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Dry needling, is it in our scope of practice?
I have been a massage therapist for almost 5 years now and my body is falling apart due to a lot of things but I would love to continue doing body work and have had huge results when receiving trigger point acupuncture and would love to provide that for my clients who have problem areas.
Does anyone know if we as Licensed Massage Therapist can do dry needling, or if that is for PTs and Chiropractors only?
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Replies to This Discussion
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Permalink Reply by Alfredo Noodle on
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I am shocked that Massage therapists are even considering taking a "dry needling" course. Dry needing is acupuncture no matter what the PTs tell you. They use an acupuncture needle and a technique described in acupuncture texts dated over 2000 years ago. If you want to learn to puncture the skin and melt trigger points, you should go to acupuncture school and get a license to do that.
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Permalink Reply by Gary W Addis, LMT on
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I agree with you Alfredo. I'm not cognizant of all states' laws, but to my knowledge, in most states, acupuncture is considered an invasive procedure and therefore cannot be performed by LMTs. With good reason. Injections, suturing wounds, performing operations, and puncturing the skin with needles are certainly invasive of the otherwise impermeable skin. Breaks in the skin allow bacteria in-- and as I read recently, almost everyone's skin has a colony of necrotizing fasciitis bacteria that literally eats human tissue. Nope, I am not interested in performing acupuncture in a massage therapy treatment room.
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That is what referrals are for! If we would all start referring our patients to competent practitioners instead of trying to take on each other's modalities, imagine how well our patients would respond?
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once again, I agree with you. But, in truth, everything an acupuncturist can do with a needle, a skilled NMT (i.e., trigger point therapies AKA acupressure) can do without violating the skin's protective barrier.
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Permalink Reply by Mitsuko Ito on
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What makes you say that everything L.Acs can do with needle, skilled NMT can do, Gary?
Would love it if you can elaborate on it.
I do think we can remove the energy blockages by removing trigger points.
I also do think using the fingers are more tiring and hard on our body, whereas L.Acs get to use needles - easy on body - so smart!
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Sure. Have you studied trigger point therapy? have you ever experienced it? If you haven't studied it; haven't experienced the instant relief provided by a few minutes treatment by an LMT skilled in any of the techniques used to eliminate trigger points, then you may not understand what I'm referring to. For a quick mini education, I suggest you check out Gordon Wallis' youtube videos...see how quickly and painlessly pain can be eliminated and normal pain-free movement restored.
Acupuncture (acupuncture without a needle) also is used to treat trigger points. But it is painful, it is invasive, and as I mentioned, most states don't permit LMTs to administer any procedure that penetrates the skin. Acupressure is not invasive: it involves searching TCM (Shiatsu) meridians for the tender spots popularly known as trigger points, and applying ischemic compression with fingertips, forearm or elbows on the tender spot until the spot is no longer painful and no longer refers pain elsewhere. BTW, Drs Travell and Simons were wrong in that not all trigger points refer pain--some are just locally tender.
View Gordon's videos, and with an open mind-- he makes it look ridiculously easy to take away clients' pain. But it ain't rocket science or brain surgery. In its simplest form, the method taught in schools, trigger point therapy involves Ischemic compression of a trigger point until the therapist and the client feel the tiny knot in the muscle dissolve and the pain go away. Using the ol' tried and true method, the pressure will need to be maintained from 20 seconds to a minute or so-- and it can be painful for the client. Diligently watching Wallis' videos, paying attention to where he lightly touches an agonist or opposing muscle, and trying the techniques with your own clients, you will quickly become a far better therapist.
Oh, for self treatment using the older method, I suggest you invest in Clair Davies' Trigger Point Therapy Workbook.
https://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Treatmen...
Referring again to your rely to me.
A closing comment about acupuncture: Aside from the legal issues, acupuncture / acupressure teaches therapists to adhere pretty closely to the meridians. Well, as you know, trigger points don't always fall neatly on a Shiatsu meridian. A skilled TP therapist treats the source of the pain, wherever it may reside. A hint of the things you can learn from Gordon. For a rhomboid trigger point? While maintaining monitoring pressure on the trigger point, with the free hand go to rhomboids chief antagonist, its ipsilateral serratus anterior and lightly tug / twist the serratus ,and the TP instantly vanishes-- a few seconds to relief for the client!
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Thanks Gary, for taking the time to write all that up.
I do do trigger point therapy and am pretty good at it. What I'm curious about is how Gordon in another thread mentioned a really easy method and I'd like to get to that eventually. Because, although I'm really skilled at finding spots, my finger joints are not holding up. The T-bars or other tools, I try to use and push them away because I really like being able to feel the melt in my own hands.... with the expense of hurting my own body.
Someone else in another thread had mentioned she sucks up the negative energy into her finger tips, which then dissipates. Perhaps I'm not releasing them and storing in my body. But that's another thread and topic.
I am curious though, because although I do know acupuncturists can hit trigger points and release them, I do tend to think they do so much more than just that. So I was curious as to what else is that we LMTs are able to do. I do think we're able to generate better energy (Chi/Ki) flow, and in our case, we can convey this sensation in real time, live, to clients.
I had an acupuncturist tell me pressing in doesn't get to some of the depth where the meridians run, and sure enough, it's been physically taxing too. So I'm following this thread with great interest.
Again, thanks for the response.
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First of all, as you know since you are a caring, thinking massage therapist, there's an awful lot of BS in our profession. I unequivocally proclaim to be BS that anyone is "sucking" bad energy from a client's body. I am a science-based therapist. I am trained in Therapeutic Touch and in Reflexology; in my admittedly biased opinion, neither has a basis in human anatomy. Reflexology claims that there's a spot in the hands and feet in direct communication with each organ of the body. Quoting a poem Robert B. Paker's Spenser character often gave, Wouldn't it be pretty to think so. But the muscles of the feet communicate directly with the nervous system and receive instructions directly from the nervous system. Blood flows from the feet back and forth to the heart; another closed system. So, no, I don't believe in Reflexology or a therapist's ability to bid Universal Chi to do her bidding if she thinks good thoughts.
Regarding the other therapist's comment to you that meridians can't be affected with ischemic compression because they are "too deep." Well, the question I'd have for him is, then where are they, how does he know that his needles are affecting them. Look, skeletal muscles do lie in layers; the rotatores for instance are covered by a smorgasbord of thick muscles. But the compression affects all the layers from surface to the bone. True, standard belief taught in schools is that to get release in a deep muscle in a heavily muscled client can require a lot of the therapist's strength.
But rather than straining hell out of your thumbs and fingers, press in to the point the tissue itself reacts but no deeper. If there is a tp in there, the tissue itself will react even if the client lies snoring-- a slight quivering or spasm can be discerned unless you bore in like you're digging a well. Too hard a pressure, you can kill the sensitivity without much affecting a deep trigger point. When that surface muscle relaxes (scoots out of the way seemingly), the next layer will get the pressure, and in no time at all you'll settle onto the active TP. Wait-- I'm making this seem more complicated than it actually is. Even if the surface is covered with a quilt of fat, light pressure will penetrate to the muscle. Use supported thumbs, don't dig in with one lonesome thumb or fingertip.
I agree with you, I too need sensory contact my skin to theirs. Positioning an obese or bodybuilder client's body can make penetration to the pain much easier. For instance, pulling scapula aside or down or up will give access to the serratus and rhomboid attachments. A physiological fact that makes out work easier is that if there is a TP in all that tissue, the client will feel even a light touch on its surface-- you may need to dig in hard to elicit an ouch or hard twitch, but even a light stroke across a trigger pointed muscle, you'll feel the tissue react if you're playing attention and not trying to dig a tunnel to China.
When you feel the reaction, just maintain that level of penetration and with the other move to its primary antagonist and give a slight twist or tug-- now, every muscle has a few antagonists, so you may have to explore to find the one that is interacting with the trigger pointed muscle; with practice you'll feel a slight tension in the appropriate strand of antagonist muscle, then a slight manipulation of that tight strand, the TP will ... just vanish.
That technique is called RIRR (reciprocal inhibition reflex release). There's scads of other techniques utilizing the body's own built in reflexes. Watch Gordon's videos diligently: try to comprehend what relationship that spot on the knee has with the trigger point he located in the client's gluteus medius, and why touching THERE caused it to release; why a tp in lumbar spine went away when he lightly touched the cervical spine. It's magical. Not actually magical, there is a physiological connection between the TP and the particular spot he used to get the specific TP to release.
Confused you yet?
Mitsuko, it isn't magic, it isn't Universal Chi (although Gordon does utilize Meridian manipulations in one of his techniques). What it is in an intimate knowledge of myotomes and dermatomes and kineseology of the human body. Muscles move bones; in order to do that they must receive instructions from the CNS and an adequate supply of oxygen and nutrients through the blood, and good lymphatic drainage. TP therapy doesn't require the strength of a Russian Olympic lifter; you can get even better results using much less pressure. Our industry gurus are wrong about that. As Gordon says, MDs, DCs, PTs and 99.9% of massage therapists remain in the dark recesses of their closed minds.-- I bet you know a whole passel of LMTs who couldn't find a trigger point if it flashed neon and a siren went off when they got near one.
So, experiment. Watch the videos, and ask questions. Gordon is generous with his store of knowledge. I've known him six years or thereabouts, and what I've learned from him has made me a much better therapist.
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Can't wait to read up and find out more of Gordon offers here :) Just re-discovered this site and am very excited!
Thanks much for your enthusiasm and explanation. Just a quick reply to share I'm looking forward to more learning and exchanges on this platform :)
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Permalink Reply by Gordon J. Wallis on
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All this talk about meridians. People act like experts when you ask them what meridians are.. People know all about them, yet can't explain what they are. At least not in a real scientific way that makes sense(to me). They discribe them as a belief system instead. Like the acupuncturist that said they are too deep to touch? When they put needles in the body, they don't go very deep. Meridians are muscle chains. At least ten of them are. A muscle chain is a group of muscles that function as one. If you stimulate a muscle chain, another muscle chain relaxes. I guess if you want to call it energy flow you can(chi). Muscles attach to bones. They also attach to spinal segments. Each spinal segment has nerve roots that controle portions of bone(sclerotome),muscles(myotomes), skin(dermatomes),and internal organs(enterotomes). If there is an irritation or a stimulation in one of the tomes ,it can effect the other tomes. I had an example of that the other day. A new client came in with no pain complaints what so ever. Just wanting to relax. And she looked very healthy. However, before the massage started she told me that she had some kind of skin irritation on her left big toe. So I figured I would just avoid massaging that big toe. Didn't want to irritate any kind of skin injury and possibly hurt her. After I finished my back routeen, I moved down to her left foot. I noticed that the skin was dry and peeling on her big toe. I could tell that it was some kind of fungus infection(guessing). All the other toes were normal. No big deal, but then I started thinking about what I said in the above sentences. That was an irritation or dysfunction of the skin. The nerve root( Dermatome) that inervates the big toe is mostly L5. All during my back massage she never complained or flinched or indicated any pain at all. I asked her if her low back bothers her at all. She said lately she has detected low back discomfort if she is on her feet for a long time. I palpated her entire spine and found only one tender point on the lower lateral side of the spine right above the sacrum on the left side. To me that's not coincidence. Not a big deal in her case. But it points to these very real connections. I'm not claiming to be an expert on acupuncture. Not at all. I just don't think it operates on this mystical chi level as most think. And I think muscle chains might explain some of the seemingly magical and wide ranging effects of acupuncture. For some reason I can only post one attachment at a time. Just look at the following two attachments closely. Meridian/muscle chain connection. Meridians are very real to me that way. Sticking a needle or manipulating muscle anywhere on that chain, can possibly have wide ranging effects? Now I want to qualify myself here. I'm just telling you what I think..
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To me this is a meridian that makes sense. It goes from the lateral ankle up over the head to the eyebrows. Where does the bladder go?
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Gordon, do you have a blog or website?
I'd love to follow you.You mentioned "Each spinal segment has nerve roots that controle portions of bone(sclerotome),muscles(myotomes), skin(dermatomes),and internal organs(enterotomes). "
Do you have any good links/images to those?
I've seen a dermatome graphic somewhere, and I just now looked up sclerotome on google, but didn't find it to give me what I am thinking I"m looking for. Are they basically affecting the same area ? For example, You mentioned in you rpost above that the nerve root that intervates the big toe (dermatome) is mostly L5. Would that be the same for bones, muscles as well?
(Internal Organs probably have different patterns.)I really like how we are starting to find the connection and correlation between what western science says and TCM has presented for a long time.
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