July, 2011 — BJC Health Connected Care
Dry Needling
Dry Needling
By Errol Lim, Physiotherapist
Dry needling has become more topical in recent years when talking physiotherapy treatment. Physios are always looking for new techniques and methods of treatment that can improve patient outcomes. The quicker we can get someone better, the better we feel, the better we “look” and more importantly, the better our PATIENTS feel. The problem for most people is the fear of the needle.
1. Is dry needling better than other physiotherapy techniques?
Dry needling is just one of a multitude of treatment options, our physiotherapists have in order to get desired outcomes with their patients. As a treatment modality, it is no better or no worse when compared to other modalities. It would only seem better if a patient has had numerous other types of physiotherapy treatment and it so happens that dry needling gave them the best result. Like many things in this world, there is no hard and fast rule about when to use dry needling as every patient is different. The art for a physiotherapist is then to know when dry needling can be most effective.
2. So, when does a physiotherapist decide to use dry needling?
Dry needling is most effective for patients who have sensitivity (or do not like) to other treatment modalities such as massage or trigger pressure therapy. These techniques can often cause pain upon a physiotherapist applying pressure to the patient’s skin/body. Hence, dry needling allows a physiotherapist to release tension or trigger points in muscles without the discomfort of finger/hand pressure. Typically, patients with conditions such as fibromyalgia or other arthritic conditions as well as patients with severe pain such as lower back disc and whiplash injuries may benefit.
In other patients, dry needling can have a better effect than massage as the needle is able to reach deeper fibres of a particular muscle group. The only way to know this is to have both treatments. The physio will then be able to make this decision with the patient. Many athletes tend to fall into this group as they are always looking for ways to recover quicker from training and competition.
Hope this post helps to alleviate some fears when it comes to deciding whether dry needling is a suitable treatment technique when performed by physiotherapists. If you still have some apprehension, let us know and hopefully we can help you through this decision making process.
Errol Lim is a physiotherapist and a director of BJC Health.
BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
Integrated Rheumatology Centre
By Dr Irwin Lim, Rheumatologist
This post was inspired by RA Guy. He recently wrote a piece about an Autoimmune Wellness Centre.
RA Guy Concept Wellness Centre
RA Guy makes many important observations, observations our group believe in strongly with our CONNECTED CARE vision:
“When you live with a chronic illness like rheumatoid arthritis, going to all of your different health care appointments can easily feel like a full time job. And to make the situation even more complicated, everything is usually in a different place.”
“wouldn’t it be nice to do so in an environment that places more emphasis on the “care” part and less emphasis on the “medical” part?”
“A place where a complete support team has already been established, where patients can choose from the wide range of different services that are available.”
RA Guy goes on to describe a 10-storey building designed for this purpose. It’s a grand design and a lovely concept. I urge you to have a look at his piece on Autoimmune Wellness Centre.
I couldn’t help but comment on his blog. This is what I wrote:
“I was really glad to see this piece as it’s our group’s vision to create this. We’re on our way on a much more modest scale but the concept of CONNECTED CARE, co-located & multidisciplinary is alive.
We combine Rheumatologists, Physiotherapists, Exercise Physiologists, Dietitian, Massage therapy, Nurse Educator, Infusion Centre, some imaging, pathology collection, an exercise gym area with classes designed for patients with chronic illness. Present in a 2-storey house but we’d love the 10-storey building if there are rich benefactors out there!”
BJC HEALTH was conceived in 2002 as a multidisciplinary clinic targeting musculoskeletal disease. We recognized that the way forward in improving the treatment of acute and chronic musculoskeletal injury would involve a coordinated, comprehensive service that no one doctor or allied health professional could reasonably provide.
Do you agree that this type of integrated rheumatology centre is the way service should be delivered?
Enthesopathy: If it’s not overuse, then what could it be?
Google images: Oxford Medicine Online
By Dr Roberto Russo, Rheumatologist
In my last post I introduced the enthesis, explaining that it is the site where the tendon (or other soft tissues) joins onto bone (hard tissue) to transmit force, which is either wanted or unwanted. In addition, I highlighted the close relationship between the enthesis and surrounding structures, such as the bursa and fat, forming what is known as the enthesis organ.
I wish now to bring that discussion forward and draw your attention to when things go wrong.
It is a simple concept to consider that when the forces put through an enthesis are larger than what that structure can withstand, then injury must follow. This is in fact true, and this form of enthesopathy is termed mechanical.
This is often encountered in the sporting population or in those who perform a repetitive task under load. However, I should point out that in this situation the enthesis is less likely to fail than the adjacent tendon or ligament, such that this population is more common to experience a tendon injury, termed a tendinopathy, or a ligament strain or rupture.
So if it is not mechanical, then what could it be?
As a Rheumatologist I wish this question were more frequently considered. That is because there are a number of medical conditions that can affect the enthesis, including most commonly a number of rheumatic diseases and a range of metabolic illnesses such as diabetes, high cholesterol, and other endocrine disorders.
Of the rheumatic diseases, a group of related conditions termed sero-negative arthropathies are characterized by inflammation/injury of the enthesis, termed enthesitis. They are termed sero-negative because those affected do not have an antibody in their blood called Rheumatoid Factor, which is seen in about 70% of those afflicted by Rheumatoid arthritis (which is also a condition associated with enthesitis). Other rheumatic diseases where enthesitis occurs include the arthritis caused by crystals, such as gout, and even osteoarthritis.
The sero-negative arthropathies are comprised of Ankylosing Spondylitis, Psoriatic arthritis, Reactive arthritis, and Enteropathic arthritis. Although as mentioned, they are related by the fact that Rheumatoid Factor is absent they also often share a genetic marker termed HLA-B27. This genetic marker is present in about 90% of those with Ankylosing Spondylitis and about 50% of those with Psoriatic arthritis. However, HLA-B27 is present in up to 10% of the ‘normal’ population and so there are other factors at play that will determine who will develop one of these diseases and who does not. What these factors are exactly is not as yet known, although an environmental agent is probably involved, which is most likely to be an infection (despite the fact that a specific causative infection has not been found). Therefore, the current idea is that these conditions develop in a genetically predisposed host who encounters a particular environmental factor at a time that is just right to trigger the disease.
So why does this sequence of events lead to an immune attack against the enthesis?
Well there are a number of theories but none that are certain. The most popular is that there is a similarity between the factor that triggered the disease and the structure of the enthesis attracting the attention of the immune system.
Whatever it is, what is certain is that the inflammation and injury that occurs at the enthesis results in pain and swelling, such that when the question is asked ‘if it is not mechanical, then what could it be?’; the answer ‘a rheumatic disease, such as a sero-negative athropathy’ should soon follow.
BJC Health established the Sydney Spondyloarthritis Centre in 2011. We raise the profile of these diseases, we provide a better pathway to diagnosis, provide education as well as world-class treatment. Most importantly, we care & we want to improve the lives of people suffering from these diseases. Read about it here.
Dr Roberto Russo is both a rheumatologist and a nuclear medicine physician, as well as a director of BJC Health. BJC Health provides coordinated, comprehensive, and colocated multidisciplinary care to achieve effective solutions for patients. We call this model of care, Connected Care. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.
This blog focuses on musculoskeletal disease, healthcare in general, and our Connected Care philosophy. Read More.
It’s hard to watch your diet on holiday
Many said it would be most difficult to maintain my recent weight loss and health gains. They weren’t wrong!
With my family being away for the best part of a month, it was an opportune time to catch up with mates. Mates don’t just like sipping cups of tea and snacking on chick peas which makes maintaining my weight more of a challenge. With this in mind, I went to the “Oracle” (or at least this is what I call my dietitian these days). Monica’s words of wisdom were to stick to the spirits and try to avoid beer. She of course told me to drink in moderation. At the same time to avoid soft drinks and snacks like chips and definitely to stay away from that midnight kebab.
So over the last month, I occasionally had a low-carb beer; I cringed when I ordered a bourbon and “diet coke”; and I snacked on fruit when sipping on a scotch (“neat” of course as there was no diet coke to be found). As for the kebab, I relented by not eating the Lebanese bread and just asking for extra salad.
Somehow, I coped whilst my family was away. I even increased the exercise sessions to 5 times per week. I had defeated the first challenge. The next and harder challenge awaited me – my holiday in Korea.
It is my 3rd day in Korea. The joy of seeing my family once again soon overwhelmed by the constant whingeing and tantrum throwing. Despite this, I am determined to overcome the threats to my diet and general well-being. I am ready for what the holiday can throw at me. This is what I have had to face thus far:
Day 1: straight to my favourite restaurant in Seoul direct from the airport. Amazing Korean BBQ with my father-in-law eager to share a shot of rice wine or two with me.
Day 2: I managed to avoid rice for most of the day until dinner. This rice dish was the 5th course and there were only 3 adults at the table. It was then followed by a mountainous dessert.
Day 3: More was to come today. The dreaded buffet! Another family favourite so how could I say no. Seoul surely has thrown its diet challenges at me but I have since learned to eat in moderation and also to watch what I eat. It hasn’t been as difficult as I have possibly described. Exercising daily in the sweltering heat and humidity has also been extremely helpful. I’ll try to take some pics of where I exercise and post it on the next blog.
Someone, please share your holiday eating journeys with me. I am sure I can relate to your story no matter where you are in the world.
Eat Legumes & Lentils
By Monica Kubizniak, Dietitian
Monica Kubizniak is a dietitian at BJC Health.