This question is a bit like should you treat a pregnant mum’s lower back using HVLA or grade 3/4 mobilisation?
It’s of those questions that’s steeped in mystery, intrigue & folklore.
I want to try and bring some science into this debate and encourage more thinking and discussion.
The main reasons for not using dry needling during pregnancy are focussed around what may happen and the subsequent inferences rather than any factual data or science.
Those who are cautious about using a particular therapy during pregnancy will say that I won’t treat a pregnant mother using this therapy because even if I believe there is no risk, if the mother has a spontaneous miscarriage following my treatment, I could be blamed.
This is a defensive treatment rationale, which may exclude a potentially beneficial treatment.
Because we can’t do a study on 2 groups of 100 pregnant mums to see what would happen if we add an intervention such as acupuncture or dry needling to one group and not the other, we have to rely on anecdotal evidence. This reliance often leads to poor management and treatment.
One of the most commonly needled points by Acupuncturists & Dry Needling therapists is (LI4) or Hegu. This point is located mid way along the 2nd metacarpal, on its radial border.
Acupuncturists use this point to treat many conditions including pain in the upper arm, axilla, head & neck, nausea, chest pain, insomnia & febrile disease.
Dry Needling therapists may needle around (LI4) when treating myofascial trigger points in Adductor pollicis & the 1st dorsal interossei.
According to some TCM practitioners this point is contraindicated during pregnancy, particularly in the 1st trimester.
According to Deadman P (A Manual of Acupuncture 1998) acupuncture has a strong action on promoting labour.
The Ode to Elucidate Mysteries tells how the Song dynasty Crown Prince, in a dispute with doctor Xu Wen-bai over whether a pregnant woman was carrying a girl or twins, ordered her belly to be cut open to find out.
Xu Wen-bai begged to use his needles instead, and on reducing another acupuncture point (ST36) & reinforcing (LI4) two babies emerged.
Due its strong action on promoting the expulsion of a dead foetus, (LI4) is contraindicated during pregnancy.
Interestingly, another acupuncture point which is very close to (LI4) is regularly used during the 1st trimester to assist in the treatment of morning sickness.
This acupuncture point (P6) is found about 5 cm above the wrist crease on the flexor side of the forearm, between the tendons of palmaris longus and flexor carpi radialis.
There is very little scientific evidence that acupuncture or dry needling can lead to spontaneous abortion even at full term.
In a book by Filshie, Cummings & White (An introduction to Western Medical Acupuncture 2008), Acupuncture is often used in China to treat many conditions during the 1st trimester without any special precautions including nausea or morning sickness.
In a trial by (Smith et al 2002) involving 593 women with nausea of pregnancy, both pregnancy outcomes and the health of the child were not affected by acupuncture.
In the absence of clear scientific data to show why Acupuncture or Dry Needling is contra indicated either during pregnancy or the 1st trimester, my approach is to:
- Use Acupuncture or Dry Needling during pregnancy
- Evaluate the risk/benefits for every patient’s specific presenting symptoms & circumstances
- Avoid strong stimulatory techniques during the 1st trimester
Dr Wayne W Mahmoud
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