Needling Techniques in Osteopathic Needling Techniques in Osteopathic Practice Practice Harm minimisationHarm minimisation

Dr Stiofán Mac Suibhne

OverviewOverview

Needling Techniques in Osteopathic Practice

What is Dry needling?

Regulation of needling techniques in Australia

Rare & Catastrophic Adverse events

Common & Trivial Adverse events

Osteopathy Australia Practice Briefing Harm minimisation

Needling Techniques in Needling Techniques in Osteopathic PracticeOsteopathic Practice

2011 AOA Survey 34% of members using needling techniques - Probably more than 50% now

Diversity in format & extent of training in needling techniques undertaken by osteopaths

Most members support the development of a mechanism for osteopaths to be granted the endorsement for acupuncture

Rickards, L. (2009). Therapeutic needling in osteopathic practice: An evidence-informed perspective. International Journal Of Osteopathic Medicine, 12 (1), 2-13.

Regulation of Acupuncture & Regulation of Acupuncture & Related Needling TechniquesRelated Needling Techniques

Osteopathic Endorsement under Victorian Legislation

Acupuncture Endorsement in National Law (S 97)

AHPRA working party - No Accreditation Standard

Definition of Acupuncturist - modality vs parallel profession

Definition of Acupuncture – undetermined

Status of Dry-needling – undetermined

No mechanism for getting endorsement

No OBA guidance on standards in practice

What is dry-needling?What is dry-needling?

Dry Needling: DefinitionDry Needling: Definition

Dry needling involves multiple advances of an  acupuncture-type needle into the muscle in the region  of a trigger point, aiming to reproduce the patient’s  symptoms, visualise local twitch responses, and achieve  relief of muscle tension and pain.

Principles of point selection blended between variants of WMA & TCM

Myofascial trigger points: the current evidence.Leesa K. Huguenin.   Physical Therapy in Sport 5 (2004) 2–12 

Myofascial Trigger Points: Caution Myofascial Trigger Points: Caution

  Stretching  the work of Travell & Simons over many / most pain presentations is both bad science & second rate medicine.

Some practitioners dismiss the work of Travell and Simons as pseudo-science.

Poor inter-practitioner reliability on locating MTrps

Travell & Simons never entertained the notion of so called  dry-needling. Yet the legitimacy of the DN is linked to their work. 

Osteopathy Board of AustraliaOsteopathy Board of Australia

‘The National Law does not restrict treatment activities or methods relating to acupuncture, only the use of the protected title acupuncturist.

Osteopaths undertaking acupuncture or dry needling are therefore not restricted in this practice, as long as they do not call themselves an acupuncturist, or hold out to be a registered acupuncturist.’

Protection of TitleProtection of Title

Holding out  is a legal concept and it means to present yourself in a way that suggests to others that you are something or someone that you are not.

It is the courts that ultimately determine if someone is guilty of holding out. The maximum fine for an individual is $30,000 and an incorporated entity $60,000 .

Harm Minimisation StrategiesHarm Minimisation Strategies

Infection control

Patient selection

Principles of Point selection

Surface anatomy / 3D anatomy

High value targets

Proceduralism

RareRare & & Catastrophic Catastrophic Adverse EventsAdverse Events Pneumothorax

Cardiac Tamponande

Punctured organs

Spinal cord injury

Hepatitis B

Septicaemia

Convulsions

Joint infection 

http://news.nationalpost.com/2013/07/04/judo-acupuncture-needle/

PneumothoraxPneumothorax

Recent ‘spike’ in cases in Australia

AHPRA not concerned

CommonCommon & & TrivialTrivial Adverse events Adverse events

Fainting or dizziness during treatment

Nausea and vomiting 

Increased pain 

Local skin irritation

Needle site bleeding /  Bruising

Headaches

Sweating

Post treatment reactions

Practice Briefing on Needling in Practice Briefing on Needling in Osteopathic PracticeOsteopathic Practice

Overview of Needling in Osteopathic Practice – regulation & consent

At a glance summary

Safety Consideration when needling anatomically sensitive sites - Point Selection

Needing & Co-morbidities - Patient Selection

Clinical Considerations

Universal Precautions for Infection Control