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Dry Needling is Great but What About WET Needling??

Many people suffering from spine related pain are desperately searching for a quick way to get back to enjoying life. There are 1 billion horrible ideas on the internet and a lot of want to be experts. Spine pain is a complex beast that requires attention to detail, a thorough history, and constant evaluation of symptomatic changes. One popular technique is the ESI(epidural steroid injection), which is commonly given in the cervical and lumbar spine to control radicular symptoms. The issue here is that people seeking a quick fix are not educated on the true mechanism of action and the proper course of care that should follow. I want to harp on this for a minute because it is not only irresponsible and poor health care but it is, in my opinion, neglectful. One could use the argument that they do not get educated on things like this in med school, well I wasn't educated on 90% of what I use during my daily treatments during my schooling but I took the time to search for the answers and implemented techniques as I saw fit. All health care providers have a responsibility to stay on top of clinical research and more importantly to stay on top of educating their patients to ensure they are not dependent on a broken system to find relief. Giving someone an injection to relieve pain without telling them that it is not a fix then proceeding to give them 3-6 injections per year as cited in the Harvard article mentioned below is just as bad as providing drugs with no way of controlling the mechanism of pain.

These injections are a reasonable option for patients that have tried conservative measures and fail. Here is another problem I will blame on inconsistent messages from various healthcare providers. Is Advil enough? PT? Chiro? What about the fact that there are different styles of treatment within each profession? Insert my take: if you have not had a mechanical assessment by a certified MDT trained clinician, you have not tried everything and are likely prolonging the course of your symptoms. Even for those that decide an injection is the right next step it is important to understand what the benefits and risks truly are. There is the obvious benefit of symptom reduction but the distinction must be made that this relief is not intended to be permanent as mentioned in this article by Harvard. ( This is a very common thing that patients seem to not always understand. It is also the main reason that after care is so important.

Got an injection. What now?

There are situations when injections are warranted. Even with an MDT assessment there can be issues that do not respond favorably, specifically when it will not centralize. This can actually be an indication for a favorable prognosis with an injection. There is evidence to support utilizing an epidural injection and following this with an MDT re-assessment. Research has found that often times the patient will centralize and have a favorable long term outcome following the procedure.

(Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery. J Back Musculoskelet Rehabil. 2016;29(2):351-359. doi:10.3233/BMR-160662)

The purpose of these injections is to help reduce inflammation around the nerve root which in theory helps reduce pain. What this does not do is change anything structural that likely caused the irritation in the first place. In essence the injection is a powerful Advil which illicit a local response at the spinal level because of the method used to deliver the medicine. So the most appropriate and effective method would be to utilize the injection to make your real treatment easier and more effective. What it boils down to is following the injection up with an MDT assessment(or any qualified PT/chiro honestly, I'm just partial) and capitalizing on the relief to achieve long term control and to learn what to do in the future to avoid exacerbations but even more importantly, what you need to do when you do exacerbate symptoms. True spine issues are recurrent in nature so the focus needs to be on patient education to ensure self management is possible in the future.

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