Pain, Healing, and the Power of Dry Needling with Dr. Aaron Wiegand

Hi everyone, welcome to ChiroCast, the show where chiropractic insight meets

everyday impact. I'm Dr. Stephanie Brown and today we're diving into a topic that's becoming increasingly popular

among chiropractors and that would be dry needling. So whether you're certified or just curious if it might be

a right fit for your office, you are in for a real treat today. We are being joined by Dr. Aaron Wiegan, president of

Chai Needle and a leading voice in the dry needling space. We will explore what

dry needling is. I'm going to be honest, I don't even know what it is. So, we're going to find out and what it isn't. Uh

clinical and business benefits and how technology like Chiro helps streamline your workflow when offering new services

like this. So, let's hop in. Dr. Aaron Wiegan, welcome.

Hi, Dr. Stephanie. Yeah, so glad you could join us today. I really appreciate it. So, could you just

start telling us a little bit about yourself and how you got into dry needling?

Yes. Uh, so I'm Dr. Erin Wiegan. I practice in Phoenix, Arizona. Um, I went

to Palmer West and, um, and, uh, graduated there about 18 years ago. Been

in practice since then and, um, do a lot of PI work now in my practice. But, uh, got into dry needling. You know, the

same way a lot of chiropractors find therapies for themselves is that I was injured. I had a 13 mm disc extrusion in

my low back at the time. Didn't know what it was, but knew I was in pain and knew I had to see patients. Had to

figure it out. Went to a physical therapist office that was in my building and they used dry needling, pulled out

this 100 millimeter needle. I mean, it was literally about that big and said, "Well, we're going to stick this in your glute me and then we're going to stem

it." And I'm like, "Whatever. I just need to get to work. I got rent." Just like most chiropractors, we got bills to pay. you can't take a day off. So, uh,

and I felt, you know, 70% better and I was super relieved and then kind of

upset. I was I I didn't even know what this was. And yet, this PT who fresh out of school was doing this amazing thing

that helped me a lot. And I was like, well, how come I can't do this for my patients? So I uh took the next four

years or so and started studying with PTs, learning everything I could about dry needling and integrating it into my

office and then eventually bringing it into my personal injury practice. Uh and during COVID, just like everybody else,

trying to find something to keep busy, developed Chiro needle to share this with the rest of the profession and

hopefully uh use it as a conduit to then help their patients find relief as well.

Okay, cool. So um we have two directions we can go here but first thing I want to

ask is what is chairo needle? Chairo needle right. So Chairo needle is

the company I created and really started off as just creating a class for dry needling. I wanted to create the class

for chiropractors. I had been spending hours and hours over 100 hours of dry needling classes in physical therapy

settings. And while there are many many many similarities and I learned a lot from them, the pace of patient care is

simply different in a chiropractic setting and the population and the types of cases that we see and also the

abilities chiropractors have to integrate dry needling in a combination therewith um uh we call a multimodal

care plan is just different. And so I decided to create a curriculum the way I

would have liked to have uh seen it as a from a chiropractic perspective integrating also the uh what do you do

after dry needling? How do you integrate it with the adjustments? What kind of rehab and therapy do the conditions that

dry needling treat you know uh demand and what what works best. So I put that together as a class just almost as a

personal pet project and then people started signing up for the class and we started doing that and

um it and it just grew from there. We started in Phoenix, Arizona, and then we started going to Austin and Houston and

Dallas and uh Flagstaff and Tucson and just, you know, getting chiropractors together and having a good old-fashioned

technique class where we get together. And unlike other seminars where you mostly just sit and uh just either learn

more about how what you're doing is already working or uh learning why some

uh you know, some machine that you're buying is working. you know, this is something you're going to get in with your friends, with your chiropractic colleagues, and use your hands and learn

a new skill set. So, it just became so much fun. And now, four or five years later, we're uh we're we're we're

teaching almost every month. Okay, awesome. I like it. So, that brings us back to probably something

more important and that would be in general just what is dry needling. So, uh kind of have to have a understanding

of that first I think to decide if you want to do that. So um and I will share with you personally

um I have I see a acupuncturist every it varies but maybe four to eight weeks on

or off and you know what have you but um so what is dry needling and how might it

be different from other modalities that use needles? Sure. That's a great question. I'm so

glad you brought that up Dr. Stephanie. I So uh let's let's just start with the

origins of dry needling. So Travel and Simmons doing trigger point injections. Well, they're injecting these things in

sugar point, seeing what works, what doesn't work. And then they want to see what the placebo effect or what the other effects of the needle and just

injecting saline. You know, what effects did those have? And first they started with saline. They found well that was

those work that worked pretty effective. And then they said, okay, what if we don't inject anything? And they found that was effective.

Obviously that led to us using trigger point injections. now, but people kind of went back, some physical therapists

went back and looked at the literature and said, "Well, you know, the needle worked pretty good just by itself." On top of that, we had pain management

specialists doing the same thing with their um with injections, using trigger point injections as well as epidurals

and uh using just the needle to see, you know, what was the placebo effect. And what they found is the needle in of itself was highly therapeutic. And

physical therapists kind of like found this, put it to use and and lo and behold, we have the advent of dry

needling. However, you know, this happened in my practice. I started with dry needling and my my patients started

asking for acupuncture. I didn't know. I I had to be honest. I said, I I don't know really, you know,

much about acupuncture. Um and they thought, well, you have these needles. Why can't you just do this thing? And I

Yeah, right. That's what I'm wondering. I feel I felt so out of my own. I said, I don't know. So, I said, you know what?

I'm going to go get some acupuncture, learn a little bit more. It was wildly difficult to get acupuncture. uh setting

an appointment, you know, when when they're available and all they can do is acupuncture. And I said, "Well, I went and got

acupuncture and I felt better. I really enjoyed it." I said, "But what if that acupuncturist was able to adjust and do

rehab and do all these other things that the patient would need after their acupuncture section?" So immediately I went and got my acupuncture

certification as well and now I integrate traditional chiropractic rehab, dry needling and acupuncture in

my practice, but they are two completely distinct things. They just happen to use the same tool.

Okay. Interesting. So, is the approach to how you would place the the needle

different than how an acupuncturist may decide where they're placing their needles? Well, just like in chiropractic, it

does. It does. Just like in chiropractic, every in acupuncture, they do it a lot of different ways.

Traditionally, the needles are only go in so far. You know, usually about 15 millimeters, maybe 25 millimeters. Um

and they're trying to stimulate meridians or neural points uh to help

the general health of the body. You know, it's not just muscularkeeletal conditions there. You know, in acupuncture, you're trying to balance

this kind of energy and or the autonomic nervous system in order for better health of everything. Dry needling is

pretty confined to the muscular skeletal system and uh it goes much much deeper.

Traditionally, there are acupuncturists doing something called deep acupuncture where they do go deeper. Um, this has

been as of late and they're even publishing on it. But dry needling often goes down to the bone level. I mean,

you're pecking the perryioium, you're in tendons, you're in ligaments. Wow. So, it really goes that deep.

It does. It does. Got it. Yeah, it can. Um there's some techniques called perryioial pecking where you're

actually going to kind of poke holes in the perryioium so you create a bleeding effect and therefore get more

fibbrinogen so you can uh create a scar tissue or heal certain things like tendons especially lateral epicondilitis

uh suppinatus tears things like that. So I always call it like kind of a poor man's PRP. It you know there's lots of

research on this. It's highly effective and it's competitive with those oftentimes higher risk um and higher

cost modalities such as trigger point injections, PRP, Botox. There's literature out there comparing dry

needling and it is considerably much safer and much less expensive and you're getting it done by a chiropractor who

can also then immediately adjust uh and give you rehab. I always say this,

you know, when you're when as you get as a chiropractor, you start young and you don't know what real pain is. And then you get older and you realize you really

appreciate what you're doing for your patients. Am I right? Going through that this week, actually.

You see your patients and you're like, you get you get your first bout of real back pain. You're like, is this what I've been helping the whole time? I

really need to charge more because I am a miracle worker. You really don't appreciate yourself until you have the pain. And you know with a 13 millimeter

disc extrusion you know even though I had to have a microisctomy you know these things flare up and I you know and

sometimes I need an epidural but the sad part is I go to get an epidural and that's it. There's no one there to

immediately put me on decompression therapy or do dry needling and some stem on the on the glute muscles to help or

do any kind of rehab or god forbid adjust. I would have to go to a pain management specialist, then make an

appointment to a chiropractor, get the adjustment and decompression. And oftentimes, because many chiropractors don't do rehab, then go find a physical

therapist that's going to put me through rehab. It would take me four appointments. I'm here to tell the chiropractic profession, guys, we could

com we could totally dominate the pain management space and uh conservative care by doing being able to place the

needle in a strategic way that's competitive with with a lot of what pain management does and then do your

chiropractic thing of adjustments you especially in the low back and neck decompression. And then if you have a

basic understanding of functional rehab, man, you are competitive with, you know, you're basically taking the place of five doctors at once. much more

convenient, much lower cost, much lower risk, much more effective than what anything else anybody has out there. So,

that's what I'm out here to tell you. It's not just about the needle. It's about how the needle makes you a

completely different chiropractor. Got it. Okay, that's cool. Um, what are

can you think of any like myths or misconceptions that you've heard that people might have about dry needling and

or how it might apply within the chiropractic profession? Oo, that is a lengthy one. All right.

Well, let's try to summize it here pretty quickly. Oftentimes, myths or misconceptions. Myths and misconceptions. One, let's do

with a myth. I love myths. So, let's dispel some myths. The one myth is that it's just rebranded acupuncture. It isn't. I'm I've done

both. I've gone through both. Eastern medicine is an elegant elegant philosophy and technique. It is

completely different than uh dry needling. Um, as far as is it extremely

painful, believe it or not, here's the thing about needles. Uh, the length doesn't really dictate the pain. It's

the gauge, right? The gauge of the needle of bit, you know, I if if the needle is as thick as a nail, but it's

only 15 millimeters. I would rather have a 100 millimeter long needle that's as thin as hair.

That's where the pain comes. Well, length people go, it's too long. The length doesn't matter. Now, the other

thing is that people say it's extremely painful. Well, just like going to different chiropractic schools, there's

different schools of dry needling. And I have been to a myriad of practitioners and just like when you get you look as

chiropractors, we go get sample adjustments from each other all the time. And you know, we're not all the

same. And some there's different strokes for different folks and and you're going to find people who needle way that you

like and needle in other ways that you don't. Some people are just trigger point needers. They go in there and they just try to airate the meat. I call meat

tenderization technique. That's okay. Others are more subtle and try to work more with the nervous system and that's

a lot what I teach. Um, so is it really painful? No. Is it rebranded acupuncture? Absolutely not. Um, is it

within the philosophy of chiropractic? Absolutely. And I'd like to take just a minute to explain why. Yes, that was going to be where I wanted

to go next. Let's do it. Okay. I'm a second generation chiropractor. And while, you know, it's easy to label me as a heretic for mi

mixing, uh, my father and I, you know, if you if you're in a chiropractic family, Christmas is always fun. But uh

so here's what we know. If you're a chiropractor and you are all about the

mindbody connection, you are a holistic chiropractor. Then it means you believe that the mind and the body they work

together uh and and they are integral in overall health. Well, if that's true,

then we also know that pain is bad for your health. We know it's bad for your mental health. It makes you antisocial.

Makes you lose empathy. It makes you uh more prone to anxiety and depression.

And we also know pain is bad for your general health. I've taken many many hours of class with Dan Murphy. And if

you've ever spent any time with Dan Murphy, if you take away anything, you should know that no COception leads to

increased sympathetic tone. Increased sympathetic tone means increased stress response and your immune system and

every other system goes in the dumper. If you were going to sum up, you know what what you know that of health. So,

what I'm here to say is pain management is health management. Being in pain is

bad for your health. And we are going to have a whole lot of people, especially with the boomer population, who are

going to be in chronic joint pain. And let me tell you folks, there are not a lot of good options out there. I work in

pain management. Right now I work in at a multi-disiplinary pain management clinic where we do epidurals. We do

radio frequency ablations, we do Botox, we do PRP, we do spinal implants, we do

everything under sun and we're grabbing at straws, especially since we can't use opiates like we used to. Thank God.

Yeah. Bad. You know, the options aren't great. So if you can find a way to provide

drug-free pain relief and neurological calming especially to people who have chronic

pain that neurogenic centrally mediated pain man you no one else is doing that

and we could be a big asset to the population and their health by being that pain doctor that they need. Yeah, I

think it's important too that then um they can be doing they can be doing that in the setting of a chiropractic office

which is going to come along with it certainly depends on the chiropractor but it's going to come along with that

approach to health versus maybe you know um outside in approach to health

perhaps. Um, so I do think that there's a benefit for the patient if they have options like this with practitioners

like us who um kind of have a different approach than western medicine does to

most most healthcare. For sure. For sure. Physical medicine is indeed in a lot of need. It's going to

be in more and more need. And pain again, it makes your psychology bad. It makes your digestion go to pot, your

immune system. And you know what? You know, it's hard to exercise if your

joints hurt. I mean, if we knew if if you were to pick something just to tell someone to be healthier, according to

literature, it would be eat more plants and move more than you did before. So, you can't move. You can't move a lot

if you're in pain. So, you know, learning how to exercise, it's hard to do when you're pain. It's hard to

meditate when you're in pain. We know meditation is good for your health and mental health. And also, if you're stressed out all the time, you know that

cortisone, it makes you crave different foods. How many of us have been stressed

out? Do you crave a salad? No. No. You want a big fat greasy burger

when you're stressed out? So, it's real hard to be healthy and in pain. And if you can and if you can help people with

their aging joints get through some get some relief and get back to an active lifestyle. You are a health and wellness

practitioner. Yep. All right. Cool. Um, okay. So, give us an idea here. In your experience,

what kind of conditions can dry needling either treat, resolve, help, improve quality of

life, all those things? Well, let's start with the literature. If you look up, you know, there's over

1,000 dry needling articles in PubMed. There's another, I believe, over 10,000

PubMed articles on acupuncture. So, you know, I always say the human body doesn't know what letters are after your

name. Needles are therapeutic. So on what conditions? Well, most basic we

know shoulder shoulder pain, shoulder tears, impingement syndrome, really effective. Planner fascitis, very

effective. Osteoarthritis of the knee, effective. Headaches, TMJ, guys, TMJ is

a horrible condition. No one knows how to treat it. If you can do that, you're you're moving mountains. Um lateral

medial epicondilitis. uh research recently on the carpal tunnel where they actually can show the needle going into

the flexor ratnaculum and changing the the thickness of the retaculum by manipulating the soft tissue inside. Um

per neural needling, it's where you put needles close to the nerves and stem them so that they can heal uh with

things like neuropractis or you've all had those brachio plexus kind of conditions after car accidents. Um, lots

look everything that walks in your office and more back pain, neck pain, shoulder pain, you know, it's going to

expedite the process. It's going to get that healing process happening faster. Got it. Also, this is going to be a

two-part question, too, because I love to do that. Um, yeah. Do you know why it's called dry needling?

Oh, excellent question. I don't know what wet needling is. Like, what's dry? Why is it called dry needling? It's called dry needling

because they at the beginning when Tel and S Simmons were doing this, they uh

they it was just sticking a hypodermic needle in with nothing in it. So it was a quote unquote dry needle.

Understood. Okay, that makes sense. Got it. I'm happy that there's an answer to that too, though.

Me, too. And I'm glad that I know it. Otherwise, I'd be really awkward right now. Yeah. Okay, good. We don't need to go there. Perfect. Okay, so then part two

to that though is you've mentioned though like attaching stem and doing stem to it. So

h obviously it's still like dry needling but how how does that add to it when you

add stem? I don't can you get into that a little? Sure. Look, everything we do in our

practice is paingating, right? We're we're trying to we're fighting the battle. There's mechano reception versus

noioception. And at the spinal cord, there's a fight to see who gets to make it to the brain. And so when you move

more, that's more mechano reception and less noception. If you have more inflammation that's going to be more nosio reception against the mechano

reception. So, you know, if you stick in, so for example, you only adjust somebody, their joint moves more, that's

more mechano reception, that's a win. If you put a needle into a muscle or a tendon or a ligament, there's a lot of

mechano receptors in there. There's a ton of them. And if you put them, especially like sub oipital muscles or these muscles that are high, high highly

inervated and then you add stem to the situation, it's like the difference between if you

just put a little needle in 15 millimeters, that's like a flashlight. If you put a long 100 millm needle in

touching all those mechanic receptors and then you add some stimulation to

that, man, it's like it's like a lighthouse. Just I always tell people if if you're of my generation, you remember

something called the Care Bear stare. It's like the Care Bear stare of mechano reception. You put a needle you put

needles in muscles all along the nerves and you turn on some electricity, man. It's just like of that mechano reception

uh going up against that that nose reception. And for our patients suffering from chronic pain where there isn't that pain generator that we can

actually heal that their nervous system's kind of misinterpreting the the the um sensation

man you know to be able to kind of hack the nervous system and send that mechano reception in to fight that noception

without having to move them all that much. These are patients that they don't do very well with manual adjusting and they maybe can't even handle exercise.

Their body is just so keyed up on pain. Some gentle needles with some stem. I mean, acupuncture is great for this, but

we can use those same principles in dry needling to really crank it up another level. Okay, got it. So, would you recommend uh

or maybe it's going to be condition or patient specific, but would you recommend someone do dry needling and then also get adjusted in the same

visit? Would they get adjusted before or after or like what is the intersection with the actual chiropractic adjustment

look like when you've got dry needling? You know, one of my mentors was Burl Pedabon. You know, Burl Pedabon used to

had this saying, he had a lot of sayings. One of them was never adjust a cold spine. It was like look, you know,

before they go get adjustment, you know, do whatever you need to do to get it kind of primed and ready for the adjustments so you get an even better

one. And I really took that to heart all through my career is, you know, adjustments are always after some preparation.

And doing dry needling increases circulation to the muscles, reduces the spasm. And even in your patients with

osteo osteoarthritis of the cervical spine, if you do perryiocking on the articular pillars, which I know sounds

very invasive, but it works amazingly. It lubricates those joints and you're going to get motions out of those

patients. Those are the patients where you go to adjust them and they get one little click and they're like, "Thank you so much." Well, this after doing dry

needling, I've had the same patient big releases, big mobilizations. It's a great preparatory to the adjustment.

Okay, cool. Um, so

here's without getting I don't expect you to be a a walking dictionary of every state, but do you have a um a

overview of, you know, are chiropractors allowed to do dry needling in every state? And like it I I don't know. Can

you speak to that a little bit? Because I'm sitting here wondering like, you know, could I even do this where I live? For example,

where do you live, Dr. Stephanie? I'm in New York State. Okay. I don't believe you can do it. New

New York straight state. Here's the general rule of thumb. If you're on the coasts, um probably not.

Okay. Okay. Uh there are states like Florida uh recently passed legislation to um

include dry needling in their practice act. Uh Texas has it. I believe Louisiana has it. Uh Arizona has it.

Nevada has it. Uh and then in the Midwest, they kind of have this we don't have we don't say no. We don't say yes,

you know there, you know. Yeah, exactly. So, you kind of have this Yeah. So, it's depends on your state.

Some states there's an hour requirement. Some states you just have to take a class, you know, some states it's like

hundreds of hours because it's they want it to be the same as acupuncture. Um, so it just depends on where you're at and

usually physical therapists, you know, they win that battle and then we kind of tag along and um get to do it as well.

So, it just depends on your state. Call your state board, call your association. And if you don't have dry needling in your practice act, you know, it's

something worthwhile to fight for because your competition definitely is gonna have it. Your PTs down the street

are going to have it. Your patients already know about it. They ask for it. You can Google it and see the results.

It's something that people already know. And I always tell chiropractors, be wary of anything that no other health professional is willing to deal with. If

you're the only health profession willing to use a technique or some sort of technology or an intervention, it

makes me raise an eyebrow because with dry needling, I have nurse practitioners

in my class. I have physical therapists. I have, you know, chy, everyone's doing it because the evidence is so strong and

it's effective. So, try to get it done in your state because it's definitely an asset. Okay. Interesting. So, do you know, I

don't know if you will know this or not then though. Um, can physical therapists do it? Is it just part of their scope

everywhere or is that going to be state by state too? Probably same state by and it pretty much it follows chiropractic and PT again they

can't on this coast it's really uh there's just lobbying efforts by the acupuncture profession to try and you

know maintain the um their kind of monopoly on uh providing the technique.

Yeah. They want they want they want to be in charge of all which is understandable but we do the same thing with adjustments and other in other

professions. So you know uh we haven't done a very good job though. I'm just going to say no. No. And no.

Yeah, we won't get into that. But yeah. No. Um different podcast different podcast. That's a whole another podcast. That's

an edgier one. That's that's on the weekends. Um but yeah. So so you know luckily, you

know, because we've teamed up with physical therapists legislatively. That's what's allowed us to kind of move

this forward state by state. you know, chiropractors on their own um pro probably wouldn't have made the victories we we would have with in

needle made the inroads without the assistance of the APA. Okay, cool. Interesting. I like it. Um

okay, a little back to clinical. Um any uh Okay, first off, I'm trying to think

when I go to acupuncture if they if they I don't think they do clean the skin first before they put the needles in.

Oh boy. Oh man, we're we're getting into it. All right. Wait, are they supposed to? Maybe they do. I guess I've never

thought of it before, but that's what I was going to ask you. You're talking about how deep these things can go sometimes. Cleanliness, infection,

clean needle technique. Yeah, let's talk about clean needle technique. Um, you know, I think it's important. Um, so

clean needle technique. You know, part of um these classes is that there are

certain requisites that the states require you go over certain things. And one of those things is bloodborne pathogens. And for good reason.

Chiropractors, we're not used to work working with bodily fluids or hazardous ways. Well, dry needling kind of changes

that. You know, it definitely increases your responsibility to your patients, your staff, and yourself. And so, clean

needle technique, you know, uh the

best practices that, you know, if you look at um that for like giving injections or using any kind, they'll

say you don't have to wear gloves unless you anticipate bleeding. Well, you don't know if you're going to if somebody's going to bleed or not. Now, the gloves

don't protect you from a needle skit stick. They're typically less sterile than your washed hands, but you want to wear them

anyway because I want my doctors wearing gloves no matter what. So, I just assume do it anyway, right? And you don't know

if someone's going to you pull out a needle. Sometimes you're like, "Oh, we got some blood. What are you going to run over and put on gloves?" Just wear the gloves. Alcohol swabs. Again, the

the recommendation is look, most of the bacteria lives underneath the surface in the sebaceous glands and you're driving

bacteria into the bloodstream no matter what. So, and the recommendation is that

unless it's like soiled or dirty on the outside, is alcohol necessary? You know,

so the answer is according to the OSHA um documents that I've read, the answer is no. That being said, do it anyway.

Mhm. You know, alcohol swab every area, put on gloves. You know, it's comforting to the patient. It costs nothing. It shows

professionalism. Um, and you don't know what's teeming on the surface. You don't

know if that person has a history of MRSA. I mean, how many of our patients come in, give us their history, and they

think they only need to tell us the things they think we need to know. Yeah. You know, they Right. You don't know

what's going on there. So, you know, be extra safe. It takes it just, you know, again, your physical therapist

counterparts are doing it. It's what doctors do. Be a professional. Use alcohol. Wear gloves. Use clean needle

technique and proper needle disposal. Okay, I got a good one. What about like is it always skin on skin or how does

that work? Well, it's not really it be needle on skin, you know, but what do you do about clothes?

Don't ever needle through clothes. I keep hearing these horror stories where it's like, oh yeah, they did the needling through their clothes. I'm

like, I'm sorry, what? Uh, yeah, that's not okay. Just let's just go on the record right now. Not okay. Wear gloves.

Can you tell us why? I I think I have my own ideas, but I'm curious. Um, yeah, there's bacteria on clothes.

Okay. Yeah. I mean, you don't know. Did that person's dog lay on their lap before you went? It's just

don't Nobody has anyone given an injection through clothes? Like, let's be real doctors and let's let's act

accordingly. Um, draping and gowning. Now, this is a big part of dry needling because you have to expose some parts.

Uh, it's important to make sure you have privacy, you have consent, right? you have hopefully somebody else in the room

um that you know you want to make sure and you talk your way through that. You know, oftentimes as chiropractors, we get into a groove. You know, we get into

a groove. We're adjusting, we're doing exercise, we're doing soft tissue, we're adjusting where it's like, it's like it's almost like a short order cook. You

know, you're just, you know, whipping up fries and then meatloaf and then a burger to go. You know, it's just I mean, you're you're in it. And hopefully

that's what your office is like. But with dry needling, stakes are too high. You got to take the moment. You got to

slow down. You got to be focused because there's increased risk with this. We're not going to pretend like there isn't. There's risk of numoththorax back

infection hitting a nerve, hitting a blood vessel, things like that. You want to make sure you are focused on

this patient and you are in communication with them. What are you feeling? How are you feeling? Is this okay? Right? You know, if you have to

dry needle a performance, there's going to be stuff exposed. We don't know what that patient has been through. And it's

very important to constantly get consent, talk to them through the process, and make sure that they're having the experience that they want in

their healing process with you. Okay, cool. Um, on that note, what about

any negative side effects? I mean, you you just mentioned some of the risks, I guess, like what are the risks or maybe

negative side effects that one might experience? So, the most common what we call adverse

event is bleeding, right? Obviously, um, now most of the times you can avoid

blood vessels. It's not the end of the world. they they seal up relatively quickly unless they have some sort of

bleeding disorder or um they're on some medications which can result in kind of uh more bruising. So you can have

bruising. Um infection is a risk, right? So you want to make sure that we're using clean needle technique. We're not

reusing needles, god forbid. Um what else? Uh some people faint. It

can if people have a history of Yeah. Some people just f I've had two students now I've been doing this a long time. I've had two students pass out my class

and when we have a part in the class to get over the needle phobia which a lot of chiropractors have to get over it we

we self needle uh for a minute to kind of get used to it and uh I've had and and it's not even just it's not from

pain it's just the the idea of a needle to me and they just

you know and that they get their money back or no actually so funny the only no because

they they honestly after they go through it it's like they wake back up that's it for the rest of they're over it. Yeah,

they it's it happens so fast. Um and so, uh yeah, so there's those

kinds of risk. Uh if you have a history of epilepsy, um you know, it could induce a seizure. So, these are all things we go over in the class.

Interesting. You know, what what kind of risk benefit um also um uh inform

consent, let them know what the risks are relative to the benefit so they can make that choice themselves as patients.

Uh and also what to do if and when things happen. You know, what if a needle gets stuck? Sometimes the needle doesn't want to come out.

Really? Yes. It winds around the fascia and it'll get stuck. Now, what do you do?

What do you do? You got to come to the class. I'm just kidding. No. I feel like I would start spinning it a

little bit and like hope the opposite direction. So, it winds tight. They get tighter. So, as you wind

it, it actually gets tighter and it won't come out. And it's great for internal manipulation of the fascia.

It's It works really good. Yeah, but then sometimes you'll staff will because in some states your staff can

remove them and they'll go, "Doctor, I can't get this out." You just have to spin it in the opposite direction or you

can put a needle next to it and the the connective tissue will kind of grab to both and you can take them both out. You

can contract the antagonist. So, there's all sorts of things to do. So, we cover all those contingencies in the class.

Wow. But you just got that part for free. Yeah. Crazy. I I that had never occurred to me that like they might not come out

at least as not as easy as they went in. That's wild. We do it on every class is I'll show I'll wind one up so it gets

stuck and then I'll let everybody try and they're like I really couldn't get this out. Like I can't get this out and you have to show them how to do it.

Interesting. That's crazy. All right, cool. Um okay, let's move on to some more boring uh component of this

actually. Yeah, this is pretty boring. What about like male practice? Obviously, you would need to disclose to

your male practice insurance company you've added this as a service in your practice. Um, I mean, you've been doing

it a long time, so maybe you don't have a good comparison, but is is it expensive? Like, does it really increase

your premium? Do you have any thoughts on that? Yeah. Um, I know I can only speak to my

own experience. Um, uh, every time I've called a malpractice company on this,

they've said, "If it's already included in your practice act, you're already paying for it." Uh, I haven't had one yet that said it's

an increase. But I would no matter you're anytime you add anything new in your office, man, check with your association, check with your board, and

check with your malpractice carrier, you know, just to make absolutely sure. But that's usually the case. If your state

already includes it, it's already you're probably already paying for it. Got it. That's an interesting way to look at it. Okay, um All right. What

about documentation? Like in terms of charting, like you obviously need to write that you did something and uh like

what do you have to keep track of like where they went, what gauge, like what do you have to what do you have to write down this?

Yeah. Okay. So, you know, it's funny is dry needling is relatively new in the

physical medicine space. And if you know anything about chiropractors and physical therapists, uh we are the worst

documentarians on the planet. Um what do you mean? That's and that's not my opinion. And

that's just Medicare's opinion. Um, so, uh, uh, we're kissing cousins when it

comes to that stuff. Um, but so what I did is I I, you know, I'm

lucky I got to work in a multi-disiplinary setting with other practitioners. So, I get to learn a lot from what they're doing. And one of the

things I did was I took their notes from doing a trigger point injection. And then I took the medication part out of

it. But the rest of it, it lists, you know, what did you do for the clean needle technique, you know, what what

what percent alcohol did you use, um what was the length of the needle, what was the gauge, um what was any needling

tech, all that stuff. So, the nice thing is working with Chiro is I've developed an um a whole um uh an algorithm, a um

what's it called? Macro set. So that Yep. I created a map, the body map with the the bubbles on it and you

can click on the muscle that you needled and then it just asks you what was the length, what was the gauge, you know,

what how long did you leave it in? Did you take it out? Did you do pistoning winding? You know, did you send them home with it in?

I'm just kidding. Don't do that. Don't do Don't do that. Uh we have a count them in, count them out policy. Um there's a way to do that.

We talk about all those things in our class. And that's one thing I wanted to add because chiropractors own their own business unlike physical therapists. you

know, you go to that class, most of them are employees. They have compliance people in their office doing all this

for them. But what's your liability if your staff gets stuck with a needle? You know, what what what things do you have

to have in place? And what do you do? What happens if your staff says, "I just was taking needles out and I walked

around the corner and so and so stabbed me or whatever." Uh well, now you have an incident. What you what is your responsibility?

And so, um, all that stuff we talk about in our class about look, yeah, there's there's there's a whole

way to deal with that to minimize your exposure. Um, and so we talk about things like that for sure.

Um, this goes back to the notes a little bit and also clinically, but how many I mean, again, it might depend on the

patient and what they're seeing you for, but say they're seeing you for like one condition, how many needles might be

involved in a one session, you know? Uh I always say uh be do the

least amount that you need to do to be effective especially on that first visit. Um needling may not even happen

on the first visit. That's pretty you know u it's like when you're getting to know someone it's like you can't just you know it's like you it takes give it

time you know you're with your patients you have a relationship and that is built on trust. um you know so you know

I I'll start with normally maybe one needle you know just to show them this is how it feels and also I want to see how

their body responds people have very odd reactions to needles sometimes even in acupuncture they'll have emotional just

catharsis for no reason not no reason but like you know it's just unexpected and you'll ask them are you okay they're

like I feel fine I just can't stop crying um or you know or they'll start laughing they'll get giddy um some you know lots

of things can happen you want to kind of want to see how or they just get really sore or they're a bruiser. They bruise like a peach and you didn't know it.

Well, do one. Um, but you could do as many of like for example,

I'll do for a purformis kind of sciatic protocol that could be, you know, six to eight needles with stem on all of them.

Uh, sub oipitals could be four. Uh, or a contusion to the leg. I deal with a lot of really bad car accidents. So, a

contusion to the leg might be 30 needles in the bruise with a cup between that and the heart. So you increase

circulation. That could be 30 little 15 millimeter needles. So it really just depends on what you're

I always tell my docs you what what are you trying to combat here? Is it neurological pain, inflammation, increased circulation, range of motion?

Once you answer the question of what you want, then you can use the needle to do it. Got it. Right. It's like a chef's knife. Are you

baking a cake or you making a steak? Yeah. Figure, you know, then decide what you're what you're what tool you're going to use.

Got it. So then the location of all those needles would have to be documented in in your chart note for

that day. Yes. In fact, the coding for dry needling is kind of like adjustments. It's not based on time, which is a huge

asset, but it's the first code is one to two muscles and the other one is

three to four muscles or three I'm sorry, three plus three plus muscles. So you have two different levels and and

off the top of my head because I am terrible at remembering codes. I don't remember what those CPT codes are off

the top of my head. Um, but you can obviously Google them. Um, but we got those passed through the AMA with the

help of the PTS. Um, I forget what year that was, but yeah, so we have coding for this. It's not time based. You could

literally do one needle in and out. It could take 10 seconds, you know, and you've satisfied the code, which is

great for personal injury. And we talk about some of the strategies in the class. Got it. Cool. Um, so you've got those

macros that you created. Have you shared them with anybody? Is that I don't know if that's anything that you've done yet.

No, they're my precious. No, of course I say or share them as many people. I tell people about mine. People are like, "I want your macros." I'm like,

"No, $500." No, I'm just Exactly. Exactly. No, I share. No, like

my whole thing is I want to, you know, because I teach a lot. I do um I'm a

medle legal liaison for personal injury. I do a lot of things that aren't seeing patients as much as I used to. So my

hope is that my experience and knowledge can then go to other practitioners who then can use it to help their patients.

So I'm very big on if you know something, share something. Especially with in chiropractors, guys, you know,

we practice in a bubble where typically we're the smartest person in the room, which as the saying goes, you're in the

wrong room. And so as chiropractors are pretty isolated by working in multi- disciplinary offices, I learned, man,

these guys get smarter and smarter so fast because they're hanging out with a pain management specialist that's double board certified in in anesthesiology

with a nurse practitioner who's, you know, his she did family practice and now she's doing pain management PAs and

and MA, you know, uh, medical assistance and we're all hanging out together. I learned so much so fast compared to when

I was in private practice that man chiropractors have got to get together and they got to start sharing their knowledge and experience with each

other. Um rather than being more I think you they like to kind of keep it a secret or they're just antisocial with

each other or competitive when they should be working because really in the end our goal is to see and help as many

people as we can. Man, we can do that much better as a team than we can individually. Yeah. Absolutely.

So, so yes, I share my macros. Absolutely. Long answer. Yeah. So, and they've helped other

people like they're easy to understand and they've been able to obviously just utilize. Have you gotten any feedback?

Yes. Yeah. I mean, it saves them hours. I mean, any of you who sat and built out your own macros, man,

many hours. Many hours. You know, I always say it's like it's like the Constitution. It's a living document. I'm always doing mine and then

I'll find a blip. I'm like, "This could be more efficient." I'll just go in real quick into the editor. It takes no time. I like this would be a little better if

I added this or made this one thing instead of three things. Um that's the beauty of Chairo Touch is

on the flyers like I have a and then I have a basic sheet that I use that um uh

that then my staff can use to populate the note and I can review it. So it's it's I want it to be so easy. You know a

high school student could create it um based on you know uh what I communicate to them. And now with AI scribe uh man I

you you know you just you can talk to the patient. dict it creates a synopsis of the visit based on you know what you

said that is so cool if I was you know seeing in full-time practice man that is something I utilize all the time

yeah it's wild it's um it's almost not creepy but it's impressive impressive um

how well the AI scribe picks things up for sure I had a funny um totally unrelated but funny story this patient

was here and she was telling me all about how like she her back was bothering her and her husband had

brought up her fall decorations with all her pumpkins and stuff that she wanted to put around the house, but she was

just in so much discomfort. She's like the the Rubbermaid container is just sitting on the kitchen table with the lid on it still. She's like, I haven't

even opened it. And so, you know, we've been working with her, but so I went down to edit my

note later and I could not believe how it had summarized this long drawn out conversation about her pumpkins that she

hasn't put out in her house yet. But like what am I I'm not going to sit here and type about the pumpkins, right? But

like the AI scribe was able to capture like the essence of that story and just

like in one sentence very clearly explain like I don't I forget what it said something about our seasonal

decorations or something. But um I I mean I laugh. I literally laugh and it's made charting kind of fun and uh

like I can't wait to see what it writes usually like be with a patient and I'm like oh I can't wait to see what it's

going to say about this. So, um, no, definitely a game changer. Um, I don't

know how much you've really used it, but do you feel like you're using the scribe as well as the macros or,

you know, I I I use pretty much the macros. I keep my stuff so simple.

Yeah. Um, you know, uh, and also what I do a lot of teleaalth uh, with personal

injuries. So like uh I'll I'll just interview people over over chat um and then decide where they need to go

and help manage their cases. I practice in a totally different and unique way. But I'm also a one-man show, meaning uh

when I I don't have staff, so you know, I see we had over a thousand referrals in the last year and a half

into my company. And you know, I have to do the everything on my own. So some of these I I end up having to do the

intakes and everything like that. So and I I do not like redundancy. So, I'm a big fan of get that that intake is so

good at getting the information that you need. Um, and then if you want it to create a narrative out of it, that's a

click of a button. Uh, and and then from there, it's super easy. So, but I could see how on

especially, let's say you're, you know, somebody just pops in, man, and you're like, I don't have time to get their paperwork. I don't have time.

Yeah. I would see how I I would just love to click on that scribe, be like, all right, let's talk about your health history. Let's talk about this. and

you're not worried about trying to type simultaneously while also trying to be

present with the patient. There's nothing worse than a doctor typing and dealing with their computer

while you're trying to explain to them your situation. Yeah. Right. So, it's such a I mean, it allows

you to be present, which I think is, you know, and that's the rewarding part of being a doctor, being present in the moment with your patient. We didn't get

into this to be typing notes all day. We got into it because we love people, which is probably why we don't like doing notes and why I love Chiro Touch

because it allows you to do more of the doctor stuff that makes you happy and less of the admin stuff that you know we

became chiropractors to avoid. Yeah, exactly. Yeah. I had actually went to see my

medical doctor this past week and it was hilarious because I know that they had migrated over to like a new charting

system in their office a year or two ago and it was actually one of my patients was like their liaison for the company

to like do this or whatever. Um, but so I'm in there Friday and I'm just looking at her because she like comes in with

her laptop and it rolls in. She's got this little table and then um and she's listening and I felt like she was

present for the most part but like she was typing the entire time and I was just thinking to myself like you guys

don't have a like a there's no AI scribe listening to us right now. So it's amazing. I mean, I've only had it in my

practice for a few months, but it's amazing to me how like I almost have this expectation now that like all of my

healthcare providers should be using it because I have it. Um, but I also was kind of like, wow,

how do you not have this technology helping us in our visit today? Like, I was surprised. It was It was weird. I'm

actually going to ask when I go next. Um, I suspect that she'll say, you know, they can only implement so many things

at a time. Um, which is kind of true, but you know, anyways.

Yeah. Yeah. Um, all right. So, oh, sorry. Did you were you gonna say something?

You know, it's I was going to say in pain management, they have a scribe. It's called a person. They walk around with a cart,

you know, and they're they're clicking away while the doctor's talking and doing their thing and it's I mean, it's

horribly inefficient. Um, and so I mean having this technology and you know the the plus side being chiropractic office

is that you can change things on the fly like that, you know, healthcare in general when you're working in medical

practice, it's too big of a ship to make quick turns. And so, uh, when those

kinds of integrations are harder to do and the nice thing about being a chiropractor and having Chiro touch, it's the click of a few buttons, it, you

know, getting in touch with somebody to help that you could you could change a policy or procedure using Chiro over

lunch. you know, and make your practice better. You see something wrong, you immediately

can change it with chiro touch, and your practice is better immediately after lunch. That I mean,

it really can be that fast. So, we're definitely fortunate in that regard, for sure. Yeah. Um, all right. We touched on this a

little bit before, but certainly like you guys have your own courses and classes, but like what's typical

training that might be involved for somebody that wanted to maybe get certified in dry needling or what does

that look like? Okay. So, every state is different. Um, uh, my classes because, you know,

first I did it kind of like my when I went to the physical therapy classes who I want to give huge credit to Sue Felone

in structure and function dry needling. You know, she I was one of the few chiropractors in her class and she put me took me under her wing and um, man, I

I she was the first uh, trainer in female trainer in MLB history for the Dodgers. I learned she was so generous

with her time and experience to to to do this for me um or to bring me under her

wing and educate me in dry needling. I TA for her and that's kind of how I learned how to do all this so fast. Um

and um but the classes were split split up into like, you know, advanced or upper extremity, lower extremity. Well, that

makes sense for a physical therapist, right? Because it's a lot of extremities and the spine is also there. you know,

it's ours is more focused spine and then extremities. And so I I I've split my

classes up into spine and extremities. So there's a whole weekend of spine and there's a whole weekend of extremity.

And I address it based on spec condition specific meaning when they come in this

is what I have as far as the literature on how to use dry needling integrate it with what you already know and then on

how to treat specific things like planer fascitis protocol migraine protocol TMJ

um sciatica all you know so it's it's organized more for chiropractors whereas if you go to a lot of these other

classes you're going to get upper extremity and maybe uh cervical and thoracic right and that's going to be a

two to three day class over the course of 24 hours or so. In mine, we do it in two days. Um, and

you and we also integrate a lot of the rehab, meaning, okay, what kind of

exercises should we do with this? I mean, you've adjusted someone, you've needled someone, you now produce this motion. What are you going to do with

it? How do we make this stick? And that's and that's I think we keep dropping the ball as chiropractors is we got to get

into active, you know, care. what the patients part of the responsibility of the care. We get them moving but it's

their job to keep it moving. So increase mobilization, mobility, increase uh stability and strength and

then how do we move someone along that program? And I think a lot of times we try to farm it out. I think sometimes

chiropractors go well here's a here's a brochure on some exercises. You know physical therapist office you

go to their it's a big open space with rubber bands and balls. It looks like cir to sole. I you know chiropractic

offices I find a lot of times when I go to them I call it like a flop house. It's just people laying on tables

getting stuff done to them. You know it's a roller table and then some stem over here and the heat pack and they're

just laying there going does it feel better yet? Does it feel better yet? We're going to get well if it doesn't then we kind of go well you got to give

it time. That's unacceptable. People need to get moving and keep moving and doing P. We know the literature is just

passive modalities do not work as well as active care. The quicker you get them

moving and doing stuff, the better they're going to be. So, we teach a lot of that in the class of, hey, you got

them moving. This is the quickest best way to get them moving is needles and adjustment. What are you going to do with that? You know, uh because we

because as we know, look, let's just be frank, chiropractic incomes have not gone up in over 30 years. insurance

companies are not going to wake up one day and decide to start paying us more. Okay, the median income of a

chiropractor, I think right now, according to the Bureau of Labor Statistics, is what, $60,000, whereas a PT is 80,000. Let's be frank. And when

as soon as they get prescribing rates, we're going to be up a creek. So, you better get real efficient at

solving the p the problems your patients want you to solve quickly because they're not coming in three times a week

anymore. I don't even leave the house to go get toilet paper, okay? I'm not going I don't grocery shopping. I don't

everything is now going anywhere either. No. So, you better be able to fix people in two visits a week and do it fast. And

that means and as income as the the as incomes go down, which has always been the case for chiropractors. My father's

a chiropractor, Mercedes 80s. They haven't come back. They're never coming back. So, get efficient. Get I mean, and

that's where chiro touch is great because it makes you super efficient at managing your practice. But needles don't cost much. Adjustments work great.

And exercise doesn't cost much either. you know, you want those are the three things that are the most effective in dealing in joint pain management. And

they don't cost a lot. We got to get fast, cheap, and effective. And that's uh actually what they're saying at the

physical therapist classes that I sit in now. Same thing. They're like, "Look guys, reimbursements are going down. All

these techs and big spaces and equipment, it's all going away. So you guys better get real consumerist real

quick. So patients come in, they say, I have this pain. You better be able to fix it." And this thing where we do,

well, your real problem is actually this, the bait and switch chiropractic. It's not going to fly anymore. So, you

better get real good at fixing the problem they walk in with super fast and was and super uh efficiently.

Yeah, for sure. So, um you have a website and you have uh

courses and trainings. Um, can people host those or do you have set places

where you are teaching or how do you like to organize that? Yeah, so right now uh I'm teaching in

Phoenix, Austin, Dallas, and Houston. That being said, um I'm always looking

for other states to come to uh and especially as their practice at usually it works like this is uh an association

uh will call me or um or practitioner say hey I want to host a class. So first we got to find out can we do this there?

As soon as we find out that we can, then it's like, "All right." And we try to bring a class there, and if it works, we'll keep coming there. So, um, we're

looking at states like North Carolina, Florida, um, Minnesota, or I'm sorry,

Mont Montana. Um, you know, trying to see where we can go to to, uh, to do these courses and, um, so we're real

open. So, my website's chai needle.com. You can see what classes we have going on right now. And then if you want one

to come to your area, let's say you have a group of docs already and you're like, "We want to know dry needling. could you please come here? Uh, I'm more than

happy to do that. Again, I just want to I want chiropractors to have this tool. I want them to be competitive and I want

them to be effective in the future coming ahead. Awesome. I like it. Yeah. So, we're going to have a link to your site um in

the description of the podcast. So, uh, whoever is listening, if you guys just pop open that description, you can find

that link there to get to Dr. Wan's website. Um, and last question, unless

you have more to add, of course, but if if there were someone on the fence, like, should I do this, should I not,

like it's going to be too hard or too much or it's like, I'm so busy in practice right now, it's just one more

thing to add to everybody's plate. Like, what advice or or how how would you respond to that if somebody was on the

fence? Well, I'd say one, you take the class

even if you don't know if you want to do it because then you can decide whether you the best way to know whether you

want to do it or not is to go do it and see if it's for you. Um are and then you know our age ranges

in our class are from people who graduated a week ago to 70-year-old practitioners. Um again my father is a

second or I'm a second generation chiropractor, you know, and his 70-year-old uh friends are in my class often. So, you're never, you know, as a

doctor, here's something you never want to hear as a doctor. I I've had doctors who say, "Well, I've been doing paper

handwritten notes for 25 years and it's been fine." I never want to hear any doctor say that. I'm like, "My dentist

said, "This is why I've been doing it for 25 years and I'm not changing." That's not what you want to hear out of doctors. There is no place for

traditionalism within healthcare. There just isn't. So, if you're a chiropractor, you know, you want to if

you want to expand your knowledge and actually gain a new skill, which again is super rare out there, uh this is the

class. And if you don't want to take mine, that's fine. There are great other ones. I love again structure and function dry needling with sufal zone.

If you're a sports person and you want to do that kind of thing with uh she is amazing. Um if you want to do more like

pain management, chiropractic and rehab, that's my class. It's what I designed it for. Go out there and there's a million

different ways to do it. It's like it's almost like adjusting. There's nothing more fun than learning how to adjust and

then doing it and getting better and better. But everything else we do in our practice is buying a machine typically.

It does stuff to people and we become technicians. Yeah. Well, good news. Dry needling is like adjusting. It's that much fun. It's like

having another adjusting tool where you get to become the artist again. I always say be a chef, not a cook. Write the

recipes, don't follow them. I like it. Nice. Well, Dr. Wean, thank you so much for joining us and sharing

your knowledge today. Um, it's really clear that dry needling is probably I

don't want to say probably going to become mainstream because I already think it's super prevalent, but I do

think that it is very up and coming and um we're just going to start seeing more and more of it. So, it's probably uh a

good idea for chiropractors to try to help be on the forefront of that for sure. Um, and I do think it can

complement, you know, what we're already doing with chiropractic care in our offices. Um, so for our listeners, if

you want to check out Dr. Wiggin's pre-built dry needling macros for ChiroTouch or learn more about a course with

Chiro needling, uh, we have added links into today's episode notes. And don't

forget to like, subscribe, and share ChiroCast with a colleague who would benefit from today's conversation. Um,

thanks for listening as always, and we'll talk soon. Thank you.

Thank you for joining us on this episode of ChiroCast. Insights for modern chiropractors brought to you by Chiro

Touch, hosted by Dr. Stephanie Brown, produced by Debbie Brooks, editing from

Matthew Dodge, and title animation by Eric Madden. Our theme song, House 5, is

from Scott W. Brooks. If you enjoyed today's show, don't forget to like, link, and subscribe. We appreciate your

support, and we'll catch you next time.

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