Elite athletes' experiences of musculoskeletal pain management using neuroanatomical dry needling: A qualitative study in Swedish track and field.

OBJECTIVES: To investigate how elite track and field athletes with a history of musculoskeletal pain (MSKP) describe their perceptions of clinical treatments based on dry needling guided by a neurological map (neuroanatomical dry needling (naDN)). DESIGN: Qualitative study. METHODS: In-depth interviews were conducted with eight elite Swedish track and field athletes (6 males, 2 females, median age 28.5) treated at a clinic specialised in MSKP management. All interviews were audio recorded and transcribed verbatim. The data were structured and analysed using a thematic method. RESULTS: The athletes approached clinical MSKP treatment from a performance-orientated perspective. They explained that they inevitably suffered MSKP episodes due to the intense physical demands of their sport. The use of naDN was considered an integral part of their sports practice and the study clinic's services were readily utilised when MSKP caused minor reductions in physical capacity. The athletes appreciated an unambiguous anatomical diagnosis, preferably supported by imaging scans, as this increased their confidence in clinical services. They valued the naDN treatment as it was perceived to provide fast-acting analgesia that enabled rapid return-to-play. These factors combined to reduce performance-related stress. CONCLUSIONS: Elite track and field athletes with a history of MSKP sought and appreciated clinical treatment with naDN largely because it provided fast-acting analgesia that enabled rapid return-to-play at a high-performance level. These athletes' expectations of MSKP diagnosis and management appear incongruent with current research indicating that MSKP sensitivity within the nervous system does not accurately reflect musculoskeletal tissue state or recovery following tissue damage.

The Electric Shock during Acupuncture: A Normal Needling Sensation or a Warning Sign.

The electric shock has been proposed as one of the new needling sensations in recent years. In acupuncture sensation scales, the electric shock is included by ASS and SNQS, but not SASS, MASS, and C-MMASS. Some scholars argue that the electric shock is a normal needling sensation, but some researchers do not agree with this view. This problem has not been resolved due to a lack of evidence from basic research. Literature and research point out that the electric shock is caused by inserting a needle into the nerve directly. A question of considerable scientific and practical interest is whether the electric shock should be a normal needling sensation. In this article, we review the historical documentation of the needling sensation and the process of formulating and improving acupuncture sensation scales to suggest that the electric shock may not be a normal needling sensation. Secondly, we collected and analyzed cases of nerve injury caused by acupuncture accompanied by the electric shock and why acupuncture caused the electric shock without nerve injury. It suggests that there may be a correlation between the electric shock and peripheral nerve injury, and acupuncture manipulation is an essential factor in adverse acupuncture events. Finally, we put forward that the electric shock during acupuncture is a warning sign that the peripheral nerve may be injured, rather than a normal needling sensation. In the future, we hope to have experimental studies on the mechanism of the electric shock or observational studies on the correlation between the electric shock and peripheral nerve injury to verify.

Safe acupuncture and dry needling during pregnancy: New Zealand physiotherapists' opinion and practice.

OBJECTIVE: Acupuncture guidelines have advised caution when treating women during pregnancy, because historical "forbidden" acupuncture points are believed to stimulate miscarriage or early labor. Despite recent research demonstrating that acupuncture is a useful and safe treatment tool for pregnancy-related low-back pain (LBP) and pelvic girdle pain (PGP), it is postulated that fear of miscarriage and subsequent blame by association, restricts its provision. More recently, an increase in dry needling (DN) courses for physiotherapists has potentiated the rapid growth in DN practice in New Zealand (NZ). Many dry needlers do not consider DN to be a form of acupuncture; it is unknown if they have similar safety concerns. METHODS: NZ registered physiotherapists practicing acupuncture and/or DN were invited to participate in an electronic survey to examine their practice and level of understanding in regard to safe needling during pregnancy. RESULTS: Of 124 respondents, only 60 (48%) would needle pregnant women, with a further 66% of those still expressing safety concerns. NZ physiotherapists practicing DN only, were more likely to needle areas related to "forbidden" points in all trimesters. However, overall, NZ physiotherapists were less likely to needle "forbidden" points than their UK peers. CONCLUSION: Conflicting literature and a "fear of blame" influences NZ physiotherapists' decisions to offer needling (both acupuncture and DN) during pregnancy. Further training in this field is recommended to ensure safe practice and adequate provision of acupuncture treatment options for pregnant women suffering musculoskeletal pain, such as LBP and PGP. Further research, particularly into DN, for women during pregnancy, is warranted.