Episode 1496 - Fainting during dry needling #PTonICE Daily Show

Dr. Paul Killoren // #ClinicalTuesday // www.ptonice.com 


In today’s episode of the PT on ICE Daily Show, our dry needling division leader, Paul Killoren, talks about how and why patients may faint during a dry needling session as well as the approach to take if this happens in your session. Take a listen to learn how to better serve this population of patients & athletes.
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EPISODE TRANSCRIPTION
0:00 – Dr. Paul Killoren, PT, DPT
Morning team, welcome back to the PT on Ice Daily Show. I’m your host for the day, Paul Killoren. It is clinical Tuesday. If we’ve never met, I’m the head of the dry needling division. So today we’ll talk some dry needling. Very excited to discuss fainting during dry needling today. Not a topic many people want to talk about until an event occurs. And actually, what kind of prompted the topic this morning was one of the techniques that we teach, one of the go-to techniques that we teach on our upper dry needling course, is a seated position. And I think it’ll be a topic for another day, the advantages of this position, allowing access to post here and anterior, honestly getting a more supported, more comfortable position for the shoulder. But what that post, the expected response from certain camps out there, the expected response was, aren’t you afraid that your patients are going to faint? And I 100% know if any of you were trained out there by other organizations, honestly, up to current day, but anytime in the past decade or so, you were probably told, we always needle prone or supine on the first visit. That’s how I was trained. That’s how I taught for a long time. But I’m going to challenge that today. Before we get deep into the positions for dry needling, the topic for today will just be fainting from dry needling. We’ll talk about some of the numbers. We’ll talk about if there’s some things we can do to avoid it. But let’s talk about fainting. And first of all, to qualify, what is a fainting event from dry needling? It’s vasovagal sympathy, syncope, not sympathy. We are sympathetic to their syncope. But it is a hypotensive, it’s an autonomic nervous system, hypotensive. Basically, your heart rate drops, bradycardia, and your blood pressure drops at the same time, which causes a very brief loss of blood flow cerebrally. So I mean, if we say fainting, it’s not just feeling dizzy or feeling faint or nauseous, it is a loss of consciousness, which can occur. But I think we have to immediately qualify how likely is it to occur. First of all, my own sample size. I personally have had two of my patients faint in the past decade. I’ve been dry needling since 2011. I mean, you can do some napkin math there. I’ve been teaching dry needling courses since 2014. And I’ve probably seen a handful more, maybe five to seven people, actually lose consciousness. So quick napkin math, we’re getting upwards of maybe 10,000 people that I’ve seen being needled. And I have less than 10 that have fainted. So first of all, we can’t say that it’s impossible. But I think we have to immediately qualify, what is the risk? People can faint. Some more data, there are 12 billion injections done throughout the world every year, we’re talking injections. And honestly, most of our needle phobic or needle related vasovagal events, our blood draws, there is something slightly more autonomic to our vessels and some of our nerves like our median nerve, tibial nerve. So we can immediately say, if we have a la