Trigger point Dry Needling (TDN) has continued to gain popularity in the clinical realm of physical therapy. As both patients and therapists observe the benefits of this treatment, utilization continues to increase. However, there is one realm where this treatment option isn’t often implemented: workers’ compensation.
Despite this treatment option falling within the scope of physical therapy practice, many stakeholders within worker’s compensation hesitate to approve this treatment option. This is further compounded by the fact that Official Disabilities Guideline (ODG) has not added TDN as an approved treatment option. But why not? Many of the arguments against implementation range from concerns over safety, to expense, to lack of evidence to support its efficacy. So, let’s discuss!
“Trigger Point Dry Needling doesn’t sound safe. What if the therapist hurts the injured worker?”
When weighing potential treatment options, one must weigh the pros and cons associated with a treatment. Just as physicians must weigh the risks and benefits of prescribing medicine, injecting a joint, or opting to perform surgery, so must physical therapists when considering manual therapy techniques, exercise prescription, and TDN. Some assume that, because TDN is more invasive, that there must be some increased risk to the injured worker. This is further compounded by the complexity of the worker’s compensation system, particularly when considering that some cases have legal implications. Wanting to avoid any potential complicating factors, TDN may be denied for fear of additional injury being sustained. That fear, however, is unwarranted.
Research has shown us (2020 study – Int J Sports Phys Ther) that major adverse events are very infrequent, 1 per 1,024 trigger point dry needling treatments or a rate of < .1%. The most common minor adverse events are bleeding, bruising or pain and can happen in just over one-third of treatments. This study was also quite sizeable, assessing 20,494 treatments of trigger point dry needling, providing strength to the argument that this treatment option does not pose significant risk to the injured worker.
“Trigger Point Dry Needling is an added expense that I don’t want to incur. Aren’t there less expensive options?”
Functional outcomes and case duration are primary focuses when managing an injured worker. Upstream Rehabilitation has continued, across the spectrum of payers, diagnoses, and demographics, to provide superior outcomes in less time than other therapy providers (as supported by KEET data), demonstrating our effectiveness with managing musculoskeletal injuries. Part of our success comes from our extensive focus on post-graduate education and training, ensuring that clinicians have a wide variety of treatment options to facilitate quick results. TDN is one such treatment.
Considering that research continues to demonstrate physical therapy as a cost saver, use of all potential treatment options to benefit the injured worker will ultimately reduce the likelihood of downstream costs (imaging, injections, and surgery). TND is another tool in the therapist’s toolbox typically deployed during a typical session with the remainder of the session focused on return to work activities.
“So, what if Trigger Point Dry Needling is safe and affordable, there isn’t enough literature yet to show that it’s an effective treatment option.”
Research is continuing to be performed to examine the efficacy of TDN. That said, a 2015 systematic review of literature (Journal of Manual & Manipulative Therapy2) has shown TDN to be effective “as compared to either baseline or control groups, [as] significant differences were found for pain (14 studies), range of motion (ROM) (five studies) and at least one item on function and quality of life measures (six studies).”
Another 2015 systematic review (Spine3) demonstrated that TDN, while perhaps not effective as a stand-alone treatment, suggested that TDN may be an effective adjunct to other therapies. This is exactly how TDN is implemented in an Upstream Rehabilitation clinical setting. Utilizing TDN to reduce pain and improve ROM, is then complemented with joint mobilizations, exercise progression, pain science, and return to functional activities.
Most clinicians would agree, that if an injured workers’ symptoms can be improved with TDN, that therapy can progress more quickly, which will drive good outcomes and case closure. There has even been some research (2017 – Journal of Orthopedic and Sports Physical Therapy4) with using TDN with difficult cases where progression has stalled. This study showed “clinically significant improvements in pain, range of motion, function, and myofascial trigger points” when TDN was used.
While further research into TDN will continue, it can effectively be argued based on current research, that in terms of a safe, cost-effective treatment, that has been shown to drive outcomes when paired with other therapeutic interventions, that Trigger Point Dry Needling is an evidence-based treatment. Considering the facts presented above, I think that the worker’s compensation payers and ODG should consider the allowance of this treatment option as a means to better serve the injured workers receiving care as part of a work-related injury.