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Canada Dry Needling courses - organized by Uplands Physio Clinic - see the dates here.

What is dry needling?

Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissue for the management of neuromusculoskeletal pain and movement impairments. It is a technique used to treat dysfunctions in skeletal muscle, fascia, and connective tissue; to diminish persistent peripheral nociceptive input; and to reduce or restore impairments in body structure and function, leading to improved activity and participation.

An analysis of competencies for dry needling by physical therapists in 2015 concluded that 86% of the knowledge requirements to be competent in dry needling is acquired during the course of physical therapy entry-level education. This comprises education with an extensive anatomy component and including knowledge related to evaluation, assessment, diagnosis and plan of care development, documentation, safety, and professional responsibilities.

The remaining 14% of the knowledge requirements related to competency in dry needling must be acquired through post-graduate education and specialized training in dry needling. In terms of skill and ability requirements, psychomotor skills needed to handle needles and to palpate tissues were the only ones noted as not being required for an entry-level physical therapist. Teaching palpation skills for dry needling points location and safe needle manipulation are an essential part of UPC's courses and need considerable time to develop, followed by sufficient clinical experience to master them.

Dry needling is different than acupuncture

Acupuncture practised by acupuncturists and dry needling performed by physical therapists differ in terms of historical, philosophical, indicative, and practical context. Dry needling performed by physical therapists is based on Western neuroanatomy and scientific studies of the musculoskeletal and nervous system. Physical therapists who perform dry needling do not use traditional acupuncture theories or acupuncture terminology. See this comparison overview between dry needling and acupuncture.

Dry needling can be categorized into ‘superficial DN’ (SDN) and ‘deep DN’ (DDN). SDN involves 5 mm to 10 mm insertion of the solid filament needle into the subcutaneous tissue while DDN goes deeper. Features of SDN include ease of administration, less risk of significant tissue trauma, reduced risk of neurovascular or visceral injury, and patient comfort. DDN is more difficult to administer and has an increased risk of adverse events.

The dry needle used is very thin and there is no injectable solution. Inserting the needle can cause some pain,‪ although this seldom occus when done by well-trained practitioners. Proper dry needling of a myofascial trigger point will elicit a local twitch response (LTR), which is an involuntary spinal cord reflex in which fibers of the affected muscle contract. The LTR indicates proper placement of the needle in the affected area and improves treatment outcomes.

Why choose dry needling?

Musculoskeletal pains are not often explained from a muscle perspective. However, referred pain from muscle parts can mimic other musculoskeletal pains as shown in the image. These so called ‘myofascial trigger points’ are sources of persistent peripheral nociceptive input and their inactivation is consistent with current pain management insights.

Trigger points of the gluteus medius muscle and its possible referred pain patterns. Note the potential overlap with 'hip', 'SIJ’, ‘sacrum' or 'low back' pains.

In clinical practice, dry needling is performed once the physical therapy examination and evaluation are completed and clear therapeutic goals and objectives are established. Dry needling may be incorporated into a multimodal treatment plan when myofascial trigger points are present and possibly responsible for impairments in body structure, pain, and functional limitations. Dry needling can also indicated for restrictions in range of motion due to contractured muscle fibers or taut bands or to other soft tissue restrictions, such as fascial adhesions or scar tissue. The solid filament needle allows the therapist to target tissues that are not manually palpable.

Myofascial trigger points have been identified in numerous diagnoses such as radiculopathies, joint dysfunction, osteoarthrosis, tendonitis, temporomandibular dysfunction, migraines, tension-type headaches, carpal tunnel syndrome, computer-related disorders, whiplash-associated disorders, spinal dysfunction, pelvic pain and other urologic syndromes, post-herpetic neuralgia, complex regional pain syndrome, nocturnal cramps, and phantom pain.

Learning dry needling from quality instructors - safety is paramount

There is worldwide interest in dry needling supported by increasing scientific evidence. Dry needling is practised around the world by Medical Doctors, Doctors of Osteopathy, Naturopaths, and Physical Therapists (PTs). The PTs account for the largest growth in recent years. Main instructor Frank Timmermans has 40 years of experience as a Physical and Manual Therapist and has been dry needling since 2002. He has published several articles on myofascial pain and dry needling and has, together with his teams, instructed many physical therapists.

There is 1:4 teacher student ratio for optimal safety and didactics. An overview of the adverse events will be presented and discussed in great detail, teaching the students how to recognize and manage the dry needling adverse events possible and specifically for those circumstances when the patient requires urgent medical assessment. Other topics reviewed for safe dry needling practice include infection control measures, maintaining a clean needle technique, and a dry needling protocol recommended by the Canadian Physiotherapy Association with check lists, hygiene aspects, indications, contraindications, adverse events and safe dry needle handling.

Follow two dry needling course levels to obtain a full and complete dry needling certificate

The three dry needling course levels offered reflect increasing levels of dry needling skill and for every muscle, the student receives information about myofascial pain and dysfunction, referred pain patterns, clinical reasoning, palpation and dry needling techniques.

The introductory 3-day course on ‘Extremities’ covers the muscles in the arm and leg and teaches the basic knowledge and skills required to perform the technique. After registration, you will recieve precourse materials consisting of power point videos, articles and links to anatomy and referred pain patterns, as well as access to the Trail Guide anatomy/palpation book At the course, you will receive a 185-page course manual and a trigger point poster. Participants must pass both theoretical and practical testing and demonstrate safety and competency in order to receive a certificate of completion of level 1. Attendance and passing the exams are mandatory in order to be able to sign up for level 2. Please see this link for a full desciption of course level 1.

The advanced 3-day level 2 course entitled ‘Spine’ can be taken after completion of the first level. Precourse materials consisting of powerpoint videos, articles and links for anatomy and referred pain patterns will be emailed after registration. At the course, you will receive a 150-page course manual and a trigger point poster. The course will conclude with a review and participants must pass both theoretical and practical testing and demonstrate safety and competency in order to receive a certificate of course completion of level 2. Afterwards, the registrant can apply with the CPTBC to be placed on the dry needling roster. Please see this link for a full description of course level 2.

Once listed on the dry needling roster, the registrant may apply for the 2-day third level 3 course 'TMD and Headaches'. Powerpoint videos, articles and links to anatomy and referred pain patterns to review will be emailed after registration. At the course, you will receive a course manual. The course will conclude with a review and participants must pass both theoretical and practical testing and demonstrate safety and competency in order to receive a certificate of completion of level 3. Please see this link for a full description of course level 3.

Ongoing support after the courses

After completing the courses you will be registered on the website as a certified dry needling practitioner. Through the 'members only' section of the website, you will have access to a consent form, clinic brochures, dry needling safety overviews, as well as relevant publications. After the courses, you are encouraged to stay in close contact with your instructors in case you have any practical questions. Regular ‘refresher days’ will be organized to allow you to stay up to date with new developments.

Feedback from participants over the years

Level 1 course 'Extremities'

The focus on safety was very good.

I really gained valuable knowledge and skill from the seminar. Looking forward to the next!

You brought in an excellent team of knowledgeable physiotherapists that were great to help us with the techniques.

I really appreciated your attention to detail, the small group & hands on time, and the general environment of the class.

Level 2 course 'Spine'

This was a fabulous level 2 course. It supports the first one so much.

I really enjoyed it and appreciate the safe & comprehensive approach.

Love the verbal repetition for techniques and reinforcement for safety.

I especially appreciated the attention to detail and repetition regarding the safety issues.

I understand that you need to do the 2 courses in this order. There is no way I could have grasped it all in one course.

I am loving finding tightness and decreased ROM and then dry needling and then re checking. It is very satisfying.

I learned a more rounded approach to needling treatments and how it fits into an overall assessment and treatment plan.