McDowell JM1, Kohut SH2, Betts D3
1ProHealth Physiotherapy, Invercargill, New Zealand, 2AUT University, Clinical Sciences, Auckland, New Zealand, 3New Zealand School of Acupuncture and Traditional Chinese Medicine, Wellington, New Zealand
Background: Acupuncture guidelines advise caution when treating pregnant patients because of historical ´forbidden´ acupuncture points, which are believed to stimulate miscarriage or early labor. Despite recent research demonstrating acupuncture as useful and safe for pregnancy-related low back and pelvic girdle pain, it is postulated the fear of miscarriage and subsequent blame by association, restricts acupuncture provision for pregnant patients. New Zealand physiotherapists have formally provided acupuncture treatment since 1982. They mainly are trained in and practice Western medical acupuncture; however, some are more traditional Chinese medicine focused. In New Zealand trigger point needling is considered both a Western and Chinese acupuncture practice. Recently an increase in dry needling (trigger point needling) courses has potentiated the rapid growth in dry needling practice in New Zealand. It is unknown if physiotherapists practicing dry needling have similar perceptions of caution during pregnancy.
Purpose: To examine the practice and level of understanding in regard to ´needling´, i.e. acupuncture and/or dry needling of pregnant patients by New Zealand physiotherapists. The hypothesis was that physiotherapists practicing acupuncture, would be more conservative when treating women with musculoskeletal pain during pregnancy, rather than those who had studied dry needling alone. Given the recent literature demonstrating safe acupuncture treatment of pelvic girdle and low back pain in trimesters two and three, it was postulated that pregnant women may be being denied safe and useful treatment.
Methods: This is a mixed-methods study. New Zealand registered physiotherapists practicing acupuncture needling and/or dry needling were invited to participate in an anonymous electronic survey. The quantitative data results from the survey are reported descriptively. Further qualitative interviews of physiotherapist´s perceptions to the use of acupuncture and/or dry needling when treating patients who are also pregnant, are to be reported in a future paper.
Results: Of 124 respondents only 60(48%) would treat pregnant patients with ´needling´, with a further 66% of those still expressing concerns. Practitioners only practicing dry needling were more likely to needle areas related to ´forbidden´ points in all trimesters. Overall, New Zealand physiotherapists were less likely to needle ´forbidden´ points than their United Kingdom peers. However, when given a vignette describing a second trimester patient with non-specific low back pain, NZ physiotherapists selected muscles to dry needle as part of their prescription; 25% of which corresponded to underlying historical forbidden points. These findings supported the hypothesis that an awareness of ´forbidden´ acupuncture points influenced physiotherapists acupuncture treatment of pregnant patients, resulting in more conservative practice. This awareness was not demonstrated in the dry needlers practice.
Conclusion(s): Conflicting literature and a fear of blame influences New Zealand physiotherapy acupuncturists and possibly dry needlers decisions to offer acupuncture and/or dry needling during pregnancy. This restricts potential musculoskeletal treatment options for pregnant women.
Implications: Further training is recommended, to ensure safe practice and the provision of effective physiotherapy 'needling' treatment options for pregnant women suffering musculoskeletal pain. Additional research into the use of acupuncture needling therapies, particularly in the first trimester of pregnancy, and specifically to dry needling of the pregnant patient is warranted.
Keywords: Acupuncture and Dry needling, Physiotherapy, Pregnancy
Funding acknowledgements: This survey and associated qualitative interviews was supported by the Physiotherapy Acupuncture Association of New Zealand Scholarship fund.
Purpose: To examine the practice and level of understanding in regard to ´needling´, i.e. acupuncture and/or dry needling of pregnant patients by New Zealand physiotherapists. The hypothesis was that physiotherapists practicing acupuncture, would be more conservative when treating women with musculoskeletal pain during pregnancy, rather than those who had studied dry needling alone. Given the recent literature demonstrating safe acupuncture treatment of pelvic girdle and low back pain in trimesters two and three, it was postulated that pregnant women may be being denied safe and useful treatment.
Methods: This is a mixed-methods study. New Zealand registered physiotherapists practicing acupuncture needling and/or dry needling were invited to participate in an anonymous electronic survey. The quantitative data results from the survey are reported descriptively. Further qualitative interviews of physiotherapist´s perceptions to the use of acupuncture and/or dry needling when treating patients who are also pregnant, are to be reported in a future paper.
Results: Of 124 respondents only 60(48%) would treat pregnant patients with ´needling´, with a further 66% of those still expressing concerns. Practitioners only practicing dry needling were more likely to needle areas related to ´forbidden´ points in all trimesters. Overall, New Zealand physiotherapists were less likely to needle ´forbidden´ points than their United Kingdom peers. However, when given a vignette describing a second trimester patient with non-specific low back pain, NZ physiotherapists selected muscles to dry needle as part of their prescription; 25% of which corresponded to underlying historical forbidden points. These findings supported the hypothesis that an awareness of ´forbidden´ acupuncture points influenced physiotherapists acupuncture treatment of pregnant patients, resulting in more conservative practice. This awareness was not demonstrated in the dry needlers practice.
Conclusion(s): Conflicting literature and a fear of blame influences New Zealand physiotherapy acupuncturists and possibly dry needlers decisions to offer acupuncture and/or dry needling during pregnancy. This restricts potential musculoskeletal treatment options for pregnant women.
Implications: Further training is recommended, to ensure safe practice and the provision of effective physiotherapy 'needling' treatment options for pregnant women suffering musculoskeletal pain. Additional research into the use of acupuncture needling therapies, particularly in the first trimester of pregnancy, and specifically to dry needling of the pregnant patient is warranted.
Keywords: Acupuncture and Dry needling, Physiotherapy, Pregnancy
Funding acknowledgements: This survey and associated qualitative interviews was supported by the Physiotherapy Acupuncture Association of New Zealand Scholarship fund.
Topic: Women's & men's pelvic health; Women's & men's pelvic health; Service delivery/emerging roles
Ethics approval required: Yes
Institution: AUT
Ethics committee: Auckland University of Technology Ethics Committee
Ethics number: 17/100
All authors, affiliations and abstracts have been published as submitted.
