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Pelvic Floor Dry Needling: With Patients Naked or Clothed? Clinicians' Headache Particularly in Patient-Centered Care
05/17/2023
The popularity of needling therapy, either dry needling (DN) or acupuncture, among musculoskeletal community is striking today. In UK, statistics gleaned by the Chartered Society of Physiotherapists showing that over 6,000 of their members now use acupuncture in their practice. In Australia, many physiotherapists now offer dry needling or Western medical acupuncture as part of a treatment approach (Wayne Hing et al, 2022).
In US, for many musculoskeletal clinicians, they feel application of DN greatly increased their confidence in their practice. Steve Curtis, a PT for three decades who also became an acupuncturist 18 years ago, says "It's a great technique. The dry needling is just a tool that blows the doors off any other (muscular-skeletal pain) technique that's out there." (Stainton, Lilo H, 2018).
According to Cleveland Clinic, "Dry needling is a safe, minimally painful and often very effective technique for people with certain musculoskeletal conditions. Many people have found the treatment to be a game-changer in improving their quality of life".
Pelvic Floor Dry Needling
Pelvic floor dysfunction is one of many conditions treated with dry needling by some physiotherapists who are specialized in pelvic floor therapy. According to Intricate Arts Spine & Body Solutions (Jason, 2023), pelvic floor dry needling is the best way to fix the vast majority of pelvic floor impairments. Whether you have pain with sex, tailbone pain, any type of incontinence, or some other pelvic floor issue, dry needling is the fastest, safest, and most lasting treatment there is.
Pelvic floor refers to a group of muscles, connective tissue or ligaments that support the pelvic organs including the vagina (penis in man), uterus (prostate in man), bladder, and rectum.
Photo from Adobe Stock
Pelvic floor dysfunction (PFD) refers to a broad constellation of symptoms and anatomic changes related to abnormal function of the pelvic floor musculature. The clinical aspects of PFD can be urologic, gynecologic, or colorectal and are often interrelated. Another way to compartmentalize the concerns are anterior- urethra/bladder, middle- vagina/uterus and posterior- anus/rectum (W R. Grimes et al, 2022).
Patient-Centered Care
In this 21st century, patient-centered care has taken center stage in discussions of quality provision of healthcare. Patient-centered care is the practice of caring for patients in ways that are meaningful and valuable to the individual patient (Niall O'Neill, 2022).
Researchers from Harvard Medical School, on behalf of Picker Institute and The Commonwealth Fund, identify Picker's Eight Principles of Patient-Centered Care. Among these 8 principles, the most meaningful to the patients, in my view, are the following two:
Respect for Patients' Preferences & Values: Treat patients with dignity, respect and sensitivity to his/her preference and autonomy.
Physical Comfort: Ensuring the patient is comfortable at all times, administering medication in a way that's easiest for them.
Needle Insertion & The Most Private Body Parts
Instagram photo
With regard to PFD, one thing particularly worthy to note is that pelvic floor is the most private and intimate parts of the human body. When treating PFD with dry needling, many PFD clinicians such as physiotherapists will insert needles into pelvic floor region (in dry needling and TCM acupuncture, local needling – needling the pathologic site or close to it is very common).
"Yes!! I can dry needle your pelvic floor!"
Jill, an American physiotherapist says to her potential patients. Specialized in pelvic floor therapy, she introduced dry needing into her practice to treat pelvic floor dysfunction. She wrote in an online post (Jill Ehrmantraut, 2023):
Pelvic floor dry needling is appropriate for many diagnoses we may see ... include pelvic pain, urinary incontinence, constipation, pudendal neuralgia, coccydynia, and even diastasis rectus abdominus.
An Awkward & Embarrassing Therapy
Trying to ease the expected embarrassment and reluctance of her potential clients, Jill added:
But I'm not going "right up in there" with the needle.
[instead,] With a patient lying on their side, I will find their "sit bone" and place the needle directly inside of this … without going right up through the perineum.
Photo from Intricate Arts Spine & Body
A note about pelvic floor therapy from Cleveland Clinic warning patients: "...it can be embarrassing to discuss your pelvic floor dysfunction symptoms ... Remember, the more open and honest you are with your provider, the better your treatment will be".
But Wait, "I Do Want To Place Needles Down There!"
The moment a pelvic-floor-disorder (PFD) patient who heaved a sigh of relief upon knowing his or her "right up there" will not be stabbed by a needle, Jill continued, saying:
The other exciting part of this all is that I can use a small hand-held device to apply electric stimulation directly into the muscle! ... help a weak muscle "wake up" in order to make strengthening exercises more effective! The electrical stim does not hurt. Rather, you will feel a deep "thump" in the pelvic muscles.
So yes, I do want to place needles down there!
The PFD patients are facing a tough decision. Simply a talk related to pelvic conditions in front of a clinician is an embarrassment, then how about your most private body parts being touched, palpated, then stabbed by needles in a gloved, lubricated hands of a "stranger"?
Clinicians' Headache: With Patients Naked or Clothed?
"Sooo…. You want to stick a needle into my pelvic floor, you say? Ummmmmm…. Yes, this is a normal response to this proposition." Jason, a pelvic floor therapy PT at Intricate Arts Spine & Body Solutions (Jason, 2023) wrote in a post. His post made every endeavor trying to persuade his potential patients into acceptance of being sticked "right up in there".
Photo from Goodman Performance Therapy
Clearly, as clinicians, we do not have very much confidence that we can persuade patients into getting their most private body parts naked stabbed in there by needles, no matter how we beat around the bush.
At the same time, a high quality healthcare requires us clinicians:
Respect for Patients' Preferences & Values: Treat patients with dignity, respect and sensitivity to his/her preference and autonomy.
Ensure physical Comfort: Ensuring the patient is comfortable at all times, administering medication in a way that's easiest for them.
"Right up in there" with needles requires a patient's bottom naked.
Ensuring the patient is comfortable at all times requires keeping the patient properly clothed or at least covered.
What's The Odds We Can Persuade Patients?
Ideal quality care issue aside, what's the odds we can persuade patients with PFD into naking themselves and consent to be stabbed right up in there with needles by a "stranger"?
For every 10 patients, how many, you can expect, will allow you to go ahead? Unless the situation is so bad close to life-threatening, I doubt there is none. Just stand in patients' shoes for a moment! Ask yourself what is the odds you would do in the same situation.
Can we avoid such a dilemma? Can we treat patients with PDF in a way comfortable and easiest to them?
Let's Treat PDF Patients into A Sleeping Cat
Yes, we can. We can do it while keep the patient fully clothed with pants and short sleeves, only socks off, and making them a sleeping cat lying on the treatment table, plus a huge bonus - with magic results: instant and reliable!
Photo from PetPlace
The only thing is you need to know the "secret" how. Once you know the know-how, you will not only be able to treat the pelvic floor muscle-related disorders with patients comfortably clothed, but also to deal with non-musculature pelvic-organ disorders such as leucorrhea, vaginal candidiasis, PCOS, fibroid, ...the list is endless.
It is utterly unnecessary to request the patient to expose any of their private body parts, even anywhere of their body trunk, if you fully understand the "secrets" of a truly scientific healing art.
In my oncoming posts, I will discuss how to treat pudendal neuralgia, coccydynia, ... with dry needling or dry acupuncture while keep patients comfortably clothed, sleeping like a quiet cat. Stay tuned.
References
Crislip, Mark. "Dry needling". Science-Based Medicine. 2016
Darius McAphee, PT, et al, Dry Needling: A Clinical Commentary. Int J Sports Phys Ther. 2022; 17(4): 551–555.
Indeed Editorial Team, What Is Patient-Centered Care? Definition and Benefits. Feb 3, 2023. https://www.indeed.com/
Institute of Medicine (US), Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press (US); 2001
Jason, Pelvic Floor Dry Needling: What is it + Who can do it? 2023 Intricate Art Spine & Body Solutions. https://intricateartseminars.com
Jill Ehrmantraut, Yes, i can dry needle your pelvic floor and yes it its an effective treatment. https://apexptwellness.com/you-want-to-put-needles-where/
Jason, Pelvic Floor Dry Needling: What is it + Who can do it? (Accessed on May 5, 2023) https://intricateartseminars.com/what-dry-needling-pelvic-floor/
Niall O'Neill, The Eight Principles of Patient-Centered Care. February 8, 2022 https://www.oneviewhealthcare.com/blog/
Stainton, Lilo H, Physical Therapists Win Latest Battle in Turf War... New Jersy Spotlight News 2018.
Wayne Hing et al, Physio 'dry needling' and acupuncture – what's the difference and what does the evidence say? June 26, 2022 theconversation.com
W R. Grimes; Michael Stratton, Pelvic Floor Dysfunction. National Library of Medicine, 2022