Dry Needling on ME

  So today, Rich found some time to do dry needling on my leg.  I've had Johanna and Erin do some therapy on my ankle (I'm scheduled to have surgery in January to repair two ligaments and remove an extra bone process).  They both thought that certain muscles in my leg were really tight, most likely from being in a walking boot for a month and a half prior to this internship!
   Rich had me lie face down as he used alcohol wipes to clean off my skin where the needles were being inserted. He ended up needling me in about six different places! For all of his other patients it's usually only two or three places. He started with my gastrocnemius, and did both heads. It wasn't painful when he inserted the needle, I barely felt it.  However I did feel a tingling, burning sensation. He continued to my hamstring. I think he did two or three muscles in my hamstrings, but I couldn't tell exactly where he was placing them.  He then went back down to my soleus.  Lastly, he did my peroneous longus, which Erin had previously mentioned was tight.  For this one, I was laying on my side.  As he inserted the needle, I felt a really strong, sharp "zing" which went all the way down into my big toe!  I immediately jerked my leg back. It really scared me! He said that was either the muscle releasing lots of chemical by products or he possibly hit a nerve.
  Once he was done, I asked if it would be alright if I ran on the treadmill, since I was planning on running today. He said he wasn't really sure how it would feel since there hasn't been much research done on dry needling. I ended up running for twenty minutes. I wasn't in any pain at all while I was running, except for feeling like I needed to stretch my calves.  Afterwards, I iced my ankle and calf for about fifteen minutes.  I got up to go put the ice away, and I could barely walk!!  My calf was so tight, I couldn't plantar or dorsiflex my foot at all. It took about 45 minutes and a lot of light stretching to finally be able to walk normally.  SO, don't exercise the muscles that have recently been dry needled!! Hope it feels better tomorrow morning.  I'm really glad I got to experience the dry needling, despite the pain that I'm currently in!

almost the end!

  These past few weeks have flown by! I've gotten to observe a lot of patients the past week, and a few of the therapists and patients actually let me get some hands on experience! For example, Erin almost always starts off by having the patient stand facing away from her.  She finds the posterior superior iliac spines and places her thumbs on them.  The patient then performs a series of movements, such as bending forwards, backwards, side to side, and marching, and Erin traces the movement of the ISPS. Sometimes one side will move farther than the other or one won't move at all, and from there she determines what joint is stiff or what muscles are tight.  So one patient today has been coming in for a while now, and she was experiencing lower back pain and stiffness in her hips. Erin showed me where to place my hands in order to feel the acetabulofemoral joint not gliding smoothly.  We compared one side to the other, and one was clearly immobile.  After some stretching and cuing to attempt to release the joint to no avail, Erin resorted to a manual manipulation.  The patient was laying on her side, with the bad joint facing up. Erin was behind her, and firmly hit the back of her hip forward.  It looked pretty strange, but the patient seemed very pleased that she had found just the right spot!  She got up and walked around and felt some immediate relief.
  One really cool thing about this profession that i've noticed is that you can do things that will provide patients with instant results.  That's a pretty amazing skill to have. I've noticed many patients sigh in relief as therapists are doing traction techniques with them or being able to stretch farther after the dry needling.
  Tomorrow is my last day in the office.  I'll only be in for about half the day, but I made sure I'll be there for the patient whom I am doing my cast study on.  Hopefully she's doing better today!  My family is heading to Florida on Wednesday, good thing we missed the storm this weekend!

hours: 12/27 4.5

More internship!

This week there has been another intern helping out. It's been nice having someone help fold towels and shadow the PT's. We are the same age, and she plays volleyball at Hollin's College.
Lately I've been able to help Johanna out more with getting people set up on ice and heat packs.  Today she even asked me to greet a client and get him heat while she was finishing up with someone else.  I was also allowed to feel a woman's neck in order to feel how certain muscles were atrophied compared to others. It wasn't extremely obvious, and it took a few tries to get my fingers in the correct positions.  The patient helped direct me, based on where Johanna's hands had just been.
Today, a lady came in with her MRI and she didn't understand any of the technical writing, so Johanna talked her through it.  I brought over the life size skeleton and helped point out a few bones and articulations.  Johanna was extremely good at explaining everything at a very basic level.  It's really fun to shadow her, especially because she takes the time to explain things to me, too.
The first day I was a little skeptical about all of this, but I'm really starting to find it fascinating!

12/13: 6
12/14: 7
12/15: 7
12/16: 7
12/17: 6
12/20: 6
12/21: 5
total hours: 44

Dry Needling

  On Tuesday, I was shadowing Rich, one of the clinic directors and physical therapists, and observed him using technique called "dry needling" on a patient.  Dry needling may appear to be similar to acupuncture, but the techniques are actually very different. Acupuncture inserts needles along a meridian, bases on a "flow of energy" through one's body.  What most people call a "knot" in someones back, to physical therapists is known as a "myofascial trigger point." This consists of a tight  band of muscles that is contracted. In dry needling, a very small needle is inserted directly into this trigger point. The technique is called "dry" because no substance is injected through the needle. As the needle is inserted, the muscle with the trigger point will twitch. This is known as the localized twitch response. Healthy muscles will not twitch.  It is believed that the needle will release a build up of neurotransmitters.. The buildup of these chemicals, such as acetylcholine, norepinephrine, substance P, and bradykinin can cause the muscles to be painful to the touch.  The trapezius is a common muscle to contain trigger points, and that was where Rich was working with the patient yesterday.  There was no blood, no screaming, nothing out of the ordinary.  The needle is tiny, and the patient barely felt anything except for the twitch and when he inserted the needle deeper. After inserting the needle into several different locations along the trapezius and lower in the arm, Rich was able to stretch her back farther than he was previously able to.  This technique displayed instant relief, and took only a matter of minutes. There was a lot less work for Rich since he didn't need to physically manipulate and massage out the knot. One insertion, and it was fixed.
  One of the PT's, Erin, took a look at my ankle today, and she says that I could use the dry needling on my peroneus longus, so Rich says he will do that tomorrow. Cool!  Hope it works!  Erin found all sorts of other things wrong with my foot and the biomechanics of how I walk and how my back is shaped. Looks like I'll be coming in for a few more treatments while I'm here.  Might as well, right?

Total hours: 20

12/13: 6
12/14: 7
12/15: 7

Internship: Day 1

  So, today marked my first day at Virginia Therapy and Fitness Center. I arrived at 9am to the office in Reston, VA. Johanna, the PT I will be shadowing (more on her later), was busy with a client so I met with Heather who works at the front desk. She showed me how their computer system works for scheduling appointments and keeping track of all the clients. There are nine physical therapists that work in this office, so there is a lot to keep track of!  She has this extremely detailed coloring system which is how she displays if someone has checked in, if they cancelled late and will be charged, if they cancelled early and won't be charged, or even if they cancelled because their insurance is out of network. Plus there was coloring systems for massages scheduled, new patients, and re-evaluations.  Basically, I learned early on that there is a LOT of behind the scenes work that goes on!
  Johanna later showed me around the office, which is mostly a large open room.  There are about 10 tables lining the side wall, cardio equipment in the center, and strength training equipment along the other side. I was also introduced to the washing machine and dryer :) I did a bit of towel folding today, but I still had other things to do.  I'd rather do something that's actually helpful to them, rather than just following someone around all day, anyway.
  One really cool thing I got to do was assigned to me early on in the morning.  Johanna had seen one girl who is about 16 and had been to a series of doctors with some unknown chronic pain in her knees.  A doctor finally diagnosed her with Reflex Neurovascular Dystrophy. Johanna didn't know much about this, so she asked me to do some research to determine what physical therapy treatment could be provided.  Cool! Now this is something definitely more helpful than folding towels!  From my research, there is very little known about this disease. There is no one specific cause, and no known cure.  I haven't gotten to discuss what I found out with Johanna yet, but I will definitely write more about this disease.  I'm also not sure if this girl will be coming into the office while I'm there, but if she does I'm considering doing my case study on her.
  Anyway, more on this curious disease later along with some info about Johanna and how I met her. Very cool story!  Off to go christmas shopping with my brother....

Total Hours: 6