Creams & Lotions after Dry Needling: Do or Don’t?
Does anyone perform other forms of manual therapy after Dry Needling? In particular what about the use of massage cream to apply massage after the needling process? Is this clinically therapeutic, is it appropriate or even potentially harmful?
What are the considerations with respect to using creams in this after dry needling?
Anyone that has attended a GEMt Dry Needling will know that we do not teach the use of creams after dry needling. This is not to say that it is absolutely contra-indicated, or that clinicians out that are not doing this with success.
One might argue that if a patient has received dry needling, followed by a measured clinical improvement using a reliable test, then what additional benefit is expected by adding in massage afterwards? Perhaps our time would be better spent educating the patient on their condition, using proprioceptive tape, or taking them through suitable rehab exercises.
However, there are anecdotal reports of patients reporting less post-treatment soreness when creams are applied post needling. So do we need to consider this technique when we expect some post-treatment soreness?
Well, most patients will initially experience a degree of post-treatment soreness, and they need to be educated accordingly. Careful patient selection and education is vital prior to any intervention, especially an invasive intervention such as dry needling.
In addition, it is recommended to needle just 1-2 muscle groups on day one until you have gauged your patient’s response to dry needling. Every patient will have their individual response and we need to assess this first before we progress the technique. This is also a useful strategy when considering some patients might experience a metal allergy and this will be more contained when fewer needles are inserted on day one.
It is also recommended to avoid certain muscle groups on day one eg Upper Trapezius and Gastrocnemius as these muscles in particular are known for causing more post-treatment soreness.
When in doubt, needle the proximal or spinal regions, rather than a sensitive region or a referral zone.
The use of the point stimulator has been shown to reduce post treatment soreness and this is highly encouraged in more sensitive regions or acute situations. Remember to read the blog post on dry needling for Acute Back Pain for further information.
And of course don’t forget your usual post treatment advice such as light exercise/stretches, drink water, appropriate rest, using compression, applying heat later on, etc.
Getting back to concept of using creams after needling, what might be the mechanism of action for reducing post treatment soreness? Perhaps it is the smell and positive association for that particular patient. Deep Heat can be a healing smell for some and remind them of their excitement in the change rooms getting ready to play their sporting match. Perhaps it is the irritant action of the cream on their skin and activation of sensory nerve fibres that either inhibits the pain process or distracts them from their pain.
Either way, if it isn’t harmful surely you can use it then?
Consider this. Firstly, some patients may not have a positive association with an oily cream on their skin.
More importantly one might argue that there is possibly an increased risk of infection by massaging a foreign substance into the skin immediately after using an invasive technique. There is no evidence at present to support this view and it is not listed as a contra-indication with the technique. But something worth considering and discussing with your patient and documenting accordingly once you obtain their consent.