Of late,Twitter has been engulfed in a rather ferocious to and fro on dry needling. The current darling of the PT world has been challenged. As any chivalrous gentleman would do, swords were drawn from their scabbards in defense of ‘her’ honor. The two sides parried back and forth until, so far as I can tell, each became weary of the other and returned to their abodes with nothing in particular resolved. (See just a few points of view here, here, and here).
— The Sports Physio (@AdamMeakins) August 9, 2015
— Matt Phillips (@sportinjurymatt) August 5, 2015
In reflecting on the various discussions surrounding dry needling on my feed today, this seemed timely. pic.twitter.com/QfNB1Jlp5M
— Todd Davenport (@sunsopeningband) August 9, 2015
This is perhaps the most interesting point of the whole episode. Dry needling today reminds me of manipulation a decade ago, which in turn reminds me of manual therapy in general a decade before that. Every so often, a ‘new’ technique arises, and everyone becomes quite besotted with it. Courses spring up, certifications abound, new kings of the hill are crowned. Then we study it, and realize that although there are benefits, they are really quite small. We shrug our shoulders and move onto the next ‘new’ thing. The cycle begins again (usually after a lot of money has been spent, and made).
You see, it’s all about movement. Humans were designed to move. When we stop moving, things literally begin to fall apart. Sometimes we stop moving because of a job, or because we’re not sleeping well. Maybe we’re eating poorly, or we’ve been injured, or overcome by stress. PT’s exist largely to optimize movement. Usually, we have to increase it. Sometimes we have to decrease it. Often, we just need to change it; improve the quality of the movement. When people move, they can participate; they’re more confident, they can strive, they can be whole again. There are as many ways to increase movement as there are reasons that Australia can’t seem to play cricket properly anymore. Whether it be with our hands, or with a tool, or a sharp stick, or with just plain old exercise, it all seems to work at one time or another. The key is knowing what to use and when to use to it, or, perhaps more importantly, when not use it. Sometimes the best intervention is to do nothing, Ah, reasoning!
Physical therapy has become too technical, too robotic, too focused on finding the best technique. We compare techniques in studies as we would two bottles of Brunello di Montalcino. The hunt is on for the panacea; the can’t miss. I don’t think it’s there. What is there is a person who can’t move properly. A person who is hurting, and needs our help. Our patients need us to think, to screen for a serious medical problem that needs attention. They need us to build risk profiles to ensure that when they do move, they are protected from further harm. Our patients need us to understand their whole story, so we can recognize their hopes, and their fears, and deliver a positive message that the body is strong, the body is robust and that the body wants to move, if only we’d just let it. Finally, our patients need us to understand what to move, when to move it, how to move and when to stop. That takes great thought, and even greater skill. The best PTs I know do this almost perfectly. We must think.
The rest is movement, however you like to do it. It really doesn’t matter. Choose what works for you.
Time to forget the obsession with ‘techniques’. Time to go back to listening. Whether verbal or not, patients usually tell us all we need to know and more about how to help them get well. We not only have to listen, we have to hear. We have to reason.