Herman & Wallace faculty member Dawn Sandalcidi and Dr. Nel Gerig, who is in urology practice in the Denver area, gave a clear presentation at the most recent International Pelvic Pain Society (IPPS) Meeting about the treatment modality of dry needling for pelvic pain. Following a clear explanation of trigger points and the high prevalence of trigger points in the population of men and women who have chronic pelvic pain, the techniques of using needles in the muscles of the perineum was demonstrated by excellent images. The treatment can certainly include other portions of the body, such as the low back or thighs, as we know that these areas often become tense and painful during the course of pelvic pain.
Dry needling, called "dry" because there is no injectable such as lidocaine or cortisone used, is a technique that allows placement of a very small needle into the skin, muscle, or connective tissue of a hyper-irritable area in the soft tissue. This is done for the purpose of reducing the tension, pain, and connective tissue restrictions in the local area. In addition to the mechanical effect that the needle has, there are also neurophysiologic effects and chemical effects from the needle placement. Dry needling is commonly practiced in many other countries and is increasingly offered by physical therapists in many states. You need to check your state practice act to find out the current status of dry needling. Kinetacore is one continuing education provider that lists current states on their website who have either allowed or who have restricted dry needling.
Dawn Sandalcidi reported during her lecture that she finds the patient's muscles significantly decreased in tension, pain, and that patients report a significant decrease in pain levels following treatment that includes dry needling. She also noted that the technique allows her to "save her hands" as the needles can treat the trigger points very effectively. In states where dry needling is not practiced by physical therapists, it may be very helpful for the pelvic rehab provider to team up with someone such as a physician who is allowed to use needles. When a pelvic rehab provider and a medical provider work together to treat the patient, it is always the patient who benefits from such coordinated care. Increased research is needed to support dry needling for pelvic pain, and as Institute co-founder Holly Herman is known to say at courses, "What a great research project- you should do it!" The more "sharp" tools that are in our toolbox that are supported by patient outcomes and by research, the better we can serve our patients.