I was just thinking about you this morning. I was DNing a patient and thought about how well run, enjoyable and useful your course was. I did the Introductory Course 2-3 years ago...
Fantastic as Usual
I found the comprehensive take home manual, and DVD of technique most helpful
Brilliant! thank you for such a comprehensive course.
The Introductory/Refresher Course was Excellent, both in clinical reasoning and in the practical sessions.
The locations of trigger points, the areas of referred pain/sensation and the...
Just want to say a quick thanks for sending out these Clinical Kit eZines to those who have previously undertaken you courses. The info is really much appreciated and the effort...
Good to get the time to practice each area + excellent guidance and supervision in checking technique
I have completed three Anatomical Acupuncture courses, traveling from Brisbane to Perth for each course. Prior to the first course I researched the available Dry Needling courses and based o...
During the Introductory Dry Needling Course, I found the practical sessions the best. Doug was really helpful. It wasn't intimidating, but fun and sessions were interesting.
Just completed the Introductory Dry Needling Course, in which I found the practical component was excellent with great demonstrations. Also found the clinical discussion throughout interesting.
I completed the Advanced Upper and Advanced Lower Quadrant courses with Doug. I found the quality of the content, especially applied anatomy and practical instruction to be exceptional, and ...
Found the course to be;
- practically based
- presented at a good pace
- provided opportunity to ask questions as needed
- Doug was excellent, promoted great learnin...
The combination of learning tools provided;
- Practicing on different people – different anatomy to consider
- Practical revision
- Case studies, anatomy review (espe...
The best part of the course was the anatomy revision. I found it really valuable to revisit it, thinking about the anatomy from a clinical point of view.
We found the following aspects of this course helpful;
- Good number of participants
- Great presenter & resources
- Very high level of teaching
- * Case studies that relate to each muscle
- * Clear explanation of technique and refresher of surface anatomy
I really appreciate the anatomy review from the presenter and his explanation of how acupuncture assists clients
The length of time + content of the Introductory Course was perfect for the two days. Plenty of time for observation of technique.
I found the practical sessions and review of anatomy most helpful. Didn't think I would lose that much recall since only recently graduating, but seems I have!
Key points were the professio...
The further information i.e. the extension from the Introductory Course I felt was vital.
Introductory Course was great, but this quadrant specific course is amazing - so much detail and s...
I found the combination of academic and practical spot on.
Great having the pre-reading materials and the practical experience under guidance. Also the anecdotal stuff and case studies throughout the course.
Thank you for another great course (Advanced Upper Quadrant), it was an excellent anatomy refresher and I have used the techniques extensively with some really good effects in conjunction with my othe...
Great course Doug. A good mix of theory and practical and thoroughly enjoyed the way you present. Thanking you.
I really liked;
- Case studies, to think about where dry needling has been applied successfully
- Review of anatomy and cross sectional slides, because I haven't seen those i...
I enjoyed the opportunity to work through a complex case study, including diagnosis and treatment (all forms of physiotherapy treatment) and then see optimal management.
Hi Doug, Thanks so much! I have found this stuff very exciting especially for my fibro long term patients. Real functional changes!!
I found the explanation of the pain patterns and clinical reasoning of case studies helpful. This helped me to understand when to use these dry needling techniques on my own clients.
I was very helpful to have the Anatomy Wet Lab Workshop before the advanced course to orientate ourselves to the relevant anatomy.
I started to learn acupuncture quite a number of years ago with Doug's Introductory course in Acupuncture. I returned to my clinic immediately enthusiastic to implement my new skill. In ...
Since doing the Upper and Lower Quadrant courses, I feel much more confident using dry needling on patients. The courses have empowered me with practical skills and knowledge that I was able to immedi...
Just completed the Introductory/Refresher Dry Needling Course. Doug was very informative and was able to look after everyone, providing great feedback!
And it was quite fun!
Appreciated refreshing the anatomy landmarks, because of their obvious importance to clinical practice
I appreciated the revision of anatomy and specifically to visualise body parts as in a 3D model. It's been great!!
Have purchased the Visible Body app for my iPad.
And how happy am I??
This app is just amazing!
Can't wait to get using it with my patients.
Big thanks to Doug for t...
I found the cervical and scapulothoracic region very relevant and applicable. Excited to practice what I have learnt this weekend.
1. Practical sessions were very helpful, as was the provided feedback by presenter
2. Course handbook as reference source
as a chiropractor, dry needling has helped achieve better clinical outcomes via decreased neuromuscular tension and decreased pain levels, allowing for improved patient compliance with home care as...
Thank you very much for coming up to Perth and specifically designing a program for us. Communication prior to the course was top standard, the custom upper limb program was ver...
I found the following aspects of the Introductory Course most helpful;
- * dry needling theory + clinical education
- * laid back environment
- * anatomical revision ...
The aspects of the course that I found most useful;
+ The detailed analysis and method of presentation of anatomy and palpation
The simple and clear explanations made it easier to und...
In the Introductory Dry Needling Course, I found the practical components and demonstrations most useful. They were very clear, with simple instructions and accurate techniques.
I found the relaxed environment, made it easier to learn and the pre-reading was helpful.
As a recent grad, I believe this information is critical as another tool for assessment and treatment....
From the course I found a better understanding of the anatomy via;
- Cross sectional anatomy views
- Description of tissues in layers and depth
- Greater awareness of what I a...
What I best liked about the course was;
- Lumbar muscle palpation and discussion about treatment theories
- Wet anatomy lab and relating to clinical relevance
- Functional and...
Most helpful for me were the specifics of palpation and approach to each muscle , positioning and technique to ensure greatest effectiveness.
Doug's clinical gems - how people present in practice, how he chose to treat them and the subsequent outcomes. We can take what we learnt and apply it to our own practice.
I appreciated learning the safety for the various muscles around the neck and thoracic spine.
I have meant to write to you for a long time now regarding the courses I completed with you in July. I wanted to write to say thank you so much for everything over those 6...
- the practical aspect
- having sufficient time and
- good demonstration & supervision most helpful.
The course manual is very informative t...
Doug I found the;
- + case study presentations
- + demos and low ratio of student to presenter
- + plantar fascia discussion
- + wet lab anatomy worksh...
I found the case studies, clinical decision discussions, differences in treatment using soft tissues techniques & dry needling, clinical findings and the range of treatment choices available...
Very specific- anatomy and technique... challenges you to think critically about exactly what your are targeting and the reason behind why you are doing it
A helpful aspect of the course for me was using drawing of the anatomy to review the anatomy.
Also liked the discussion on electroacupuncture and hypermobility.
Surface Anatomy - great revision of what we all think we know so well, but actually don't!
The teaching of the anatomy - superficial and deep was very helpful and presented differently to uni - I would be keen to learn more anatomy this way
I appreciated the excellent and precise nature of lecturing and practical demonstrations.
I liked the demonstration and then having time to go away and practice. Also the take home needling kit to practice at home straight away. It was a good course enhancing understanding of anatomy at a ...
Theory covered - good refresher Surface anatomy + palpation - good refresher Inclusion of case studies very helpful
The course had a great balance of theory and practical. I enjoyed learning all the trigger points and referral patterns.
I really appreciated the casual environment in which the course was ...
Creating Clinical Success
Regular blog on Education, Research and Clinical Ideas by Clinical Director Doug Cary
Clinical Kit 13/11/2012 - Red Flag Tumor 1
This is the first in a series of tumor case studies that I have been associated with while in clinical practice. This is not an area of my expertise, rather interest and I provide these case studies to alert other primary contact practitioners
of the importance of a heightened clinical awareness and client followup in unusual situations. The other case studies can be accessed via these links;
Clinical History 1 (64 yo male)
24 May Initial Physiotherapy Appointment
S/E 2/12 intermittent right suprascapular, post upper arm pain, intermittent P & N sensations in little and ring fingers. Works levers on heavy machinery and has been worse since lifting heavy farm gate. Thought he had strained his shoulder and slow to settle. No other treatment, seems to be more frequent.
O/E Cervical Active Movement Rotation R=L=70
Shoulder Active Movement Flexion 160, POS and Abd same
Palpation C56 right and Infraspinatus right painful. Upper thoracic spine very stiff, tight anterior chest muscles
Rx Cervical 56 R & L dry needling (DN), Thoracic 1 - 4 unilateral R & L G3 mobilisations. Commence home upper trapezius and infraspinatus stretching
29 May Physiotherapy
O/E Active Movements Isq.
Palp C56 good, T12 stiff and sore
Neuro Reflex C67 reduced right, Power C6/7 right & left reduced, C8 & T1 R reduced, Sensation reduced upper inner arm
Rx DN T12 R & L, T12 (Mobilisations with movement) MWM to left for increased right rotation, postural education.
7 June Physiotherapy
S/E Good after last treatment, trap shooting all day at competition (National level) and stirred up shoulder again plus lower ribs from repeated gun recoils.
O/E Active Movements Isq.
Small mass midline supraclavicular fossa (SCF), non-tender, smooth and immobile. Wasn’t aware of it. ? Bump from gun stock recoil?
Palp T12 painful R. No chest pain, no cough, no haemoptysis
Rx Mobilisation and DN as before. XR requested. Report XR Cervical 6/7 degeneration. Soft tissue density in the SCF
Letter to GP requesting follow-up investigations
13 June G.P. notes
S/E Presented with R shoulder pain, tingle in little finger and ulna forearm. Worse driving truck. Developed over several months. Health good, weight steady, 2/600 national trap shooting championships
O/E Local, hard mass SCF R, non motile
14 June G.P. notes
O/E Chest XR. Mass present in apex of R lung. Erosion of the posterior margin of 1st rib.
7 June Department of Respiratory Medicine
O/E CT scan. Showing mass of 6 * 4 cm, invades both first and second ribs and transverse process of T1. Additional metastases were found at different vertebral levels.
Biopsy also performed. Referred for oncology review, MRI and blood scans
21 June Physiotherapy Phone call
S/E Improving pain, P & N little finger and ulna boarder forearm. Seated more upright in loader.
1 August Department of Respiratory Medicine
Oncology treatment commenced using; Cisplatin (a chemotherapy drug that is given as a treatment for some types of cancer, most commonly testicular, bladder, lung) & Etoposide (chemotherapy drug that is given as a treatment for various types of cancer, most commonly lung, ovarian and testicular cancer). Repeated*3
Commence high dose radiotherapy. Started Docetaxel (treatment for symptoms of locally advanced or metastatic breast and lung cancer)
Radiotherapy to left lung
What Did I Learn?
I included this case study because it would have been easy to justified this pain presentation with the clinical history of heavy manual labour, his age, repeated jarring from shooting and poor posture. There were no other key flags; past Ca history, non responsive to treatment, unremitting pain.
It was the appearance of the small raised area, that I thought hadn't been there the week prior, even though he felt that it was in response to the all day shooting. I could have delayed further investigations for a couple of more treatments, to gauge changes, but wasn't satisfied with the clinical picture and requested an XR on this suspicion. The XR demonstrated an already advanced nature pancoast tumor, confirming diagnosis.
Pancoast tumors are lung cancers that begin at the top of the lung and invade the chest wall. They are also called superior sulcus tumors. Pancoast tumors often come along with unique symptoms known as “pancoast syndrome,” which consists of pain in the shoulder and the inside of the arm and hand. Most pancoast tumors are non-small cell lung cancers, usually stage 2B.
Pancoast tumors are much less common than other lung cancers.In past series, the rate of Pancoast tumors varied from 1-3% of all lung cancers. A major issue with Pancoast tumors is the delay in diagnosis. The apical lung cancer may not be visualized on an initial chest radiograph, and, by the time the patient presents with symptoms, the tumor has almost always invaded nearby structures. In addition, the symptoms produced by the disorder can be mimicked by numerous neurological or musculoskeletal disorders, thus delaying diagnosis.
The risk factors for almost all lung cancers are similar.These include prior prolonged asbestos exposure, exposure to industrial elements (e.g. gold, nickel), smoking, and secondary smoke exposure.
The mass in the superior sulcus is an extension of a lung tumor;most of it lies outside the lung and involves the chest wall, nerve roots, lower trunks of the brachial plexus, sympathetic chain, stellate ganglion, ribs, and bone. Most Pancoast tumors are squamous cell carcinomas or adenocarcinomas. Only 3-5% are small cell carcinomas. Squamous cell carcinoma occurs more frequently, although large cell and undifferentiated types are also common. Adenocarcinoma is sometimes found in this location and can be metastatic.
The symptoms are typical of the location of tumors in the superior sulcus or thoracic inlet adjacent to the C8 –T2, nerve roots, the sympathetic chain, and the stellate ganglion. Initially, localized pain occurs in the shoulder and vertebral border of the scapula. Pain is frequently relentless and unremitting, may extend along the ulnar nerve distribution to the elbow and ulnar surface of the forearm plus small and ring fingers. The patient may support the elbow of the affected arm in the hand of the opposite upper extremity to ease the tension on the shoulder and upper arm.
If the tumor extends to the sympathetic chain and stellate ganglion, Horner syndrome and anhidrosis develop on the ipsilateral side of the face and upper extremity.
The hand muscles may become weak and atrophic, and the triceps reflex may be absent. Confusion with thoracic outlet syndrome and cervical disk disease is common in the early clinical course. Careful neurologic examination, electromyographic studies, and ulnar nerve studies are performed to verify the precise diagnosis. The first or second rib or vertebrae may be involved by tumor extension and intensify the severity of pain. The spinal canal and spinal cord may be invaded or compressed, with subsequent symptoms of spinal cord tumor or cervical disk disease.
All the best,
Doug Cary FACP
Specialist Musculoskeletal Physiotherapist
ph/fx 08 90715055
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