The Get Healthy Tampa Bay Podcast

E90: Understanding Dry Needling, Insights from Dr. Ray Moore

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I'm excited to welcome Dr. Ray Moore, a physical therapist specializing in myofascial trigger point dry needling. In this episode, we delve into the world of dry needling, discussing what it is and how it differs from traditional physical therapy techniques. Dr. Moore explains the mechanisms behind dry needling and its effectiveness in treating various muscle pain conditions. He also addresses common misconceptions, the relationship between dry needling and acupuncture, and shares patient success stories. Tune in to discover how dry needling can enhance your recovery and improve your overall well-being!

Ray earned his Doctorate of Physical Therapy from University of Maryland, Eastern Shore and has a B.S. in Kinesiology from University of Maryland, College Park.  He was born and raised in Baltimore, Maryland where he practiced PT for 12 years.  Ray enjoys working with patients with a variety of conditions including orthopedics, sports injuries, acute spine pain and hypermobility conditions.  He focuses on each patient’s unique functional limitations and incorporates advanced manual therapy and dry needling techniques learned through Residency and Fellowship training.  Ray and his wife traveled to 22 countries worldwide prior to joining OPPT, and he enjoys spending time on the water with his family, volleyball and mountaineering/rock climbing in his free time.

0:28 - Introduction to the Podcast and Guest
1:09 - Meet Dr. Ray Moore: Background and Experience
2:34 - What is Dry Needling?
3:38 - Mechanism of Dry Needling: How It Works
4:28 - Safety and Considerations in Dry Needling
7:53 - Soreness and Recovery After Dry Needling
9:30 - Conditions Treated with Dry Needling
11:24 - Differentiating Dry Needling from Acupuncture
12:56 - Trigger Point Injections vs. Dry Needling
22:00 - Patient Success Stories and Final Thoughts

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Kerry:

Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. Today, we have a very special guest, Dr. Ray Moore. And, well, welcome to the podcast, first of all.

Ray:

Thank you, Dr. Reller.

Kerry:

Yeah. Thank you so much for joining me. And I guess it's kind of interesting how we connected, but you walked into the office and brought in some really interesting information that you're going to share with us today. And you and I both trained in Baltimore, which is super exciting as well. And you recently moved to the area so happy to have you on the podcast. And I would love to hear and have you kind of introduce yourself a little more, telling us a little bit about who you are and what you do.

Ray:

Absolutely. My name is Ray, Ray Moore. I'm a physical therapist originally from Baltimore. I went to University of Maryland just like you did, Dr. Reller, and I had seen that in your profile. So that certainly interested me. And I've been down in Florida for a year and a half now. We moved down here after living and practicing our whole lives. My wife and I have been in Baltimore. So we just moved down here a year and a half ago and I've been practicing for 15 years and I've been practicing something called myofascial trigger point dry needling for 14 years. 12 years up in Baltimore in the past a year and a half down here in Florida, since it was approved into the Florida practice act, I believe in 2020.

Kerry:

Oh, okay. So that's more recent. I didn't realize this was, approved in Florida a little bit late. So that's, that's awesome. Yeah.

Ray:

told that it's been practiced by chiropractors, some trainers and different professional sports league staff for quite a while down here in Florida. So it's not like it's brand new to the state, but in terms of the Florida practice act for PT, it's just been the past couple of years. And then where I come from in Maryland, it was in the practice act or at least could be included in PT practice for a long time. And it's a very popular modality up in Maryland.

Kerry:

Cool. Yeah. Well, tell us about it. What is dry needling and how does it differ from traditional physical therapy techniques?

Ray:

Dry needling is a kind of an umbrella term. It can be used in a lot of different ways. What I practice is called myofascial trigger point dry needling. And it's an adjunct modality, which means that it's not our, you know, bread and butter treatment in physical therapy, which would be like therapeutic exercise, manual therapy neuro training and balance training. Those are some of our staple interventions that we use. It's an adjunct modality that's used to treat muscle pain, and we use a thin monofilament needle, which is in the case that I use is an acupuncture needle. We don't use it for acupuncture. We use it for the treatment of muscle pain and any sort of dysfunction, tension, tightness, spasms, spasticity that might be coming from the muscle. There certainly can be other uses for dry needling. There are some types of dry needling that we'll use it for some joint pain and we use it on tendons also. But for the most part, what I use dry needling for is pain that has an origin from the muscle.

Kerry:

Okay. Isn't it used like anywhere on the body, like any muscle?

Ray:

Technically speaking, you can dry needle any muscle that you want to. There's some much easier muscles to do like the upper trap, the biceps would have you I recall back to my training over 10 years ago where there's a muscle called the longus colli. That one's right there in the anterior neck between the internal carotid and the esophagus so that one's a little more. So with competency and practice and training, you can needle any muscle that can be safely needled in the human body. Absolutely. And the suboccipital area, which we might talk about a little bit later some cadaver studies have shown that one of those four muscles can be safely needled. So that's the only one that I will need all when it comes to dry needling. The most important thing always is patient safety.

Kerry:

Absolutely. Hopefully that's for everything, not just dry needling, right?

Ray:

It's for all treatments.

Kerry:

so can you explain the mechanism behind it and how it helps the alleviate pain or improve function?

Ray:

Yeah, there are these myofascial trigger points, which we would call muscle knots. Everybody has felt them, whether it's in your upper trap and your low back, wherever you may carry your stress or have your pain. We have these knots and they can be contracted muscle fibers that are shortened or maybe even spooled up into a little circle. When you look at the electronic microscope and when you look at these trigger points, they have a more acidic pH. There may be alterations in their blood flow to them, and they can be either active or latent. I use a analogy, a volcano analogy, where you can have volcanoes that are latent and are inactive can't really cause any harm. And then you have active trigger points which are spontaneously causing pain or can become a problem like an active volcano. So we mostly treat those active trigger points that are causing spontaneous pain. And they're not just an area of your body that's tender. We're mostly interested in treating pain that is spontaneously causing discomfort in your body. How it works if we're going to get a little scientific for a second, it works by mechanically disrupting the contracted fibers in this trigger points and it is an invasive technique. So it's a little more specific than massage therapy and other therapies that are very good. And go back on what I was saying before I think most PTs and rehab specialists would tell you that at the end of the day individualized exercise therapy is what's most important for patient pain problems and function and improving quality of life, especially over the longterm. So dry needling is a modality that we're going to use mostly for a short period of time. while promoting healthy exercise as as the most important tool that we have to use. This causes a local twitch response. So when we put the needle on the trigger point, it can get the muscle to kind of spontaneously twitch. This is because of a spinal cord, single loop reflex. That's the sensation that most people find to kind of be weird. It's not necessarily that painful, but it's usually you know, an odd feeling that you haven't felt before. I can restore the P H to the proper balance. That should be in the trigger point. I can bring oxygen circulation to the trigger point. Dry needling has been shown to release things like substance P, epinephrine and other chemical mediators, which are associated with pain and increased activation of the trigger point. It releases lactic acid also, and lactic acid is responsible for Dom's or delayed onset muscle soreness. Which is something that we get after lifting weights or doing a new activity we haven't done in a while. So, after dry needling, you can feel soreness for maybe a day or two. It's not sharp pain, but like a muscle soreness. And it can also potentially improve something called central sensitization through stimulation of the peripheral inputs. So, with central sensitization, we're talking about things that might be associated with fibromyalgia or conditions like L. R. Stanlow syndrome. And it's proposed that by treating the distal or area locally that you might be able to send a message back to the central nervous system to allow that response to reduce.

Kerry:

Okay. So, With the lactic acid thing, you said you get sore after having this session of dry needling or would it help soreness after, you know, person has an

Ray:

It causes soreness. In the courses, they'll say tell patients that it's not that painful. Well, I think it's best to tell patients what the actual response is going to be. And I think that it, it depends from person to person. I've had patients describe it as a good internal massage. And then some people do find it a little more painful or sore, but it usually causes the release of lactic acid. Which causes. you to feel like you just lifted a bunch of weights the day before. So to summarize kind of all that would what dry needling does, it mechanically stimulates these tight or taut bands inside of the muscle that allow the muscle to relax and go back to its normal state, thus reducing pain and any dysfunction that's coming from the muscle.

Kerry:

So, does it take time to do that or is there like immediate effectiveness?

Ray:

varies a lot. I've been doing it for a while and I've seen, I've seen people come in. I had a firefighter a couple of months ago where he was lifting a ladder overhead and he had an issue with his first rib and his upper trap muscle went into spasm. One or two sessions worked very well for him. Then some people has chronic conditions like Ehlers Danlos syndrome and they might get repetitive dry needling once a month or once whenever the muscles start to tense up. Some people, I would say the majority of people will have improvement within one or two or three sessions, whereas some conditions it might take a little bit longer.

Kerry:

Okay. And so what I thought was interesting with the details, right? Like reducing substance P I remember, you know, setting that with the pain pathways or anything. So that's good. Cause obviously if we're reducing that, then there's less likely to need to treat with like a pain medicine or something like that. And then I mean, I don't know much about the pH, but I thought that was also very interesting of how that mechanism can work and like change actually the acidicness of the site, I guess. And then you, you said they can experience this twitch after, so they may have this weird twitch, they may be sore, but eventually, the muscle will have that ability to relax and they can feel better overall.

Ray:

In most cases, again, we are treating sometimes there's underlying pathology in the case of the firefighter. It may have just been that he was used in the wrong mechanics on that one day. He has no underlying pathology. It's going to resolve very quickly. If we're treating lumbar, low back muscles. Because someone has an acute disc herniation, and if that's pushing on the nerve root, we can improve pain sometimes muscular pain by dry needling. But if there's some sort of underlying cause that keeps coming back, like a nerve impingement or an acute disc herniation or labral tear, then those trigger points may keep redeveloping because you're not treating the underlying problem,

Kerry:

Interesting. And then you mentioned like fibromyalgia, right? So and maybe that was decreasing the central sense of sensitization. So I thought, I thought that was interesting because I don't, typically do the whole 12 point method of diagnosing fibromyalgia, but I wonder if there's a role or integration there between, like, treating those trigger points that, hey, those trigger points are positive, you're getting a diagnosis of fibromyalgia and is dry needling going to help treat those, like, specific spots. Is that kind of what you're saying? Like, they could get regular help with that.

Ray:

Absolutely. Dr. Jenna Travelle wrote a book called Travelle's Trigger Points, and there's a little bit of overlap, I think, between those trigger point or she was a a physician. And there's some overlap between those points and the 12 points in fibromyalgia. I've treated a lot of fibromyalgia over the years and I don't think you have to have those 12 points or a certain number of those. I think it's a collective subjective history of the patient and a look at the entire picture. But in fibromyalgia and sensitization, we're talking about people that, let's say for you and me, you have to push my arm really hard in order for it to elicit a pain response. Someone with fibromyalgia or central sensitization You don't have to push as hard for that nociceptive or pain response to be evoked. We could spend an entire podcast or like a week of podcasts on fibromyalgia, but dry needling is something where the, the proposed mechanism is you treat the, these peripheral tender points, and that can possibly reduce the central input. It doesn't always work like that, but usually people with fibromyalgia do get relief from dry needling because their pain is mostly coming from the muscle

Kerry:

Yeah. I mean, I, they did change the way to clinically diagnose it, but I remember in the past it was like, you know, all these positive points or things like that. So interesting.

Ray:

and you do find, especially in the scapular area that that people with fibromyalgia have a lot of tenderness there. So those are, I do think they're accurate. Yeah,

Kerry:

Well, let's dispel some I don't want to say myths, but confusion, right? So what is the difference between dry needling and acupuncture? You mentioned acupuncture. So let's, what's the difference between that?

Ray:

the only real similarity is that we use the same needle in most cases, not all. I use a sarin acupuncture needle. It is a thin monofilament needle. It has nothing on it. It's called dry needling because there's no medication used there in the past have been some physicians that use like a lidocaine that would dip the needle into a lidocaine and insert that needle. But what the research didn't really show significant difference between the two approaches. Yeah. While I'm not an acupuncturist. I do think it's very important to establish our scope of practice. And the difference is, I believe in acupuncture. I usually try to find an acupuncturist in the area that I'm practicing to refer for patients that are requesting it or may benefit from it. I am going to go to my notes for the acupuncture since I'm not a traditional Chinese medicine specialist. For acupuncture it involves using the needle to restore the interconnected nature of the body's inner systems, and acupuncturists will apply the needle to an area where they believe that the qi, or flow of energy, is being blocked throughout these invisible meridians that circle the body. So there is this energy flow that keeps the restoration of our inner body systems in acupuncture kind of moving smoothly. Acupuncturists believe that. That qi or flow of energy around the meridians can be blocked in a certain area. And so when they're inserting a needle, usually it's just into the subdermal or superficial layer under the skin, but they certainly have the training to go into the muscular level and some do, but they are going into spots along those meridians. So for a shoulder pain, it could be here. It could be one down in the wrist or hand down the foot, the head. Whereas with acupuncture, we're mostly just going into the muscular layer and we're going into the area that's just around where the patient's pain is. With one exception, there is

Kerry:

You mean with dry needling.

Ray:

with, I'm sorry, with dry needling, yes, with dry, with dry needling. So with one exception for dry needling, with dry needling, we're going into the muscle layer and mostly pretty local to where the patient's pain is, but there is referred pain. So there are times where we are needling more proximal for pain. That's more distal. What I mean by that is one example is that the trigger points, the infraspinatus muscle, one of the rotator cuff muscles can refer down to the arm, into the forearm or the rest of your hands. So every once in a while we find a really active trigger point in the muscle that is referring, or maybe a more common one would be the upper trap muscle can cause headaches or pain up in the head. So there's a lot of differences between acupuncture and dry needling. And I've personally found a lot of patients benefit from incorporating both into their treatment plan.

Kerry:

Okay. Are there. Well, you mentioned trigger point. So, can you also tell the listeners what the difference between a trigger point injection is and dry needling.

Ray:

Absolutely. I actually would say that dry needling, the way that I practice myofascial trigger point dry needling is probably most similar to a trigger point injection. The difference is a medication will be injected by the physician Our nurse practitioner applying the trigger point injection whereas I'm going to take a needle without medication, go into that same trigger point, and I'm going to kind of move it around a little bit and piston it and try and irritate that trigger point while the muscle twitches until it relaxes. So it's two different mechanisms to try to get the same outcome.

Kerry:

Okay. And I thought. correct me if I'm wrong, but I thought the needle that you use was a longer one, but you said it's an acupuncture needle.

Ray:

No. Yeah. It's just an acupuncture needle. I've got right over here. I've got a few here. So you know, for, we'll use a 30 or 40 millimeter for cervical area or a small area. And there is one of the smaller ones there. And then for a quad muscle or a piriformis or glute might use a 50 millimeter, which is right there, but yeah, they are the gauges, very, very small and needle. But I tell patients if you put it into An acutely painful muscle, then that little teeny tiny needle can cause some pain for sure.

Kerry:

Yeah. Obviously I think with trigger point injections, we're using a wider needle to get the medication in there too.

Ray:

Yes, you are.

Kerry:

Let me give you a scenario. So I was just rolling over in bed the other day

Ray:

Okay.

Kerry:

like did something funny. This is how I get injured rolling over in bed. And like, you know, I got a little tight spot right here. So what would be best for me? Cause I have to keep stretching it. You know, would it be acupuncture? Would it be dry needling? Would it be a trigger point injection or just be rest and suck it up?

Ray:

Or all four

Kerry:

Or all four. Yeah.

Ray:

No, I for that type of thing. Look i'm biased. I'm a physical therapist. I've been practicing this for 14 years I've seen the benefits of it. I tried to not over or under sell dry needling I try to really specifically apply it to people That it's gonna be useful for and not, and not waste anybody's time for this type of thing. What I usually find is that my mom would sometimes call it like a crick in her neck where where you get a joint, I think the facet joints that glide in the neck sometimes overnight get stuck. One of them will get stuck. So you have a joint that's stuck and then the muscle can go into spasm right around that area. I think for that specific cause of pain, dry needling is most effective because I'll put the needle right into the area of the paraspinal muscles that's affected. I'll move that needle around. I'll get the muscle to relax. Usually within a day or two, sometimes you'll get like a small little click or pop in that facet joint and it'll start moving on its own and it'll get better. I also have the training, which we can talk about where I can do some. mobilization or manipulative therapy where we can get that facet joint to glide a little bit better with manual therapy. But in this instance, probably one of the best things to do early for that would be dry needling. And you're welcome to come see me anytime.

Kerry:

All right. Yeah, no, usually it's more like the crick in the neck. This one was like deeper down, like on my

Ray:

So that's probably.

Kerry:

problem is, yeah.

Ray:

I was going to say that's probably your levator scapulae muscle. It could be upper trap or it could be the upper portion of the rhomboids. One, or another thing, great thing that dry needling did for me is I already had a very good, solid fund fundamental understanding of the muscle anatomy, but doing dry needling, I think deepens that even further and you can really separate because a lot of these muscles either overlap or right next to each other and you really have to differentiate between which one you're treating.

Kerry:

Okay. You kind of probably already answered this, but what types of conditions or injuries can they dry needling effectively treat?

Ray:

So some of my favorite things to do are acute low grade muscle strains, like, for example, someone strains their calf in a soccer or sport game. As long as it's not a high grade two or grade three tear that just needs time and healing to take place, but either acute or subacute muscle strains also chronic muscle pain. Let's say that you had a strain in college of your right quad. It's a couple of years later and you're trying to squat and it's still bothering you. That's something where dry needling can help get you back to the point where you're able to squat and do your exercises without pain, neck and back pain. Both acute and chronic. I'll see people with acute neck pain from car accidents. And also chronic back pain from decades of history. Scapular shoulder blade pain, thoracic outlet is one of my favorite things to treat. Another thing that's really interesting is cervicogenic headaches. Cervicogenic means cervical or neck. Ingenic means of genesis of origin. So it's headaches that are of the origin of the neck areas that could be from the facet joints or from some of those cervical muscles we've been talking about. So I'll see a lot of patients that have headaches, not necessarily migraines, but headaches that are coming from the neck region. And I treat a lot of that. Those are some of the things that we also talked about fibromyalgia as well.

Kerry:

How does one know that the headache is coming from the neck?

Ray:

That's a tough diagnosis. So differentiating between migraines and headaches is usually straightforward, but sometimes can be a little complicated. Migraines will cause auras and other things, whereas cervicogenic headaches will not. Often people have stiffness in their neck or tension and tenderness in the upper trap muscles. And when they pinch this upper trap muscle here. It can refer up into the head, but you know, a proper orthopedic or a physical therapy evaluation should be able to differentiate and figure out where the cause of the headaches are coming from.

Kerry:

Interesting. Could you share any like patient success stories or case studies where dry needling really impacted their recovery?

Ray:

Absolutely. I have a few, I, I really thought back on this one and, and just maybe think of some, some fun cases from the past. I had a nurse in her forties who had a 10 year history of right upper trap and shoulder blade pain. She was an ER nurse and she carried this heavy 40 pound ER backpack and it was always on her right dominant shoulder. And so she was always kind of hiking her shoulder up and all these different treatments she had tried on the right side had never really helped. She found out about dry needling. She came to see me and it worked very well for her. The pain maybe didn't go away completely, but there was, you know, maybe 90 percent improvement in her pain. And she liked it so much that she was going to, this was during the Ebola crisis in West Africa. So she was going over there to treat patients. She liked it so much that she asked me which needles we use. She brought a box of needles with her and taught one of her colleagues how to dry needle her upper trap. So that worked very well for her. I had a soccer player who was at this time in college and he was having pain and headaches. From studying in high school, he had gotten kicked in soccer right in the face, point blank, right in the head, caused a concussion, and he had these headaches for years that never went away. They could come and go a little bit, but dry needling in his cervical region, as I was talking about the cervicogenic headaches, dry needling really helped his headaches go away, and he was able to finish studying for his his finals with with, without pain and then more recently down here in Florida, a local high school football player who had a year before strained his quad muscle and there was a small proximal quad tendon tear very small one. He had been sidelined for a year which should not nearly have taken that long. This is again a grade one strain it shouldn't have been that significant. He saw a doctor in Tampa who did PRP to the tendon. So the tendon was healing, but he's still having pain in the quad muscle. So I did dry needling with his quad muscle. And after a couple of sessions last summer, he was able to do a full football season for his senior year this past year.

Kerry:

Yeah, those are great stories. Thank you for sharing. I'm sure you have more, but we don't have all day. Well, that's those are awesome. So you mentioned like you also do like manipulative therapy. How do you incorporate that with your dry needling techniques?

Ray:

Absolutely. So just to give a ballpark while I love talking about and practicing dry needling, I still probably only use it for about 25%, 20, 25 percent of my patient population because that's who it's appropriate for. I'm selective in, in who I use it for. I also love doing manipulations because I'll only use those maybe 5 to 10 percent of the time because I don't think that's the main issue that the patient needs to get better. Again, going back to exercise, we believe in physical therapy that exercise is the main intervention and treatment that we have to promote health and function, improve pain in patients. But for a joint that may be stuck, whether it's in the neck or the mid back could be in the foot and ankle. I did residency and fellowship training in advanced orthopedic manual therapy. So I learned from some really excellent manual therapist providers when I was up in Maryland and my old boss took a lot of my weekends from my twenties and my thirties away in order to, to learn these techniques that can be when applied for the right patient, the right patient problem, they can be very effective. So, you know, we typically think of chiropractors as kind of being the masters of adjustments, which they certainly are. And chiropractors are very, very good at them. And I certainly refer patients to chiropractors at times. I also have advanced training in that in that area. I may do the techniques a little bit different than they might, but I can use those techniques to mobilize the joint. And then I also have the dry needling, which can help treat the muscle. Once we have those two tissues moving properly, then we show the patient the right exercises to do and the rest is on them.

Kerry:

Mm hmm. And then is this different than osteopathic manipulation as well? Or

Ray:

I would say what I do is much more similar to osteopathic manipulation than it is to a chiropractic adjustment. So some of the courses I took were taught by Greenman up in Michigan, who was an osteopath. I'm a huge fan of osteopathic medicine. I think it's an excellent thing when still practiced.

Kerry:

yeah, cool. So you're just kind of incorporate the two to help analyze if you can help the patient in the best way.

Ray:

Exactly. Yeah. So for example, that firefighter who came in his, his right first rib was elevated. So I did a thrust technique where I had him on his back and I get kind of on top of him and I get my hand or thinner eminence right on top of his first rib and I do a thrust manipulation to the first rib. I dry needled his upper trap muscle and I think within two sessions he was doing a lot better.

Kerry:

I'm picturing the Heimlich on a baby. Okay. Okay. So when, needling session? Is it painful? Is it comfortable? We kind of hit some of that, but maybe just real quick, I guess.

Ray:

Yeah, no, it is painful. It's not terribly painful for the overwhelming majority of patients. It's very tolerable. I treat a lot of people with needle phobias, so I'm very used to doing that. I always meet the patient where where they are at. I tell the patient you're in control at all times. you know, if, if this is too painful for you, we, we won't, we don't have to continue. However, most of my patients tolerate it very well. It's when someone's in really acute pain, maybe they have a really acute spasm in a muscle from a car accident or something that did risk recently. That's where it can be a little less tolerable, but it's still not usually that bad. I describe the pain as like a moderate ache during dry needling while we're doing it, which takes, you know, about five to 10 minutes at most. And then afterwards, it's a, it's a mild muscle soreness ache. We usually just do some stretching and heat afterwards to alleviate that. And most people say that it's not too bad of a sensation.

Kerry:

So you did not say a moderate eight, right? Eight. Cause I'm like hearing, oh my gosh, eight out of 10 pain.

Ray:

No, moderate ache. I personally think it's a two or three. I think most people would say around a three or a four at worst. And then again, I've had some patients that will say it feels good and they look forward to it and they want a two more and it feels like an internal massage.

Kerry:

yeah.

Ray:

yeah.

Kerry:

there any risks or side effects associated with it?

Ray:

Not very much at any, you know, any time that you are getting a flu shot or getting bloodshot on any of the similar risks that would be associated with that. But when it's practiced properly, that the risks are minimal. I will say specifically over the plural field or the lung field you know, theoretically it could cause a pneumothorax. There is really very little literature or evidence in the literature of that. And, and you really kind of would have to abandon all of your training and preparation. That you were taught in the certifications and coursework for that to happen. So something like that should never happen, but we take extra caution wherever we are putting a needle in the patient's body, anywhere in the body, especially around the plural field. But I, I need all that area all the time for scapular pain, fibromyalgia, thoracic outlet syndrome. And in 14 years, I've never had a single patient adverse reaction to dry needling.

Kerry:

Cool. Okay. When you're like looking or examining the patient, can you see like the muscle tension before you like to find the spot or whatever before you know, putting the needle in, or do you have to use the needle to find the spot?

Ray:

Visually, visually, we don't usually see it. It's palpation. So dry needling will significantly improve your hand palpation skills too. So we're feeling the area. When I first started, I really didn't feel like I knew what I was doing, you know, all those years ago, but now I can go and I can feel the patient's muscle and I can find that top band. I push on it. I feel that kind of ropey nature that the top band and then the patient's that's how that's, yeah, it's right where it hurts.

Kerry:

So you had to do like extra training and physical therapy for this. Like how long did it take you to do that? And where, like, I don't know what other providers do it. So, I mean, how extensive is the training and how does that work?

Ray:

Well, I won't talk about the early Wild West days back in Maryland in 2009 because it was the regulations have changed substantially since then for for good reason. There were very few providers really using it back in the 80s, 90s and earlier 2000s and it's gotten increasingly popular since maybe 2010. I would say That there's probably physicians. I was taught by a neurologist and a physical therapist for dry needling. So there's physicians, athletic trainers, chiropractors, PTs and other providers that do it. Each, you know each profession will have their own certification process. In Florida, you have to be practicing PT for two years, and then you have to take a certification course. You have to test, which is a physical practical as well. So you have to demonstrate skill. And then you have to get that certification and maintain it for for dry needling in Florida. Back in Maryland, it's one or two years. And then you also have to take that post graduate coursework. So this is something that originally I didn't even learn in PT school. And when I first saw one of my colleagues at my first job in Baltimore practicing, The heck is that?

Kerry:

Yeah,

Ray:

So

Kerry:

obviously extra training,

Ray:

The regulations are substantial now as well as they should be, you know, anytime that you are doing any invest invasive technique or really any treat medical treatment with with a patient, it needs to be certified monitored and, you know, everyone needs to be properly trained in that, obviously, as you do very similar things you do a lot of needle based treatments and therapy yourself.

Kerry:

Mm hmm. So is it covered by insurance?

Ray:

Great question. In some, again, it's very dependent on the state. In Maryland, it was covered by almost all insurances. It's not covered by Medicare. But, and then, of course, it's going to be in every state. So up in Maryland is covered by most insurances. Down here, it's not really covered by most other than Worker's Comp and VA Tricare, which is great. We're working on getting it covered, but as a company, OPPT really, we can, since we consider it an adjunct therapy and not part of our core interventions that we use with all patients, we try to keep the cost very low as a company, which I really appreciate. We try to make it affordable for all of our patients.

Kerry:

Awesome. Okay. So what advice would you give to a patient who's considering dry needling as a treatment option?

Ray:

Well, you need a physical therapy evaluation first. In Florida, you can see a physical therapist directly for 30 days and then you would need a physician referral. You need to be evaluated to make sure that your pain is coming from a source that would benefit from dry needling and that you'd be a good candidate for it. So you could find a local physical therapist wherever you are, if you're in a state where we're dry needling is practice, which is. overwhelming majority at this point. And then you can either show up to that clinic or make an appointment or get a referral for PT.

Kerry:

So where can listeners learn more about you or how can they find you?

Ray:

Yeah. So I, this is only my second job. My first one was again, and keep talking about Baltimore, but it was in Baltimore for for 12 years. And then I've, I joined OPPT optimal performance and physical therapies down here in the Tampa Bay area. We have 20 clinics in the Tampa Bay area. So all over Hillsborough, Pinellas, Pascoe all the other counties that I don't know in the area. the surrounding area. But we have clinics that are going to be near where most people are. So if you're in the Tampa Bay area, you can find one of our clinics and all of our clinics are run very similarly. We really believe in individualized patient care and low patient volume. So we're not treating a lot of patients at the same time, which is a lot allows me to do manual therapy and dry and my specific practice is called Bayside, and it is in East Clearwater by the Bayside Bridge. And our website is theoppt. com. And you know, we're kind of all over the area.

Kerry:

Yes. Yeah. You guys are definitely all over Tampa Bay area. So that's great for all of our listeners who want to want to go and see you. So any final thoughts or advice or anything that we missed that you wanted to discuss about dry needling or PT in general?

Ray:

I think that covers you know, most of it. We, we really appreciate being a part of the continuum of care as physical therapists. We're, we're conservative minded. But we, you know, we like to treat all sorts of different patients. In addition to dry needling, we treat people with balance disorders, vestibular, lymphedema, pelvic floor and whatnot. So there's a lot of different things a physical therapist can do. So if you have a problem that you think could be related to a physical therapy, find a local physical therapist or a great primary care physician like Dr. Reller, who is a believer in PT nearby and get some treatment.

Kerry:

Fantastic. I do have a good question because you mentioned lymphedema. Do you guys have a lymphedema location?

Ray:

We do have one. We have one in Northdale. We may have several others since we have 20 clinics. I don't know off the top of my head where everything is practiced, but near you in Palm Harbor and at Oldsmar, we have some great pelvic floor women's health therapists, which is fantastic for a lot of conditions, also postpartum conditions as well.

Kerry:

Yeah, we definitely have had lots of, I guess, episodes about pelvic health and importance of PT. So I refer to you guys, lots of patients for that. But I've had a hard time with lymphedema finding somebody. So I will look into that

Ray:

It is It's hard to find a specialist, but we do have one at our, at least one at our Northdale clinic, and we probably have some others as well.

Kerry:

Awesome. Well, thank you so much for joining me on the podcast is always a pleasure. So I appreciate that. And I'm sure we'll connect again soon. And like you said, anybody, if you're looking for a primary care doctor or, you know, obesity, medicine, allergy, asthma we're taking new patients and our number is 7, And we will include all your information in the show notes as well. Okay.

Ray:

Thank you, Dr. Reller.

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Dr. Kerry Reller

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