By Mitch Hauschildt, MA, ATC, CSCS
As you likely know if you read my blog very often that I’m a huge fan of all kinds of tools and modalities. Things like IASTM, cupping, flossing, massage and tape are staples within my therapeutic process and just because I have adopted dry needling into my practice doesn’t mean that I don’t still use these tools. I still use all of them extensively for a number of reasons, but mostly because dry needling is aggressive and invasive, so it is rarely my first treatment of choice. But, I have also found that when you combine needling with these other various tools, you can get even better outcomes.
Each tool offers its own unique “handle” into the body and knowing how and when to use them in conjunction with dry needling can be a game changer. In this part of our dry needling series I want to take a few minutes and discuss how I combine theses various tools and techniques to offer the best possible outcome for my patients.
Manual Massage
Massage can be used before or after dry needling without any issues. Deciding how I combine needles with massage really depends on my desired outcome. If I’m using them to move fluid, like in the case of acute swelling, I’m probably going to needle it first (with small 15mm needles) to stimulate lymph drainage, and then I will manually massage the fluid out of the area.
If I’m looking to reduce pain in the area (i.e. post needling soreness), then I may perform a light massage after I remove the needles to downregulate a painful response. This is essentially giving the local tissue some needed love. You can massage before or after needling if you are looking to change local tone in a muscle or area of the body.
IASTM
Much like manual massage, you can use IASTM to change tone, move fluid or downregulate pain. I personally use IASTM mostly to reduce post needling soreness. I use a very light touch (at Rocktape we call it a feathering stroke) and the goal is to stimulate the interoceptors that communicate directly with the happy areas of the brain. This helps the local tissue to not be so cranky after the needles are removed and reassures the patient that the needles will, in fact, help.
Cupping
Cupping and needling can be a good combination of tools, but they do need to be performed in the proper order. Unless you are trying to practice “wet cupping”, your needles should always come after you perform cupping. Because of the hole created in the skin (albeit a very small hole), blood can be pulled out of the skin by the negative pressure of the cup. Most of us don’t want to be cleaning blood out of the inside of our cups.
The decompression effect of the cup is great for separating densified tissue and then providing a strong neurological reset with the help of needles can be a very effective combination. This works well when you are short on time and need to see quick improvements, but it is a bit aggressive, so it isn’t for everyone.
Floss Bands
I love me some flossing. It is so simple and effective, that I have come to believe that it might be the most economical modality that we have. It is very versatile and costs next to nothing and they last a long time. If I’m going to use floss bands in conjunction with dry needling, I usually floss after the needles are removed. Much like the massage and IASTM, I like to use my floss bands to disrupt the local pain receptors in an effort to reduce post needling soreness and build confidence in the overall treatment.
Flossing is also an effective tool for improving densified, or “stuck” tissue, by creating a local shear force. This shear force, combined with needles, can be very effective at improving tissue slide and glide and changing local viscosity. From a mechanical perspective, there is no real difference between flossing before or after dry needling.
Kinesiology Tape
As most of you know, I love to tape as well. Just about every person that I dry needle gets taped afterwards. I have found that tape is highly effective at reducing needle related soreness. It is simple and only takes a minute or two. I usually just apply a regular pain application with the goal of closing the pain gate and disrupting the local pain receptors. This is a simple thing to do as you send them out the door after having a needling session.
Ice
I don’t recommend combining ice with dry needling because ice can slow the inflammation process down. Remember that with our needles we are trying to stimulate the inflammation process within the local tissue so that healing can occur. If we slow that process, it can have a detrimental effect on the overall recovery process.
Heat
Heat can be used effectively before or after needling because it is soothing for most people and it won’t interfere with the local inflammation effect like ice can. I like to use a heat pack either before or after needling to make people feels better and increase blood flow to the area.
Topical Analgesics
This is an area that I think can be used more effectively than most of us currently do. Using a topical analgesic, like Rocksauce, can help with overall pain and soreness and won’t interfere with tissue healing. Feel free to pick whichever your patient likes the best (heat or cold), and use it to make them more comfortable and confident in the day(s) following a needling treatment.
Vibration
This is an area that I think we have room to explore in combination with dry needling. I haven’t combined vibration with needles very much, but it is an area that I want to play with more. I wouldn’t recommend using a percussion massager or even a vibrating ball in close proximity to needles that are in the skin because as the tissue gets moved by the vibration, it will likely be a noxious stimulus to the local tissue. But, if you use vibration on an extremity (i.e. foot or hand) that doesn’t vibrate the local tissue, that stimulus could act as a distraction away from the uncomfortable feeling of the needles.
We know that distraction therapy is effective for pediatric patients who receive injections, so in theory, this could act the same way. I love the concept of using vibration after needles are removed to reduce soreness. This makes a ton of sense is easy simple and effective.
There are other options to consider with tools and modalities as well but hopefully this provides you with some ideas and insights on how and when you can combine some of your traditional rehab tools with dry needling.
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