Trigger Point Dry NeedlingDavid G Simons Academy™ of Switzerland

Dry Needling 1 (DN1 – 3 days): Introduction, Safety & Extremities

Nov 5th‐7th 2015 (24 hours) University of Limerick www.unitedphysiocourses.com or phone: (061) 339991

David G Simons Academy FacultyChristian Grobli PT

Dr Jan Dommerholt PT

Dr Johnson McEvoy MISCP, PT

About the David G Simons Academy™Foreward from David G Simons MD

The aim of the David G. Simons Academy™ (DGSA) is to internationally promote the understanding andknowledge of the myofascial pain syndrome (MPS) and trigger point therapy. To guarantee a highacademic and didactic quality standard and impart the necessary, continuing and self-critical analysisof the scientific background, we have teamed up with leading trigger point instructors and basicresearchers. I welcome this opportunity to emphasize my complete support for the concept of theDavid G. Simons Academy™ for the purpose of promoting better understanding and treatment ofmyofascial trigger points (MTrPs) and neuro-musculo-skeletal dysfunctions.

Now, that this is the goal of my life, the David G. Simons Academy™ is a wonderful means of helping usmake significant progress toward that goal. The lack of sufficient understanding and skilful treatmentof MTrPs causes so many people unnecessary pain and motor dysfunction that it is a tragedy ofmodern medicine. When MTrPs are identified and treated effectively early, it can completely eliminatethe development of a disastrous chronic pain condition that is incomparably more difficult to treat. Iam absolutely delighted with the leadership and determination Christian Gröbli and Ricky Weissmannhave demonstrated in establishing the David G. Simons Academy™ for this purpose.

David G. Simons, MDApril 24, 2005

RIP April 2010From www.dgsa.eu.com

United Physiotherapy ClinicUnit 23 WhitethornsCastletroy, Limerick, Ireland

Phone (061) 339991unitedphysiocourses.com

Trigger Point Dry NeedlingAmerican Academy of Orthopaedic Manual Physical Therapy 2009

Support statement

“Dry needling is a neurophysiological evidence-based treatment technique

that requires effective manual assessment of the neuromuscular system.

Physical therapists are well trained to utilize dry needling in conjunction with

manual physical therapy interventions. Research supports that dry needling

improves pain control, reduces muscle tension, normalizes biochemical and

electrical dysfunction of motor endplates, and facilitates an accelerated

return to active rehabilitation.”

United Physiotherapy ClinicUnit 23 WhitethornsCastletroy, Limerick, Ireland

Phone (061) 339991unitedphysiocourses.com

Trigger Point Dry Needling

This Trigger Point Dry Needling (TrPDN) course, by the David G Simons Academy™ of Switzerland,introduces the clinician to the concept of trigger point dry needling for myofascial trigger points(MTrPs) including theoretical and practical application of trigger point dry needling techniques formuscles of the extremities, spine, head, neck and trunk.

Trigger point dry needling, is an invasive therapy in which a solid filament needle is inserted into theskin, fascia, and muscle to treat MTrPs. Different needling techniques and models are available,including trigger point, radiculopathy, and spinal segmental sensitization models. The two main MTrPneedling techniques are superficial dry needling (SDN) and deep dry needling (TrP-DN). SDN usuallyentails inserting a needle into the skin or fascia overlying a trigger point, and was popularized by Dr.Peter Baldry in the early 1980s as a safer approach to needling certain more difficult muscles such asthe scalene muscles. In contrast, during TrP-DN, the needle is inserted directly into the MTrP, and themain aim is to elicit LTRs, which occur during dynamic needle penetration of the MTrP. Thereproduction of LTRs during needling therapy is essential and is associated with improved outcomes;direct needling of MTrPs appears to be an effective treatment for pain.

Historically, TrP-DN developed from Travell’s trigger point injection technique, in which local anestheticwas injected into the MTrP while the hypodermic needle was moved through the muscle to elicit LTRs.Investigators proposed, and later supported, that the therapeutic effect was likely related to themechanical movement of the needle and the elicitation of LTRs, as opposed to the anesthetic or fluideffect. The exact mechanism of action of TrP-DN on myofascial pain is not known, but investigatorshave reported that TrP-DN reduced nociceptive chemical concentrations in the vicinity of active MTrPs.In an animal study, TrP-DN was effective at diminishing spontaneous electrical activity (end-platenoise) when LTRs were elicited. Other modes of action of analgesia have been proposed fromexperimental animal studies including recovery of circulation and descending pain inhibitory system.

Adapted from McEvoy, J. and J. Dommerholt (2012). Myofascial trigger point of the shoulder. Physical Therapy of theShoulder. R. Donatelli. St Loius, Elsevier Churchill Livingstone: 351-380.

Introduction

Trigger Point Dry Needling

A meta-analysis of MTrP needling therapies supported the use of this approach in the treatment ofpain, but this analysis could not conclude efficacy beyond placebo, mainly because of the difficulty ofplacebo needling design. A Cochrane database systematic review supported the use of TrP-DN forchronic low back pain, especially when combined with other treatments. TrP-DN was reported to offerpain relief and improvement in quality of life in older patients with osteoarthritic knee pain, neck pain,and low back pain, when compared with acupuncture. In patients with bilateral shoulder pain, withactive MTrPs in the infraspinatus muscles, TrP-DN of the infraspinatus muscle increased active andpassive range-of-shoulder internal rotation and PPT of MTrPs and reduced pain, compared with thecontrol side. In addition, TrP-DN of a primary MTrP (infraspinatus) inhibited the activity in satelliteMTrPs (situated in the referral zone of primary MTrP) in the anterior deltoid and extensor carpi radialislongus muscles. In another study, TrP-DN, as part of a rehabilitation program, was reported to besuperior to standard rehabilitation alone in the treatment of hemiparetic shoulder pain syndrome. TrP-DN of the extensor carpi radialis longus muscle reduced pain intensity, increased the pressurethreshold in the ipsilateral trapezius muscle, and increased cervical spine range of motion in patientswith active MTrPs in the upper trapezius.One session of TrP-DN to the supraspinatus evoked short-term segmental antinociceptive effects in theC5 segment when compared with a control group. Latent MTrPs affected muscle activation patterns ofthe shoulder, as measured by EMG, when compared with control subjects, and TrP-DN and stretchingrestored the muscle activation to normal. This finding has clinical implications because the aim ofshoulder rehabilitation is often to improve and normalize glenohumeral and scapular function.

Adapted from McEvoy, J. and J. Dommerholt (2012). Myofascial trigger point of the shoulder. Physical Therapy of theShoulder. R. Donatelli. St Loius, Elsevier Churchill Livingstone: 351-380.

Selected evidence

Course Pathway

Trigger point coursecan be done beforeor at any time. It is notrequired

TrPDNRefresher &Advanced CPD

Dry Needling 1 (DN1)IntroductionSafetyExtremities

Dry Needling 2 (DN2)SafetySpine, HeadNeck & Trunk

3days

3days

Pathway Design

Course Outline

DN1 – Course Contents

This 3-day indroductory course covers the foundationsof dry needling, the myofascial pain syndrome

and trigger points. The course is a hands on course.Participants practice trigger point dry needling of the extremity

muscles among each other. This is a trainingprogram with immediate clinical applicability upon

completion.

DN2 – Course Contents

This 3-day advanced course covers dry needling ofthe spine, head neck and trunk. The course is a hands on

course. Participants practice trigger point dry needling amongeach other. This is a

training program with immediate clinical applicabilityupon completion

Course Duration: 24 Hours / 3 days Course Duration: 24 Hours / 3 days

Requirements:Physiotherapist or Medical Doctor

Prerequisites:Foundations course & DN1

Course Objectives

Dry Needling 1: Intro, Safety, Extremities

Upon completion of the course, participants will ...

Understand the basic scientific background of themyofascial pain syndrome and of trigger points

Be able to identify the extremity muscles bysurface anatomy, palpation and by function andknow their clinical symptoms and perpetuatingfactors

Be able to identify the features of trigger pointsby physical examination and apply this knowledgeto the extremity muscles

Understand the specific indications andcontraindications of dry needling and be able toapply the safety rules for dry needling and beable to perform dry needling of the extremitymuscles

Know possible side effects and complications ofdry needling and will be able to reactappropriately

Have updated their anatomy skills and knowledge

Dry Needling 2: Safety, Spine, Head, Neck Trunk

Upon completion of the course, participants will ...

Understand the basic scientific background of themyofascial pain syndrome and of trigger points

Be able to identify the spine, head, neck andtrunk muscles by surface anatomy, palpation andby function and know their clinical symptoms andperpetuating factors

Be able to identify the features of trigger pointsby physical examination and apply this knowledgeto spine, head, neck and trunk muscles

Understand the specific indications andcontraindications of dry needling and be able toapply the safety rules for dry needling and beable to perform dry needling of spine, head, neckand trunk muscles

Know possible side effects and complications ofdry needling and will be able to reactappropriately

Have updated their anatomy skills and knowledge

1The international David G. Simons Academy™, DGSA offers courses in dry needling and manual trigger point therapy worldwidesince 1995. We are Clinicians, Authors and Educators.

2We take our role very seriously. We have a practical focus and a strong scientific background. Our international, experiencedinstructor team guarantees highest professional and didactical competence. Our courses are designed for Physiotherapists andMedical Doctors.

3We offer the most comprehensive professional Trigger Point Dry Needling courses available in Ireland (48 hours + 16 = 64hrs).Actually we offered the first TrPDN Courses for physiotherapists in Ireland. DGSA™ instructors are Physiotherapists or MedicalDoctors.

4We are authors in the new and only dedicated text book on Trigger Point Dry Needling. Dr Jan Dommerholt PT is co-editor.Trigger Point Dry Needling: An Evidence and Clinical-Based Approach by Jan Dommerholt and Cesar Fernández-de-las-PeñasChurchill Livingstone 2013.

5We are policy makers and co-authored the ISCP Guidelines for Dry Needling Practice 2012.Dr Jan Dommerholt PT is on the DN policy working party for the American Physical Therapy Association (APTA).

6We don’t teach DN from a purely biomechanical perspective. We appreciate the importance of understanding the MyofascialTrigger Point Construct and impart an understanding of the pain sciences model, peripheral and central sensitisation concepts.

7

We recognise the ability to accurately locate Trigger Points (for identification, manual therapy & DN) is directly linked to beingknowledgeable and trained in trigger point palpation (McEvoy & Huijbregts 2011). If you are learning TrPDN without a focus onpalpation skill, treatment may be less accurate, less effective and more difficult for patient and clinician.Your DN confidence and skill is important .

8 We offer clinical support from within Ireland by email or phone when required.

9 We offer regular TrPDN refresher courses to meet ISCP CPD demand.

10 We ensure strict participant / instructor ratios. This ensures improved supervision and learning. We don’t over allocate places.

10 Reasons to Train With the David G Simons Academy™?

1 Prior trigger point course is NOT compulsory. You can attend the 2 day TrP course prior or at any time

2MISCP or other WCPT member group / Medical Doctor / Other Healthcare Practitioner (Audit)For those using the title physiotherapist or physical therapist please see www.unitedphysiocourses for eligibility criteria

3Insurance coverage for the clinical settingIf MISCP insurance coverage is automatic for attending courses

4 Acceptance of the personal and professional responsibility of DN in clinical practice

5You will be required to practice DN on other delegates and will be required to be practised upon and a waiver will be requiredfor the practical sessions

6 Follow ISCP rules of professional conduct etc and ISCP Guidelines for Dry Needling Practice (2012)

7Practice with clinical decision making with reference to Evidenced informed practice, Clinical Reasoning and Patient OrientatedCare

8Consider DN as an adjunctive therapy for MTrPs and recognise the wider aspects of treatment including perpetuating factorsand the need for a comprehensive physiotherapy evaluation and education.

9ClothingPlease wear comfortable clothing and bring shorts and sports top (ladies) for the practical sessions

10Recognise DN of trigger points is not acupuncture and agreement that patient education should make a clear delineationbetween the two.

Course Requirements

1It is the responsibility of the individual to stay up to date with current trends within the physiotherapy profession via the ISCPand maintain insurance coverage.

2 Insurance coverage is individuals responsibility

3Delegates are recommended to follow the guidelines for CPD as detailed in the ISCP, Professional Development Portfolio inaccord with the World Confederation of Physical Therapists

4 It is essential to stay up to date with current literature

5If the physiotherapist practises as part of Public / Healthboard services it is the individual’s responsibility to ensure the ability topractise DN in this setting. The individual employed in private practice should ensure that their employer endorses DN usewithin the individual clinic setting

Other Issues

Course Logistics etc

Course The course is a 3 day course of 24 hours CPD

Course DatesDry Needling 1: November 5th 6th 7th 2015

Dry Needling 2: Scheduled for 4th 5th 6th March 2016

FacultyDry Needling 1: Christian Grobli PT / Dr Johnson McEvoy PT

Dry Needling 2: Dr Jan Dommerholt PT / Dr Johnson McEvoy PT

Venue The Pavilion, North Campus, University of Limerick, Limerick

Cost

DN1 course 3 days inclusive: 3 days – 24 hours: €650

Discount 15% available €650 compared to usual cost of €775

Includes:

Course Booklets and information; CD (PC) with course material electronically

Needles, Gloves etc, Starter Needle pack after DN1

Certificate of attendance will be supplied

Refreshments& Lunches

Refreshments and Light Luch supplied

Course FormatLectures, Demonstrations, Practical sessions, Discussion

Aim is to have delegates work in twos - at times it maybe required to work in threes