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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
Hey, everybody. Welcome to the Doctor. J. Thomas podcast. Today, we're gonna switch it up a little bit.
Dr. JJ Thomas:We are gonna share with you some of our live footage from our most recent dry needling master class. And, in it, you're going to find some very useful tips and tricks that I often give newer needlers in order to help them be more effective, more efficient, and safer in their needling technique. One of the main things you'll find if you focus and continue on and listen is that needle redirection that I find very, very helpful and often undervalued when when therapists first come out of training in dry needling. I hope you enjoy it. Let me know if you have any questions.
Dr. JJ Thomas:I look forward to hearing from you as always, and don't forget to hit hit that subscribe button so you don't miss out on more of our content. Take care. Very quick review of, like, why do we needle. We needle because everybody wants to be fixed like yesterday, and if they could just drop their cars off looking like this you've seen this slide now. This is the 3rd time.
Dr. JJ Thomas:But if they could just drop their cars off it would be great if they could be like, you know what? My shoulder has been banged up, and I'm just gonna drop it off. And if you could just when's it gonna be done? Friday? Perfect.
Dr. JJ Thomas:I'll pick it up on my way to get the kids. You know? It doesn't work like that. They need they need their bodies. They need to come in temporarily, and we need to get it we also have to treat the body as a system.
Dr. JJ Thomas:Like, more and more and more when we look at how we're actually getting people better, not just calming down active inflammation in an area, we have to treat the body as a system. And there's really, I'd say, nothing better at it doing it very quickly, than dry needling because it has all these things that you learned about when you took your foundational courses. Remembering that when we actually needle, we have structural, biochemical, and electrical changes that allow that muscle to work better. And that's why, to me, it's the the the highest, I wanna say value to a tool like needling, is that we now have the capacity to say, okay, let's move this way, and I think it's this. Let's test it.
Dr. JJ Thomas:Let's needle what I think it is. Let's needle the muscle groups that I think are affecting it, and then let's retest it. And then, if you're a decent needler, if it doesn't change right away, move on, find another theory. Because it's that good. It has that good of a response.
Dr. JJ Thomas:And I do I tell newer needlers, like, okay, maybe you're missing it. Like, maybe you need to do a couple needles or maybe you need to do but once you become once you go to enough of these classes and you really get a little bit more refined in your technique, if you think a muscle is involved and you needle in it, it doesn't create a change, move on. It's not that, I can tell you right now. So that's, so that's my spiel on that. In all my courses, really our entire 2 day primal foundations course is really about reading the regional interdependence model, which if those of you that haven't seen it, it's basically the concept that seemingly unrelated areas are actually regionally interdependent.
Dr. JJ Thomas:So from a from a neurodevelopmental perspective, from a neurological, so inhibitory perspective, from a mechanical perspective, just dynamic mechanical pulls from a fascial perspective. So there's all these different reasons why something might be regionally interdependent. And, again, the needling is gonna allow you to test that better. We'll do some of those examples here. If you're interested in more of that, the primal foundations is really what goes heavily into that.
Dr. JJ Thomas:And then we also bring into integration into it too. But I'm definitely gonna bring it into here because I just feel like as a profession we have to get past just treating symptoms and we really have to when someone comes to us, 9.8 times out of 10, they think they're coming to us for one thing, but probably if we really look deeper, we're gonna find something else was a precursor to that. And so that's just what I'm saying is that the needling really can be used as a diagnostic tool. And with that, if you use it consistently as a diagnostic tool, then you're gonna have pattern recognition. And then next time that person that is like my girl earlier today, who comes in and says, my knee hurts, and it might be my back.
Dr. JJ Thomas:And then she didn't even tell me about her shoulder, and then I'm like, well, your back is actually from your shoulder. But I was able to pick that up because now after all these years of of pattern recognition, it's much easier. On the other side of diagnostic tool, one of my other goals for you guys is as your needling technique gets refined, what you know how, like, when you first started and learned to, like, Moog joints, And you're Let's say even in PT school and they're like, okay, grade 1, grade 2, like you're trying to assess grade, and they're like, what's the end feel like? And you're like, I don't know. And you don't really know, but the more you touch, the more you feel, the more you take something to end range, the better that becomes.
Dr. JJ Thomas:Needling is the same way. What you'll find with enough reps and enough guidance is that you'll feel tissue integrity on the end of that needle. You'll feel like I'm gonna teach you one of the very first things I do every time is work on actual technique handling of the needle within the tissue. Because what I found is when you can be more accurate with that, you're gonna be able to rely on your test, retest better. And so using it as a diagnostic tool to say, like, right now, I can feel I'm gonna go into one area.
Dr. JJ Thomas:It's pretty smooth there. Oh, right there. I can feel the tension. I'm gonna I'm actually gonna either leave that needle in there, I'm gonna spend a little time there. Also with, like, in the spine, you can feel, you know, if you guys have read those studies that talk about, like, in dysfunctional areas of the low back, you'll have, like, fatty infiltrate.
Dr. JJ Thomas:Actually, and you can in the multifidus, and you can actually feel that fatty infiltrate on the end of the needle once you get better at assessing, like, tissue integrity with the needle. So, my hope is to help you guys with that. And then I always sort of start this off with, we've all trained in slightly different, maybe some of the same, some different methods, and and I'll say even within my own training, when I first started, needling was a very pistoning heavy. We barely stimmed at all. We had the stim the hand the point stimulator to confirm if we were on what we thought we were on in certain areas, but mostly we were in and out, pistoning, test, retest.
Dr. JJ Thomas:I still use a lot of that in my practice, and part of that is because it helps me find the root cause better. It takes less time for me to look at an assessment and then go in and do a couple, you know, couple twitch releases in a couple different muscle groups that are related, and then retest them 5 minutes later, and then tell confirm to myself and them whether or not it's related, rather than leave muscles in, stim them, let them sit there for 10 minutes, at least, you know, and then undo the stim. By the time I've done that, it's 17 minutes of their treatment, and then I'm retesting. And then if I missed the mark, then I just wasted 17 minutes of their time. Not wasted, but it's definitely less efficient from a time perspective.
Dr. JJ Thomas:When you're in a cash based model, I try to respect the patient's payments, and they pay by the minute. I find that newer needlers sometimes, don't have the same confidence when they insert, and it makes a difference on your patient's comfort level. So really making sure that you're backing up and you're doing, firm pressure with your palpation hand and firm pressure with the tube, and then they stacked me, but they reorganized them, so now I need to find where everything is. Hold on. Okay.
Dr. JJ Thomas:We'll do this one. Do you want me to do quad? Yeah. I'm just gonna do quad. I'm just gonna literally find a spot.
Dr. JJ Thomas:I'm gonna show so like I said, we learn We kinda learn in reverse. Right? Like, what I'm gonna do is, yeah. You're fine. He can you can work around.
Dr. JJ Thomas:Right? What I'm gonna do is palpate for a tight area or for a limited area, and then show you the technique from there. Rather than, like, in the courses when you learn, normally, they're like, okay, everybody do vastus lateralis. It's about here. You're gonna right?
Dr. JJ Thomas:But I'm gonna so I'm gonna 2 finger palpation, and then you're gonna palpate perpendicular to the muscle fiber or yeah. Basically, perpendicular to the way the muscle fiber orientation is until you feel a change in tissue density. She's got something right there. You guys can almost see it as I roll over. Right?
Dr. JJ Thomas:So 2 fingers, this will make you more efficient with your needling. Like, I can just feel change in density here. I describe it to patients, like, 2 things. I either say it's like overdone chicken, You know, when you're checking chicken for doneness, and like you're like, it's not cooked, not cooked. I should've come out a little earlier.
Dr. JJ Thomas:It's like overcooked. That's really the one I use most. So 2 fingers together, compress the tissue against the bone, and then spread. And everybody just look real quick. There's, you can see a white blanched line when I do that.
Dr. JJ Thomas:And that's gonna be really important when we do the spine later. Because when you can this white blanche line to me, what it says, I see it talking, it says, stick me right here. And the reason I wanna stick it right there is because I just felt that that's where that limitation is. Or in the spine, when we get to the spine, when we make that delineation with that white blanched line, I know I'm in my safe area. So this, but two fingers are always telling me, that is going that is telling my brain you are where you think you are.
Dr. JJ Thomas:Whereas if you have hands like this, your brain doesn't have that input that somatosensory input the same. Your brain is sorta like, I think I'm where I think I'm kinda And then that's when you'll find yourself going in kind of not very confidently, and it's uncomfortable for them, and it's uncomfortable for you. So be very confident and deliberate in your palpation. So I feel that spot again. Two fingers, compress, spread.
Dr. JJ Thomas:I see my blanched line. I'm also going to place one finger on for balance. The tube is gonna compress firmly in, then I'm gonna DIP tap hard, and now the needle should be nice and firmly in the subcutaneous tissue like that or just really just below cutaneous. And then to piston this, I'm gonna keep my pressure here, I'm gonna balance with my my kickstand pinky and then I'm gonna go directly towards the femur. There's femur there.
Dr. JJ Thomas:Now, that's step 1 is the insertion. I also want you to practice redirection. So for redirecting the needle, if I wanna go this way now, I'm gonna aim my needle that way. See how it's bending? Bending, bending, bending, bending.
Dr. JJ Thomas:It's not in sub q yet. Now it's straightened out. Then I can redirect the needle. So we're gonna do it again. So I'm gonna come over here.
Dr. JJ Thomas:If I wanna go this way now, I'm gonna bend the needle the way I want it to go. See how it's bending? Bending, bending, bending, bending, straight. Boom. Now I'm in the right now I'm in different tissue.
Dr. JJ Thomas:As opposed to most people when they come out of needling courses, they end up like they see us needling fast, and they I'm gonna piss in a little like, they end up, like, doing this. And they, like, move their hand, but they haven't come out in subcutaneous tissue. So all you're doing is essentially going in that same track, and no wonder they're getting so sore. And no wonder you're not getting the response you want because you actually didn't You you might have just missed the mark because you didn't really redirect. So what I what I always start these master classes with is, let's spend some time refining redirection.
Dr. JJ Thomas:So insertion and redirection is really critical in your effectiveness as a needler, And even if you do a lot of stim in your in your in your treatments, at least you still want that stim to be in a more dense active tissue that or or inhibited tissue, but a more, I'd say dysfunctional tissue. So I'm gonna show you one more process. So here's another tight area there. I'm gonna compress and spread. So I have that blanched area.
Dr. JJ Thomas:I'm gonna compress the tube. I'm gonna DIP tap. I have it there. I'm gonna go to the femur. That's my, like, I know where I am in space.
Dr. JJ Thomas:And now if I'm gonna redirect this way, I'm gonna bring the needle the way I want it to go until I see it straighten. Boom, there it goes. Now if I wanna go another direction, I'm gonna bring the needle I want it to go until I see it straighten, and then boom. Make sense? You continue to keep compression Yeah.
Dr. JJ Thomas:I mean, there are times that you'll need I'll show you, there's another way we can actually like thread along the bone. There are times that you may need to move that finger if you're like, I wanna go up there and it seems to be in my way. That's fine. But but most importantly, that blanched area is for I mean, that is gonna be highly valuable in the spine when you know when you need to know, especially when you get to, like, TL junction where the transverse processes are so small, that, it just helps you be so much more confident in inserting that needle. Cool?
Dr. JJ Thomas:Mhmm. Good. Alright. Any questions? Let's practice that on each other.
Dr. JJ Thomas:Break. I know we teach this, but I don't know if all the courses teach it, like, only the needle goes in these. We should. And then, tubes and cotton balls, everything else go in the trash bin, and you can just empty it. K?
Dr. JJ Thomas:Cool. I was constantly piling things, and then putting it in the trash can. I was like, why then Isn't that amazing? I know. And those little tabs are, like, in everywhere everywhere.
Dr. JJ Thomas:The tabs are I told Paul, because Paul owns the iDry needle company. I was like, you just need to put a fleck of metal in them for me So that I can just go around at the end of the night with a metal detector. So we'll kind of start with hamstrings because that's what actually feels a little tighter, To me, on her So these are those 10 packs. You do have to hold on to the 2 if you're gonna do it, but I'll show you them later. So I'm gonna do what we said, we're gonna I'm gonna grab the tissue, and it's really like the greatest tension I feel on her is actually where my fingers are on the back side of her thigh.
Dr. JJ Thomas:So I'm gonna bring that tissue up, and then bring the other tissue to that, and really, like, identify the space here. So I would say just like just like carpentry, measure twice, cut once, It's just like that with the body. The more you can measure twice, meaning palpate, like, maybe 3, 4 times even, really identify the area that you wanna get. And then before you stick the needle, ask yourself, am I near any structures I don't wanna be near? In this area of the thigh, I'm totally fine and I can I'm really isolating it right there.
Dr. JJ Thomas:Pushing my thumb in to get that skin a little bit more taut here, compressing the tube so it feels better, and then DIP tap. And then I'm just heading right to where I feel that tension is. And then I've got my kickstand with my other hand. I can feel out that tissue and I can move this. I can even move my grasp a little bit more.
Dr. JJ Thomas:You feel it? Within the tissue. Good job. You good? Mhmm.
Dr. JJ Thomas:Good. So, and then I'm reassessing, so this is literally how a treatment will be for me. Then I'm reassessing muscle play, how does it actually feel. It feels a little bit better, but I feel another spot further up, so we're gonna go up. And so now I'm gonna bring this tissue, like, again, it's this kind of posterior it's really hammy more.
Dr. JJ Thomas:It's, like, right there. Do you guys see me snapping over it? It was very triggering. Yeah. So I'm gonna go right into that.
Dr. JJ Thomas:Sciatic nerve is way above this. It's it's it's behind the femur. Sometime, there it is. Usually with a big twitch like that, it'll bend, it didn't. Sometimes It just grabbed the cubic foot.
Dr. JJ Thomas:It is. It gives you a job. You're safe. Honestly, it's like, it's also a safety thing for people. Like, they need to know that they're that they're they've got they're protected there.
Dr. JJ Thomas:So, I was gonna say, sometimes when there's a lot of dysfunction in an area, you'll find that it doesn't twitch right away. It's not sometimes it's not that you're missing it, sometimes it's that that neuromuscular connection is actually dampened. And so it may not be twitching because it's actually every pass you're doing, you're sending a signal to the brain that says, okay. Remember me? I'm still down here.
Dr. JJ Thomas:You haven't called on me in a while because I got because, you know, I wasn't reliable, but I I need to come back. So I'm still feeling this, I'm going back there again one last time. That's fine. And then, and then redirecting. And you can kind of move your thread hand to play with getting the tension that you feel in there.
Dr. JJ Thomas:But, essentially, what I wanted to show you guys is I feel like we gave you, like, a lot of early needling classes. They're like they're like, okay, you can go here, and you can like go here, and then you can flip over and you can go here and here, and then that's it. And really, like, once you're comfortable with once you're better with needle application, you can especially in the thigh, you can you can go almost anywhere you want other than short of being right in the femoral triangle. And even, like, as you get much better, I'll go midline on the like, right over and approaching the sciatic nerve, even up by lateral to ish tube and all of those areas. You just have to tread lightly, and, and if you think you're, like, touching a nerve, I wouldn't high high frequency stim it at all because that will aggravate it.
Dr. JJ Thomas:But you can even like, there is some stimming we do where we do low frequency right at the perineural area and it has benefit. So just knowing that, you know, there are treatment applications where we do approach the nerves on purpose. You just have to do it mindfully and, but it should scare you a little bit less. Okay. Let's retest.
Dr. JJ Thomas:Wait. Let me show an adductor actually. So, I'm gonna show you guys pectineus too, because I think pectineus is one of the best muscles. It goes nuts. Yeah.
Dr. JJ Thomas:It goes nuts. You're gonna be down. Yours will. Yeah. But I find, like, if you reassess the pectinias will go nuts nuts if the pubic synthesis is really out of place.
Dr. JJ Thomas:But once you treat that, a lot of times it tells It settles. That'll be perfect, because you can do both now. Like, you can do it through needling. You can do both. So, and for the, you know, for others that may not have good ways to reset it.
Dr. JJ Thomas:So the way we do pectineus, so I palp yeah. Hold here again. So I palpate so remember, pectineus is the floor of the triangle. Right? So what I'm gonna do is I'm gonna palpate femoral nerve artery and vein.
Dr. JJ Thomas:I feel it, we can see my fingers bumping. Right? We're in the club. Welcome to the club. Right there, you can see my fingers bumping.
Dr. JJ Thomas:I'm literally gonna stay blocked on the femoral artery there, and then I know that pectineus, if I come medial to this, and I go basically straight PA to the angle of her or AP to the angle of her femur, I'm gonna get the floor pectineus. So I've blocked the structures where I don't wanna go. I can literally, in real time, feel that my fingers are still covering my no go zone, and then I can just insert right next to that, and then go straight AP to her to her femur to get pectineus. And that's Pottery? Is that what you're saying?
Dr. JJ Thomas:Technically, I'm like actually AP. I wanna be like At your posterior. At your posterior at the angle of I'll show on someone else for you. It'll make more sense. Yeah.
Dr. JJ Thomas:Alright. So let's practice those too. If you feel somebody and their adductors like that we'll show one more. And they're because adductors are a little tight there. You can grasp the adductors way up here even and just thread across them.
Dr. JJ Thomas:So here. Right there. So this will be more like Magnus. Gracilis, you know, I I didn't actually tease it out, but Gracilis, you can see her twitching at the, yeah, at the adductor attachment. That was good too.
Dr. JJ Thomas:Yeah. That was actually so tight, I didn't, yeah, it was good. It's gonna be weird. This one will be more of a direct, probably. I mean, you can, so that's what I'm trying to teach you guys is, like, the exploration of you can either you can either let me put a glove on, and I'll show you the different, just so I don't dirty your area.
Dr. JJ Thomas:You can either grasp, you can either grab all of that, this isn't how I showed it, but this is how we often teach it in the earlier levels. So you can grab all of that and literally needle all of that. Okay. Like, I can feel tension right there. So I would actually get a long enough needle to go right across that.
Dr. JJ Thomas:Mhmm. Because think sciatic nerve, like, okay, this is what I feel. Can I get it safely without hitting something I don't wanna hit? Well, I know that sciatic nerve comes off lateral to ish tube here, so I'm safe there. I'd be medial to that.
Dr. JJ Thomas:And then that femoral artery is only really exposed, like, anterior and and cranially to where I have this tissue here. So if I pull this tissue up and bring this tissue to it, I can go right there very safely. But I could also say, like, she's tight here too. So I could also say, you know what? I think this is really the main problem, so I'm gonna compress this, and I'm gonna pull it that way.
Dr. JJ Thomas:I'm just gonna be a direct technique straight into that. Okay. And then because sciatic nerve lies close to the bone, even if I bring this all like, across pretty far, probably not gonna get it, but I'll go slowly just to be cautious. If I decided to go towards the femur there, I'd have to be more careful about sciatic nerve. Right.
Dr. JJ Thomas:But again, you can do it. You just have to know where you are and know how to proceed with caution or not. Got it. You know? Okay.
Dr. JJ Thomas:Go ahead. Go for it. I'm gonna go right down. I was too I'm way too lateral. Yeah.
Dr. JJ Thomas:So this is I'm telling you, it's so tricky. Knee extend, extend. Quad is, like, still. Like, that's still quad. Yeah.
Dr. JJ Thomas:Isn't that crazy? I know. And then, and then knee flex. And so there's the border. Right?
Dr. JJ Thomas:You were you got I mean, you figured it out, but that's it always surprises me still. I'm always like, wow. Yeah. It's crazy. And do you like hook in and down?
Dr. JJ Thomas:I do. I would hook even further in. I I was telling I was telling Ang like, I would actually literally choose midline, like draw a middle line and then come just lateral to that and then compress down onto the femur. Oh, okay. Yes.
Dr. JJ Thomas:And then literally compress onto the femur. Don't even drag it that way, like, compress in. Okay. Yeah. And then, you know, you're close there, so you'll you'll tap hard, but then as you proceed, you'll go nice and Right.
Dr. JJ Thomas:Like, cautiously. It's like walking in a dark room. I think you're almost there. I like to move that. I think you're almost there.
Dr. JJ Thomas:No? Get a new one then. And you honestly may still have to go out of like, mhmm. Like you're not quite PA to the femur there. You're still, instinctively, you're like, I know the sciatic nerve.
Dr. JJ Thomas:I'm just gonna go that way just a little bit. Love it, boys. Yeah. You you're like, JD's telling me to go straight down, and I I wanna trust her, but I think I'm just gonna still go lateral. So you're like and if you think about it, like, even one degree of up here, one degree of change ends up being very different down here.
Dr. JJ Thomas:Yeah? Are you grabbing any good more like a block like a bracket. So and that is, like, it'll help to have it shortened. So maybe slide down a little bit, Erica. Oh, I got your shoelace in there.
Dr. JJ Thomas:Are you good? Good. So so see, you'll be able to just draw midline and then come just you wanna be at this, like, the proximal part of the distal third of the femur, if that makes sense. So, like, if this is the distal third, the top half of it, essentially. And then you're literally gonna draw a line, midline, and then just come just lateral to that.
Dr. JJ Thomas:Compress Don't even scoop it, just lock it onto the femur. So like, yeah, right there works. Yeah. That's a perfect spot. So just draw midline, and then 2 fingers compress onto the femur.
Dr. JJ Thomas:These 2 fingers or these 2 fingers, whichever ones you want, but, like, just compress it down and get your hand out of the way, because you're gonna compress and spread, and then stick. Up here. You're gonna no. See? Oh, I see what you're doing.
Dr. JJ Thomas:You're going to bracket this way. What I wanna show you is, like, you can bracket, but I think you'll be more, like, succinct if you just midline, compress, spread, stick. Got it. Okay. Maybe too lateral there.
Dr. JJ Thomas:Like, you're pulling it lateral. Yeah. You really wanna be just just lateral to midline. That's better. Yep.
Dr. JJ Thomas:And then just try to go right for the femur. You're on the very lateral edge, like if you don't angle slightly medial you'll probably miss, honestly, you'll probably miss femur again.