killoren discusses the safety, efficacy, and utilization of palpation when incorporating dry needling treatment into your practice. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling. EPISODE TRANSCRIPTION PAUL KILLORENGood morning, crew. We've got YouTube, we've got Instagram. My name is Paul. I'm representing the dry needling division for ICE. My name is Paul and I would like to talk about palpation this morning. Pretty dry topic you might think, but depending on if you're trained in dry needling and how you're trained in dry needling, palpation may have been one of the key aspects to your course, your training, and then fill in the blank from there. I mean, our accuracy, our safety, and even our effectiveness for dry needling relies at least somewhat, high percentage, low percentage, on palpation. So we're talking palpation this morning, not even actual needles in, but this is heavily a dry needling topic on our clinical Tuesday. IS PALPATION-BASED DRY NEEDLING SAFE? First of all, to get it out of the way, there is actually quite a bit of research saying, is palpation-based dry needling enough? Enough being, is it safe? Is it consistently effective? And the answer is yes, most of the time. Meaning there's solid data that says if we're palpating rotator cuff muscles, so a 2023 publication last year said, if we're palpating infraspinatus, even teres and supraspinatus, compared to ultrasound, we're reliable. Maybe that's because it's accessible, we have a big spine of the scapula to rely on, but unfortunately we have data, a publication from 2021 that says if we're palpating ribs, especially posterior ribs, so deep to rhomboid and trap and all of that, unfortunately we're not very reliable. So first of all, to say, um, not the topic exclusively for this morning is can we rely exclusively on palpation for dry needling safety? The answer is yes. Most of the time. Um, I mean, one stance we do with ice, even on our advanced courses that we do not do rib blocking techniques, uh, meaning we don't palpate and rely on the rib as a bony backdrop for for like thoracic extensors, rhomboid, all of those muscles. So we can rely on it most of the time. There are certain regions where it's less, research says it's less consistent, less safe. And that's pretty obvious stuff. Can we palpate everywhere else in the body? Spinous processes for the spine, trochanter sacrum for the glutes. Can we palpate muscles for quads and all that? The answer is yes. HOW IMPORTANT IS PALPATION FOR DRY NEEDLING? So really the topic of this morning is how important is palpation for dry needling? And I'm gonna break this, the rest of the discussion into two topics. The first one is how important is dry needling as a diagnostic criteria? And the second one is how important is palpation, we have to put it in the palpation bucket, but I'll say how important is tissue control when we're dry needling? So let's tackle topic number one. How important is palpation as a diagnostic criterion for dry needling? And this is where we'll start to see a separation based on when you were trained and how you were trained. Meaning, if you were trained more than five or 10 years ago, or if you took a fairly exclusively trigger point dry needling course, then palpation is key. as a diagnostic aspect, meaning hopefully you're doing other assessment, but when it comes down to firm pressure in tissue, identifying trigger points or top bands or even muscular tissue that reproduces a patient's symptoms or refers into different patterns, very, very high on that diagnostic algorithm, the palpation is. For ice, we are drifting in almost every respect away from the trigger point paradigm. I mean at the highest level we're drifting away from trigger points being necessarily the singular explanation for pain, the direct dry needling target, and even the twitch response as not necessarily being deactivation of shortened sarcomeres, trigger points, all of those things. So the question is immediately asked, so does that mean that we don't palpate? Are we just randomly, generically floating needles into a muscle? The answer is no. We don't palpate trigger points, we palpate motor banding. This follows other philosophies, but motor banding being a slightly larger, slightly more macroscopic tone, I mean it is palpable, but it's not on that microscopic sarcomere level. If you have been needling for any period at all, or if you do any type of any soft tissue work, you know that you can find motor banding in almost everybody's glute medius, vastus lateralis, medial gastroc, tricep, deltoid, infraspinatus. These aren't trigger points, these are motor bands. And there is value to palpating that, and there's value to treating that tautness, that motor banding for dry needling. IS PALPATION DIAGNOSTIC? So back to the question at hand is like, how important is palpation as far as a diagnostic criteria? For ice, for us, it's a little less important than perhaps a purely trigger point based therapist, but it's not completely unimportant. It's just a lower, it's lower importance on our assessment, meaning Hopefully we had a full patient interview, a subjective, a full assessment. There was something that led us to treat vastus medialis for Gladys' knee pain or infraspinatus for Gladys' shoulder pain. So we're already approaching the patient, essentially knowing that we're going to treat these muscles. Then, and the narrative that we use on our courses is that, that very last piece of the puzzle, like if there are any puzzlers out there in the group, you know, depending on how challenging your puzzle is. It just took you a few hours, a few days, a few months. You did the edge first, maybe that's your patient interview. Then you fill in different colors, different objects. Maybe that's the rest of our assessment. But then there's that last puzzle piece. Almost always it's lost under the couch or something, but it's that last piece. And you're like, sweet, found it. I'm gonna put this in. That is our palpation. meaning everything else in our assessment, in our treatment model, interviewing the patient, led us to treat this muscle. That last puzzle piece before we put in a needle, so we've decided we're gonna use dry needling, we've decided we're gonna treat infraspinatus, that last puzzle piece is spending five to 10 seconds finding that motor banding, finding tautness, finding any tenderness, finding anything that reproduces symptoms. But the shift that I'm acknowledging is that that final puzzle piece was not the full puzzle. Depending on how you're trained and when you were trained, palpation was what created the whole puzzle. Meaning if you are a little bit more trigger point centric, we really rely on palpating a trigger point or palpating that banding and having it reproduce the patient's symptoms or at the very least be a familiar sensation. Or to say an extreme opposite of, If you're relying exclusively on trigger point identification and you palpate, you dig your fingers into a muscle and don't find tautness, that almost starts to sound like, okay, we're not gonna treat this muscle. So again, the paradigm shift we're talking about is that palpation is always a part of the equation, even for diagnosis, I'll say, or even when deciding where to place our needle for dry needling. But depending on how you were trained, depending on how much emphasis you put on that pain generating reproduction of palpation based tone, it is like what decides if you're gonna needle at all, or it really just decides where you're gonna put the needle in. So that's number one. If we're just talking palpation this morning, the first topic I wanted to tackle was how important it was diagnostically. and the TLDR there was that we're going to treat that muscle anyways, but there is that final puzzle piece, that final five seconds or so where we look for motor banding. That is where we want to put our needle. GREAT PALPATION IMPROVES PATIENT COMFORT Topic number two, I guess we're still going to call it palpation, but now it is about the technical aspects of controlling tissue while our needle is in. No matter what technique, no matter how you were taught to tap the needle in, set up a bracket window with compressed tensioning of tissue, or squeezing, or setting up the OK sign. Now we're saying, how important are the more nuanced aspects of tissue control? So again, we're not talking diagnostic criterion anymore. Here is where this tissue control, this tissue feel, this firmness of palpation separates novice needlers and more experienced needlers. Here we are saying that this is one of the primary aspects for making dry needling comfortable. You could probably argue this is part of making dry needling safe, but here is where palpation, quote unquote, becomes hugely important. very specifically the technical aspects of needling. Myself, when I'm on courses, every once in a while I get on the table for our faculty or just to get some free needles or just to volunteer my body. And when I'm on the table, this probably applies to all of you out there who have been needling for a while or work with someone who's needled for a while, you can tell pretty quickly, meaning before a needle is even tapped in, you can tell pretty quickly how confident that clinician is, how experienced they are based on how they palpate. And that is key. This tissue control, how we identify those motor bands that we just discussed for diagnostic or deciding where to put our needle, but really making the insertion comfortable, getting through some dense fascial planes or deeper into tissue, or just quickly, confidently, consistently getting into a muscle. There's kind of a clinical proficiency here as well. That is an expert art. Masters who do dry needling do this very well. So again, we've split the road. We're no longer talking about that being important for diagnosis. Now we're saying this is what separates expert clinicians from newer needlers is the tissue control. If you've ever taken a course for me or a course for me recently, when we leave the weekend, the last few slides, I kind of give you a few things to remember. And one of those things I hope was, Dry needling is a skill that you have to use, use it or lose it, unfortunately. That's tough in some states where you just learned, you just took your weekend course, you just learned how to dry needle, and you can't immediately go back and start needling every single patient in the clinic. But what you can do is start palpating your colleagues, your partners, your patients. You can work on that firmness of tissue pressure, you can work on tissue control, and really I'll say that is a primary aspect for dry needling. Again, not diagnosis necessarily, but making dry needling more comfortable, more effective, and clinically more efficient. SUMMARY And that's where I'm gonna drop off today. I mean, the emphasis today, I'm Paul, I'm one of our leads for the dry needling division, so this is kind of a dry needling topic, but really, didn't talk much about needles today. The question I wanted to answer is how important is palpation? And if you're just jumping on, thanks for joining. See a bunch of folks joining on Instagram. First of all, can we be safe with palpation only, meaning compared to ultrasound guided dry needling? The answer is yes, most of the time in most places. If we're palpating ribs posteriorly, maybe not. Number two, How important is palpation for guiding our diagnostic, our diagnosis, as a diagnostic criteria and how important is palpation? And the answer there is a little less if we're not talking trigger points, but it is that final piece of the puzzle. There is that final three to five seconds before we put the needle in that says, aha, motor banding, just palpated it, that's where I'm going. The third aspect of palpation is how important is it for dry needling, comfort, efficiency, all of that. And that's where we say very high. That is really what separates experts from novice or that's what separates a more efficient, proficient, confident clinician when it comes to dry needling. So the challenge this morning is if you have not really been waiting palpation as important for that pre-insertion with your needle. The challenge this morning is to spend two to three extra seconds. Add five more pounds of pressure through your fingertips. See if you can be a little more precise with identifying your motor banding before you put a needle in. And from there, once you've tapped the needle in, maintain that tissue control or that palpation focus for the entire time the needle is in. So this morning we won't talk about are we gonna piston a bunch, are we gonna twist it, are we gonna just leave it, are we gonna do e-stim. For now I'll just say for the entire time you're inserting the needle, you're moving the needle, you're repositioning the needle, focus on the palpation, the tissue control, maybe more than you were before. That is what separates the experts. So with that, I'm going to drop off. I held it to 15 minutes, which is always a victory for me. I apologize for the darkness this morning. I have my ring light on, but otherwise, kiddo is sleeping right next door. So we are dark and quiet here in the Killoran household. It is very early on the Pacific coast. So if you're jumping on, catch the recording, catch the first 10 to 15 minutes. How important do you feel palpation is? Or even to ask it another way, how do you feel your palpation, your tissue control, your confidence in palpating stuff has matured and improved from when you started dry needling to today? I'd love to hear, I'd love to have a poll, maybe I'll throw it up on Instagram, but I'd love to hear some comments on has it gotten better, has it stayed the same, more important, less important, where do you place palpation on your paradigm of importance, your pyramid of significance when it comes to dry needling.  Otherwise I'm dropping off, if you're trying to catch a dry needling course with us for ice, The next few months are key, meaning we've had a really busy February. We have a really busy March and April. Then things kind of slow down. May, we take Mother's Day off. We have Memorial Day off. We have a post-sampler rest. So things start to slow as we get into the summer. All of our faculty have kiddos and family, and we know you all do too. So the summer will be a little lighter for courses. So if you're trying to catch us before the summer, Check out March and April courses. Ellie will be in Bozeman, Montana this weekend. I'll be in Baton Rouge. And then we've got a handful of other ones coming up. Otherwise, we're setting up our fall calendar now. So keep your eye on the calendar if you're looking for something post-summer for dry needling. As always, at PTONICE.com or check us out Instagram at Ice Physio or DPT with Needles. Thanks for listening, folks. Catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling division leader Paul Killoren takes a deep dive into how dry needling has been traditionally marketed and offers some tips to improve your marketing via your website & social media to demystify dry needling in a manner that results in more patients choosing your clinic for treatment. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling. EPISODE TRANSCRIPTIONINTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. PAUL KILLOREN Good morning team. This is the PT on Ice daily show and I am broadcasting worldwide from my hometown of Appleton, Wisconsin. My name is Paul Killoren. I'm the current division lead for dry needling for ice. We just wrapped up a banger, an awesome group in Milwaukee last weekend. I am from Wisconsin, so wife, kiddo came with me and we drove up to Appleton, which is my hometown. So I am broadcasting from Appleton from my father's office. The childhood nostalgic vibes are strong. I've been in Wisconsin for a week, so you might hear some accent come out of me like, oh, you know, here we are in Wisconsin but wanted to grab this PT on ICE slot to jump on today and discuss how to market dry needling and even kind of how to market dry needling 2.0 maybe even differently than the other dry needling out there. DRY NEEDLING MARKETING 1.0 So I'm gonna be quick this morning, but picture with me, and this shouldn't be hard to picture because almost any website, almost any social media post, if it's a clinic, state to state across the country, here's our list of services, manual therapy, BFR, dry needling, when you click on that dry needling tab, it jumps you to a page, what is dry needling? And that's the page I wanna discuss this morning. Because here is what 90% of those pages start with and look like. Dry needling is a technique that uses a monofilament needle. And from there, I mean, first of all, from there, most narratives, most websites, most explanations of dry needling still kind of go into trigger point-ish theories. So I'm going to give a few tips today. One of them is, is not to go down there, but, and if you've taken a course from us, you get that, that influence that we have better explanations, better narratives to how we do the technique, but what the benefits of dry needling are. But first I want you to picture that snapshot of you've jumped over that dry dealing page on a website. Before I get into the actual explanation, the content of the page, let's just talk how that page should be designed. Because we are in the social media, the Google web page realm where we're trying to get a three second impression to that patient. Everything we know now is that that patient is not necessarily going to spend two to five minutes reading one, two, three paragraphs about dry needling. So really we have above that scroll line, above that page to capture their attention, I mean make it visually appealing, but also give them enough info that either we answered their general question or intrigued them enough to keep scrolling down. MAKE DRY NEEDLING MORE VISUALLY APPEALING So what is dry needling? Before I get into the content, this page. should be visually appealing. I mean, it should fit your website for sure. But here, when I say visually appealing, we have that main homepage. I think a good half or third of it, so large enough to be visible, central, and appealing, should be a video or a picture of dry needling. And here's where I'll say 90% of the webpages out there have a pretty generic stock photo of, you know, maybe a hand, maybe a hand without a glove, gently placing a needle. And I get it, we're using Canva, we're pulling from Shutterstock, we're using generic stock photo libraries for this. First, I think we could admit the stock photo libraries are getting better. So if you created your webpage years ago, there are more dry needling specific images out there to use for this webpage. So if you're not going to have photography of yourself, which first of all I think is a nice touch to have you with a patient doing the technique, but if we're gonna use a substantial portion of this above the scroll line presence on the what is dry needling page, make it a nice looking photo and make it dry needling looking versus acupuncture looking. I know from a still photo there's arguments that you can't tell, but find an image of a clinician using a glove. Find an image of, you know, a more assertive tissue grasp where it looks like the dry needling technique that we're going to do in the clinic. If you use electrical stimulation, find a nice image of a needle with the clip attached, or you the clinician or a clinician using e-stim with dry needling. So make it visually appealing and make that image or video informative. Again, if we only have this small footprint on a webpage or three seconds to grab someone's attention, or really answer their questions. Like, oh yeah, I've kind of heard about dry needling. They click over to your what is dry needling page. That image, that video should immediately answer lots of questions. SIMPLIFY YOUR DRY NEEDLING EXPLANATION Part of why I think that visual is so important is now let's go to the text block. Now let's go to the content, the written information. I would say you have two good sentences that a patient is actually gonna read. Or to be even more extreme, I'll say, if your definition of dry needling says, dry needling is a technique done by physical therapists using a monofilament needle, I think you've already lost your audience. I mean, at this point, I think as soon as we say filiform needle, monofilament needle, they're like, I have no idea what a monofilament needle is, I'm out. We're not talking to colleagues here, we're talking to patients. So again, back to I think that image, that video or that image on the page is intentional. It shows a monofilament needle. They get it. They can see it's not a hypodermic syringe. It's not a blood draw or injection. we immediately answered one of their questions, which is, man, what does this needle look like? What does it feel like is what they're asking, but really they're saying, what does this needle look like? That's what the image is for. Don't waste half or a full sentence in your initial description of what is dry needling to say monofilament needle, which no one in the public has any idea what a monofilament or filiform needle is. So let's not start with that. Again, what we see a lot of over here is dry needling is a technique performed by PTs with a monofilament needle. From there it typically goes into to deactivate trigger points, improve tissue health, all of these things. I think we can refine this first sentence a little bit. And whether I'm saying that this is now how all of us as rehab professionals should market dry needling, or if I'm really just talking to this, to our ICE dry needling 2.0 crowd, I would say dry needling is an intramuscular technique with electrical stimulation. And from there we can say two, improve tissue health, decrease pain, improve muscle responsiveness, improve performance, evacuate fluid. So that would be my first sentence. From that first sentence, I removed that monofilament, filiform, that distracting word that patients don't know anyways. I did that with my picture. And I explained intramuscular. I mean, maybe that might lose some patience, but what we're trying to say in a word or two is this needle's going into a muscle, deeper into a muscle. Again, I think a video or an image showing that should be helpful. Use of electrical stimulation, that is key. And I'll take that point a step further in a moment. But we have an intramuscular with electrical stimulation and then why? And I think that why is just the generic. Patients are saying, why would I consider this? And if they're considering it to decrease pain, improve muscle function, maybe rehab a specific injury, improve muscle responsiveness, tissue health, all those things. That would be my first sentence. I'm not saying from that first sentence we've answered all of the patient questions, but we're starting to frame dry needling in a context that either they're going to form more questions, and I guess if I haven't said it already, the intent of this first paragraph, this first what is dry needling above the scroll line block is not to answer all of their questions. If you think we can answer all of their questions about what does it feel like? Is it acupuncture? Does it hurt? Is this the same as a blood draw or injection? If we think we can answer all those questions in one paragraph, I think that's going to be unsuccessful and to some degree is going to be a little scattered and chaotic. We have our webpage, we have an appealing picture that fits how we treat with dry needling. We started it with an explanation, ideally explaining that it is inside of a muscle using E-Stim and what the goals are. And we removed the words monofilament or filiform needle and removed the narrative and the explanation of trigger points. DRY NEEDLING MARKETING 2.0 So big picture, let's say you were just trained or let's say you were trained years ago I'd love you to go back to your webpage, go back to maybe your most recent patient-specific or informative social media post for patients and look it over. And I mean, be that naive patient and say, take a look at that page for three seconds and say, man, how was that interaction? Could I update this picture? Could I invest in taking my own photos or maybe making a 15 to 20 second video post? If you do that, it should be you, your voice explaining the procedure, but also have the procedure there. Again, the visual of dry needling answers many questions. Everything from the size of the needle, what does it look like? to your specific application of, are we just placing needles like acupuncture? Are we pistoning a little bit? Are we using e-stim? Is it one needle? Is it 20 needles? That little snapshot, actual snapshot of an image or 15 to 20 second video is very helpful for patients. So from there, I think that might be a slightly updated version of preparing for this podcast. I really just went typed in dry needling and a few specific cities. So that the main hits weren't like Wikipedia and all that. It was actually like physical therapy clinics. There are some good looking websites out there. So I love that. But the what is dry needling page, I think needs to be better across the board. I think we need to be more succinct in our explanation and narrative of what dry needling is a little more contemporary, which again, is not just that sterile definition of a monofilament needle. One more thing I'll add is that we are now living in a world, depending on which state you're in, but really if dry needling has been more and more mainstream, really starting in the 90s, early 2000s, a decade, a decade. So let's say we're at least 20 to 30 years removed to where Dry needling has been a part of physical therapy practice in the public sector for a while now. What that brings is either confusion or patients with previous needling experience. More and more patients are saying, I've had dry needling. And whether they loved it or whether they did not love it, we now have to explain how we specifically, you specifically, are going to use dry needling. So if you are ice trained, I'm speaking to you all to say, how do you market dry needling 2.0, the training you all have had, how do you market that as slightly different than just other forms of dry needling out there? First of all, you all know, you should know, and you should be marketing pretty strongly, the use of e-stim. And really, if that patient comes in and says, You're talking about dry needling, I saw your poster, I saw it on your website, like, I really don't wanna do dry needling. Patient's always in charge for sure, but I have more questions first. I'm like, okay, respect that. Where did you have dry needling before? Was it a PT? Was it a chiropractor? Was it an acupuncturist that is just going to call it dry needling? What was it like? Did they piston? Did they just place needles fairly superficially, not very deep? Did they use e-stim? How many needles did they do? These are all questions that we kind of need answers to. If the patient is saying, I had dry needling and I hated it. I was sore for two days. I'm not sure if it helped. Okay. Was the needle dose, the mechanical pistoning, a little too aggressive? Did they not use e-stim? Did they not reinforce it well after the treatment? Or, I had dry needling, you know, I don't care about the needle, but I just, I didn't feel like it did much. That patient is like, well, okay, how did they use the needle? Did they displace it? All the same questions. So we kind of have to frame the patient's previous experience. And that's easy with a patient in front of us where we can do a quick Q and A. But let's say it is just general patients coming. Maybe you have a pretty good grasp of your competition, I guess I'll say, or people in your community who are marketing dry needling, maybe you already have a pretty good awareness of how they're doing it versus how we do it differently. we need to have that on our webpage as well. We need to market that actively as well. And at this point, it's my own sample size. It's previously not using as much e-stim to now I use e-stim almost exclusively. It is worth marketing that our e-stim or our needling, sorry, our needling with e-stim is a little different than maybe the dry needling that our patient has had at this other clinic or other types of dry needling. So I'd put that on the page, and I'd put that high on the page of, at DPT with Needles Physical Therapy, we do dry needling a little differently. We really believe on a little less tissue trauma, that's less pistoning, and using E-Stim. E-Stim allows us to be a little more deliberate, a little more tactical for pain relief, neuromuscular changes, moving fluid. However you need to market that, but I would market that. The E-Stim, The e-stim across the board might be novel and unique to your patient, but having the ability to decrease that post-treatment soreness and be more effective or be more intentional and tactical is worth marketing for the patient. And again, I think that has to be a pretty succinct written webpage, text block explanation, but there's value in having a really nice looking image or a 15 to 20 second video. So I think that's where I'm going to drop off today. And really what inspired this, I think it was a month or so ago. Mitch Babcock jumped on and he's like, how do we perform the art of that 15 minute exposure? He wasn't talking needling directly, but he was saying, you're at that CrossFit gym, that competition, you have your booth set up, your table set up. How do we master that 15 minute exposure? I think we can run something similar to that for dry needling in the future. But even before I got there, I thought it was worth kind of having this discussion of, we need to kind of update, we need to modify some of our social media and webpage appearances. I was gonna say explanations and that's part of it, but it's not just the words, it's not just the text block. We really have to update how it looks and feels on that first, what is dry needling webpage on your website or on social media. So, Go take a look at your own website or make a post today or in the next week and give it that fresh look. Give it the fresh look using Canva, do all your stuff or with an image, but give it a fresher explanation. I'm going to drop off there. If you've got questions, this will be, uh, I guess live is wrapping up now, not seeing any immediate comments. Thanks for joining those. See lots of folks jumping on. Um, but drop some comments, questions on Instagram or YouTube. Uh, I am at DPT with needles, otherwise at ice physio on Instagram. How does your dry needling marketing look if you have three to five seconds or if you have that above the scroll line page? That's the challenge today. Let's see how it looks, folks. Thanks for joining. We'll catch you next time on the Institute of Clinical Excellence, PTN Ice Daily Show. Out. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Ellison Melrose // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling lead faculty Ellison Melrose discusses key set-up, anatomy, and technique to target the subscapularis muscle. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling. EPISODE TRANSCRIPTIONINTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ELLISON MELROSE All right, U2 is up. Good morning, PT on ICE Daily Show. My name is Dr. Ellison Melrose. I am lead faculty with the dry needling division of Ice. I am here to piggyback off of the Fitness Athlete Fridays for the past two weekend, or two weeks. Two weeks ago, we had Alan going over the evaluation process for determining if the gene is subscapularis muscle. And then last week, Zach Wong went over some treatment techniques, and he hinted at one of the most efficient ways to treat the subscapularis muscle, which is dry needling. So what I wanted to do today was to go over a demonstration of how to needle the subscap muscle safely and efficiently. NEEDLING THE SUBSCAP So in order to be able to do this muscle, our patient needs to be able to get 90 degrees of shoulder abduction with some moderate external rotation as well. So patient positioning, they're going to be laying with their arm up in this abducted and externally rotated position. My patient here has some decent mobility, so she doesn't have any issues getting into that position. But for someone that maybe struggled with maintaining that position for the duration of treatment, we can bring their shoulder down slightly. And you can also prop their wrist up so they're not in so much external rotation as well. But again, this patient doesn't have issues getting into that range of motion. The reason we need to have this position is because we need this scapula to be protracted out from underneath the thorax for this to be a safe and effective drain forming technique. So we need to be able to palpate the lateral border of the scapula and appreciate the difference between the lateral border of the scapula and where the lateral border of the thorax is. In this position as well, we can think about the rib cage. It's not parallel, or excuse me, perpendicular with the table in this position. It's kind of diving around. It's oval shaped, right? So it's diving around and posterior and a little bit medial there. So if we get that scapula out from underneath that rib cage, we have some good real estate to needle this muscle. This is a direct technique. So we go for different types of techniques. We have a threading technique and a direct technique. Typically, when we talk about direct techniques, they are direct to a bony contact. So in order to ensure that we're at the depth of the subscapularis muscle, we need to have a bony contact with our needle in that subscap fossa there. IMPORTANT ANATOMY So again, patient positioning here. Some other considerations in this area. A, we have the lung field. Appreciating where that rib cage is and how it's diving away and where our scapula is in relationship to that. But we also have some other sensitive structures in the axilla. So we have our brachial plexus that actually runs just anterior to the subscap muscle and exits down the medial humerus here. So we want to orient ourself to where the brachial pulse is as to avoid needling in that region, right? So the best window for subscapularis is going to be just distal in the axilla. If we go too distal, we're likely going to miss that bony contact that we need for ensuring that we're in the subscapularis muscle. Some other considerations here is we have a really strong and powerful motor branch or motor nerve, the thoracodorsal nerve, that runs along that lateral border of the ribcage, which innervates the lats. So if we were to interact with that, we would likely get some fairly strong um, lat muscle activation. So typically it kind of looks like that sprinkler, um, dance move that we all know too well from middle school dance. Um, but so those are our main considerations. So one field and some other sensitive structures, uh, the brachial plexus and brachial artery and vein in that axilla. So again, first we want to bring our patient into this abducted externally rotated position. If you feel like you can't appreciate the, or you don't have a good real estate of that scapula, you can assist by protracting, like grabbing the medial border of the scapula and pulling it laterally. So again, you should be able to appreciate lateral border of the thorax is there, lateral border of there. So we have a good two inches of room to play with. A lot of these athletes that have So we're thinking the athletic population would be one where we want to treat this. Crossfitters, for example, they also have fairly hypertrophy flats. So that's another thing that we have to appreciate is we're going to have to be sinking in to get, again, that bony contact on the scapula. Another common patient population that you may be needling this muscle in is going to be the thawing stages of frozen shoulder, right? So this person was able to They're now in that pain-free, able to access at least 90 degrees of shoulder abduction, or post-op rotator cuff, where they're really struggling with some of that end range shoulder abduction, external rotation, and shoulder flexion even. Sub-scalp is going to be a good muscle target for those patients as well. So before we do anything, we want to prep the tissues. So we're going to clean the skin. SUBSCAPULARIS TECHNIQUE I prefer to do most of my needling techniques in standing, especially for this muscle, as sometimes our fingers are not going to, like just our finger pressure is not going to be enough pressure to sink in to approximate that subscap fossa that we want to. We're going to be needing a longer needle than we think. So for Sam, I have a 75 millimeter needle. Some folks may even need longer and that's just based on excess muscular tissue, the lat, the pec muscle that we're kind of orienting ourself around, the skin recoil. So as we compress that tissue, once you release, that skin recoil is going to potentially move that needle. If we don't have a long enough needle and it will choke up on the handle there and it'll pull it off of that bony contact that we've Spent so much time finding. So we want to make sure that we have a long enough needle to maintain that bone depth. ADDING E-STIM Another thing to consider is when we're with ice, we are dry needling with e-stim, right? So we're not doing a ton of heavy pistoning. Again, there's a lot of sensitive structures in this area, so it's usually not very comfortable to piston a lot. So we're going to be wanting to layer in the strategy with Easton. When thinking about ECM, you always want to be thinking in pairs. So how can we pair this muscle with another muscle that may be doing something, a similar movement pattern that may be also restricted, or something that's going to reach that motor threshold at the same time? So we want to be thinking about muscle spindle density in our muscle tissue of what's going to reach that motor response around the same time. Typically, I like to pair subscapularis with the clavicular fibers of pec major. So we have another technique for pec major clavicular fibers. Of course. Of course. Why was I logged out? OK, well, I was logged out on Instagram, so we're just going to continue on YouTube here. So we want to maintain the or we want to be able to pair this muscle with another similar muscle that has a similar muscle density. And it's also going to be limiting some of that external rotation in this position as well. So I like to pair those muscles. For today, we're just going to go with the dry needling demonstration of subscapularis. SUMMARY So again, we want to orient our patient into abduction external rotation. We want to maintain an appreciation of that lateral border of the thorax. And then we're going to compress the tissue down, down towards the subscap fossa. Usually your palpation here is going to be the most assertive part of the technique. And you might get what we call the Grunner sign, where some people don't tolerate that very well. So orient yourself to that brachial artery. We can find the pulse. So typically I would come around to the other side, palpate the pulse here. Pulse is under my index finger, so I've oriented myself to where that neuromuscular bundle is, and I'm going to be treating just distal to that. So, right in here. All right, so we have an appreciation of that anterior surface of the scapula. Again, using a 75 millimeter needle. So I'm doing a firm palpation, my medial aspect of my hand, so my pinky, ring finger are appreciating that lateral border of the thorax. My needle angle is going to be perpendicular to the scapula here. So really, it's fairly directly anterior to posterior, almost paralleling, or excuse me, yeah, paralleling the ribcage, anterior to posterior. So we're almost, we're very close to that ribcage, but we're going, we're paralleling it, so we're not going to be interacting with in a postural space or lung field here. So again, appreciating lateral border, knowing where that neurovascular structure is, that means safety, lateral border of our scapula, firm compression down. I feel that muscle. You can always do a little internal rotation, good and relaxed, to feel that muscle activation under your fingertips, compressing, giving yourself a little treatment window directly anterior-posterior. and you're on bone right there. So if you look at this, you're like, dang, she's got a lot of needle left over, but let's allow for that tissue recoil. So as we let for that tissue recoil, we have about a centimeter left. So a 60 millimeter needle would not have been long enough to appreciate that depth of the sunscan. As we allow for that tissue recoil, you may start to see like the needle directions a little bit and it may look a little bit suspect, but knowing that we're on that bony contact, that needle tip is not going to be going anywhere once we've reached that depth of the scapula. So we can allow for that tissue recoil and set up our next needle and then set up the stem and feel fairly confident that that needle is not going to go anywhere. Main concern with safety here is if this person were to move their arm, right? That would be something to be concerned. or if we're interacting with that thoracodorsal nerve and we get a very big motor response into that sprinkler dance move. So when we are bringing the stim up and looking for that motor response, typically I would suggest maintaining that appreciation of where that lateral order is and kind of bringing that needle back into its original orientation. Once you feel confident that we're not getting any sort of interaction a less of a motor response than what we want or more of a motor response than what we want, we feel fairly confident that leaving that needle at that bony contact is a safe needling technique. We are rarely or really ever, we shouldn't be leaving our patients stimming with needles in them by themselves. I feel like that is a best practice to be in the area with our patients. And so if this needle were to move slightly or anything like that, you can always maintain contact or redirect as needed. So there we have the dry needling demonstration for subscapularis muscle. Again, my name is Dr. Allison Melrose. I am the faculty with the dry needling division. Some of our upcoming upper quarter courses where you can catch this technique and a bunch of other techniques. We have a three-day course in Longmont, January 26th through 28th. Paul will be out in Wisconsin, February 3rd through the 4th. I will be down in Greenville, South Carolina, February 17th, 18th. Paul will be out in Bozeman, March 2nd through the 3rd. And then I'll be out in Maryland. It's Sparks, Maryland, 22nd through the 24th. So there we have our upcoming courses. And this, hopefully, was a good review or a new driving learning technique that you guys can use in the clinic. Awesome. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Dry Needling division leader Paul Killoren discusses key research supporting using dry needling with electrical stimulation to target peripheral nerves to reduce pain and improve muscular function. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn more about our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling. EPISODE TRANSCRIPTIONINTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. PAUL KILLOREN Good morning team. We've got YouTube up. We've got Instagram live. Happy to kick off the PT on ICEDaily Show this morning. If we've never met, my name is Paul Killoren. I'm the current division lead for the dry needling division with ice. And this week you actually have a dry needling double header coming at you. On Thursday, our lead faculty, Ellie Melrose, is going to dive into technique Thursday. with some subscap tips. Zach Long, barbell physio, hit subscap pretty hard last week. So we want to bring you the dry needling tips for subscap on Thursday. That's with Ellie. Catch it live in the morning or catch the recording. Today is clinical Tuesday, and we're actually going to kick off a topic that really celebrates our advanced dry needling course. As a division, we have two courses going down this weekend. One of them is myself hitting the advanced dry needling course in Bellingham, which is really cool for all of the reasons. It's an advanced course, it's kind of the last part of our dry needling trilogy, our three course series, which will build out our dry needling cert with ice. It's really cool in Washington that that third course is what gives our kind of our inaugural group the 75 hours, which as of last week, the word is that in Washington, PTs will be able to dry needle patients as early as July. So really cool stuff happening this weekend. And the advanced course is really my direct segue into the topic this morning. PERIPHERAL NERVE STIMULATION If you saw the teaser yesterday, we're going to talk peripheral nerve stim. And I guess first to qualify our advanced course, the first half of the course is treating more technical or slightly higher risk targets. Muscles around the scapula, around the thorax, we treat the suboccipitals, we treat some more technical muscular targets. That's the first half of the advanced course. But the second half of the advanced course, we stop having intramuscular interactions with our needles and e-stim. And what I mean by that is we do tendon needling, we do scar needling, but we do peripheral nerve stim techniques. So I figured it'd be worth at least having a little teaser topic on the podcast to discuss What are we doing with all that? And really, this is a short format this morning. So what I'm not going to do is dive deep into all of the things and all of the reasons and all of the research as to why we might intentionally, directly interact with a peripheral nerve with our needling and e-stem. But I wanted to give you some research teasers, kind of a little sampler platter, a little charcuterie board of research when it comes to peripheral nerve stem. And again, without getting into all of the reasons we might do it, it might be obvious for me to say that there's actually some pretty sound research that says if we have a true nerve injury, it was injured in surgery or there's a degeneration or a palsy or a tractioning, but if there's a direct trauma to a nerve and we're trying to regenerate or we're trying to improve the nerve health, It might sound kind of obvious that there's quite a bit of research that says if we can directly stimulate that nerve with our needle and e-stim, that there's great benefit there. I mean, that's obvious, that's a home run. Treat the tissue that was injured, all of that stuff. What you might not necessarily immediately assume is that there's actually pretty solid research when it comes to direct nerve stim being the sciatic nerve for low back pain or for improving muscular performance. even some neuropopulation stuff. That might not be the immediate thought when we talk about influencing a nerve with e-stim. And again, what I'm not going to get into today is all of the stratifying, the decision-making process of when we might stim a nerve versus when we do our intramuscular stuff. I really just want to tease you with some research because these techniques are out there. These percutaneous neuromodulation therapies are actually becoming much more popular. whether it's for pain relief as an alternative to pharmaceuticals, whether it's post-surgical pain modulation or improving muscular performance. These techniques are growing in the rehab realm, in the sports medicine realm. So I want to tease you with some research. THE RESEARCH BEHIND PERIPHERAL NERVE STIMULATION The first one, it's kind of a pilot research study from 2019. The author is Alvarez-Pretz. That's a hyphenated last name. And what they did was basically did one bout, it was 10 trains of 10 hertz frequency, but one session of femoral nerve stim. And what they looked at, these are patients with unilateral knee pain, they looked at immediately before and immediately after strength output. So max isometric strength for the quads before and after femoral nerve stim. And it improved. Not only did it improve statistically significantly from pre to post, but it outperformed a healthy control. So pretty cool stuff. Again, I'm just giving you these little nuggets today. But here's the first citation that says femoral nerve stem improved quad performance. And these are knee pain patients. So again, you can get deeper into the inhibition mechanisms and why that might be, but immediate change in max strength output of the quads with femoral nerve stem. Since I brought up the femoral nerve stem, let me tease you with one more. It's a 2020 publication by Paola Garcia Barmejo. Again, she's looking at anterior knee pain. One bout of ultrasound guided femoral nerve stem improved knee pain, but also range of motion, functionality, and there was a crossover. So they did it on one side, and they saw changes on both. So again, femoral nerve stim, we have changes in not just quad strength, but knee pain, functionality, range of motion, all the things. But let's talk back pain. Or let's frame it this way. Let's talk sciatic nerve stim for a moment. Because the first research publication, 2008, it's by an O, Fascinating stuff. Because again, it might be kind of obvious for me to say if we wanted to improve blood flow to the sciatic nerve, if we wanted to send blood into the vasonevorum, like engorge the vessels to the nerve, improve blood flow to that nerve tissue, it might be pretty obvious for me to say that doing direct sciatic stim does that. And it does. But here's a research article that's fascinating and gives context as to other interactions. Because for this research, they're looking at blood flow to the sciatic nerve, and they had three groups. Group one, they actually did lumbar muscle pumping e-stim. So they didn't necessarily say multifidus, but they did that muscular motor response e-stim to the lumbar paraspinals, and then they looked at blood flow to the sciatic nerve. Group two, they did the sciatic nerve stim. They put a peripheral nerve stem directly on the sciatic nerve and they looked at blood flow. Group three, they actually did e-stem to the pudendal nerve. So a separate nerve, but again, they're looking at blood flow to the sciatic nerve. Here are the fascinating findings. 57% of the folks in that lumbar paraspinal group saw improved blood flow to the nerve. So whether you want to say that that pushes us kind of towards the the changan, the radiculopathic influence, or like the segmental influence of nerves, the myotomal influence you could say, 57% of the folks that got lumbar paraspinal e-stim saw improved blood flow to the sciatic nerve. But here's the rest of the fascinating findings. 100% of the folks that received sciatic nerve stim saw improved blood flow to the sciatic nerve. That was almost their control and it worked. But the last piece here is that 100% of the folks that received e-stim to the pudendal nerve, also 100% of them saw increased blood flow to the sciatic nerve. Fascinating. So we do have an influence approximately from that muscle pump of the lumbar paraspinals, but it's almost like we don't have to be nerve specific because we can put some e-stim on the pudendal nerve and we saw improved blood flow in the sciatic nerve. Again, I'm just going to tease you with more research. The next publication by San Mitro Iglesia in 2021. Love these names. I mean, I will say most of the research being done right now is overseas, international. For this research, they had folks with low back pain and they had three groups. Those three groups all received sciatic nerve e-stem. but they were in three separate anatomical locations. So group A, they put e-stim on the sciatic nerve proximally, so near the issue of tuberosity. Group B, they put e-stim mid-hamstring, so mid-thigh, just a different anatomical location for a sciatic nerve. And then the last one was actually the popliteal fossa, so you wanna call that tibial nerve, whatever. But they're stimming the sciatic nerve or sciatic components in three separate anatomical locations. Fascinating outcomes, these are folks with low back pain. Every single group that received eSTIM to a nerve improved in low back pain, in range of motion, actually in their balance tests, and in their functional scales. And there was no difference between these three groups. So with those last two kind of research nuggets, I'm calling them, it almost seems like we can have a profound impact with nerve stem, peripheral nerve stem, and maybe we don't need to be nerve specific and we certainly don't need to be location specific, meaning we're having a global impact here. And if you've, and if you're out there and you've taken one of our upper or lower courses already, hopefully you gathered that the nervous system influence is really the driver of our contemporary understanding for the therapeutic benefit, the therapeutic mechanisms of dry needling. Now that we're interacting with a nerve, a peripheral nerve, early indications are that we're having a very similar, but maybe a more profound, more substantial nervous system interaction. Maybe it's everything we talk about, muscle spindle and motor unit loop interactions up to the dorsal horn and then, you know, supraspinal centers going to the cortex and somatosensory, all of that stuff. We're now interacting with a much more sensitive much more nervous peripheral nerve structure, and that nervous system influence has to be times 10. So again, today I really just wanted to tease you with that. We do cover peripheral nerve stim techniques on our advanced course. Again, the first half of the course, we keep doing muscular interactions. We do the rest of the muscles that you didn't get in upper and lower, the more advanced, the higher technical muscles. But then the second half of our advanced course, we do peripheral nerve stem, tendon needling, and scar needling. And maybe we can grab a few more of these podcast spots throughout the rest of this year to say, why would we interact with a peripheral nerve? Today, I just set for you a little charcuterie board of research that says we can change, not just nerve health, not just nerve blood flow or neuro regeneration, but we can improve muscle function. We can change strength. We can change pain. And maybe there are patients like low back pain where the initial strategies of conservative therapy, maybe even our, our typical paraspinal or multifidus estim isn't working. We now have one more strategy, one more tissue interaction to consider. But again, that's all I wanted to jump on today was to give you a quick snapshot of nerve stim research. Not gonna give away all of our secrets on how we stim nerves. It's probably fair to say or fair to acknowledge that all of the research I just went through, almost all of the percutaneous neuromodulation, so peripheral nerve stim with needles, fair to say that almost all of that research is done under ultrasound. And that's to ensure safety kind of, but also ensure that it is a direct peripheral nerve interaction. We're not going to use ultrasound on the course. So really the beauty of the technique is how do we interact with it safely again, for sure, but consistently and effectively. So peripheral nerve stim is a big topic on our advanced course. We have a couple that will be popping up. Again, the first one is this weekend in Bellingham. If we're not sold out, we're nearly sold out. We have one in December in Colorado, and there'll probably be one or two more that pop up Q2 and Q3. Hopefully we're targeting the Midwest. We are probably going to be back here in Washington, because again, we need that for our 75 hours to treat patients. But peripheral nerve stim, if anything, I wanted to put that in your mind today. And I mean, big picture before we continue this podcast series about why and how and when for peripheral nerve stim. At the very least, I want to keep throwing out this topic because on the ground floor, if nothing else changes in your mind, I'd like to kind of decrease the paranoia or the concern of needling near a peripheral nerve. Or if you use eSTIM, I'm sure you've had that interaction where the needle goes in, all of the words from the patient are normal, achy, crampy, sore, no nerve words. But then you add yeast into the equation and clearly you're near a peripheral nerve and you generate a different response. At the very least, I'd like to turn off some of the alarm bells that we're so paranoid of interacting with a peripheral nerve that we don't acknowledge there's benefit there. Again, upper and lower, our goal is just to treat muscular targets. We're not intentionally trying to interact with a nerve, but advanced we will. So on the ground floor, I'd love for just The, we always respect nerves for sure, but we don't want to respect them so much that we don't see that there's benefit there. Again, you should be trained in a technique. We're not trying to intentionally or accidentally interact with the nerve. We need to know where they live. If you took a level one or a level two course from somewhere else, I'm sure they mapped the large vessels, the large nerves, and we want to avoid them at all costs. And you should do that to start with. I mean, there's, There's something very precise and very safe about knowing how to not interact with it directly with the needle. But then there is another layer on top of that, that eventually, especially when we use e-stim, so we're going to piston much less, we're going to use e-stim, there's value to knowing where these tissues live and interacting with them directly. So for now, I just want to put that thought in your mind. I want to decrease some of the paranoia, some of the nervousness of being around a nerve, and hopefully I can keep teasing you with certain research. We'll throw some stuff up on Instagram. If you've taken upper or lower through us, you can look for the advanced courses popping up. To complete the CERT for ice, it is upper, lower, and advanced, but you only need to take one of them to show up on the advanced course. So let me know what you think. I mean, do you have questions on peripheral nerve stem? Throw them on Instagram. Hit me up directly on Instagram if you'd like, at dptwithneedles. Otherwise, stay tuned for Thursday. Ellie is going to jump on and show you some subscap tips. Such a key muscle for your shoulder, folks. Again, go back and listen to Zach Long's episode from last week. and how he assesses it and how important it is to treat and how he loads it because Thursday Ellie's just going to bring the dry needling smoke. She's going to teach you how to get in there safely, consistently and effectively. It's a key target. So that's what we got coming at you. Thanks for joining. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. 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Chatting all things physical therapy, healthcare, fitness, mobility, tissue work and everything in between with Dr. Michael Price. Michael earned his Bachelor's degree in Kinesiology Exercise and Movement Science from the University of Wisconsin-Madison and a Doctorate of Physical Therapy from the University of Wisconsin-La Crosse. Following his Doctorate he completed an Orthopedic Residency and is a Board Certified Orthopedic Specialist (OCS). He also is a Certified Strength and Conditioning Specialist (CSCS) and is Certified in Foundations of Dry Needling for Orthopedic Rehabilitation and Sports Performance.  Find him at: www.mymodernmovement.com and IG at @modernmovementpt Love our Content? Drop us a quick review CLICK HERE Join the Jeremy Scott Fitness App  HERE Want to talk more? Schedule a Call with Me: Click HERE Thanks to our Sponsors: AG1 www.DrinkAG1.com/jeremyscott Free year supply of vitamin D3 with 5 free travel packs or want a FREE sample? Shoot us a DM and ask! Sleeves Sold Separately My Workout Gear -  https://sleevessoldseparately.com/collections/jscott Code JSCOTT15 for 15% off all clothes & gear Jaylab Pro Our Protein, Turmeric, Collagen, Krill Oil - https://jeremyscottfitness.jaylabpro.com/products.html Code JSF40 for 40% off Collagen if you wish to try it. Dry Farms Wine - dryfarmwines.com/jeremyscottfitness Each new member will earn an extra bottle for just a penny with their first order of wine when they use this link. Kettle & Fire Bone Broth Use code SCOTT20 for 20% off our favorite healthy high protein bone broth. -  https://glnk.io/v153/heathascott