36. Needling for Pain with Mandy Blackmon, DPT

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00:00 

Jen Milner 

Welcome to bendy bodies with the hypermobility MD, where we explore the intersection of health and  hypermobility, focusing on dancers and other aesthetic athletes. This is co-host Jennifer Milner here with the  founder of bendy bodies, Dr. Linda Bluestein. Our goal is to bring you state of the art medical information to  help you live your best life. Please remember to always consult with your own healthcare team before making  any changes to your routine. Our guest today is Amanda Blackmon board certified specialist in orthopedic  physical therapy, head physical therapist for Atlanta ballet and dry needling instructor. 

00:52 

Linda Bluestein 

Mandy. Hello, and thanks so much for being here today.  

00:56 

Amanda Blackmon 

Hi guys. I'm so happy to be here. Thanks for having me. 

00:59 

Linda Bluestein 

We're thrilled to have you, and we'd love to hear first more about your background.  

01:05 

Amanda Blackmon 

Okay. I grew up as a dancer, but knowing that I really wanted to do physical therapy from an early age. I went  to the university of Georgia and majored in exercise and sport science and gerontology, and then went to Emory  university and got my doctorate of physical therapy in 2005. Very quickly after graduating from Emory I was  really missing the dance world and performing arts. I started taking courses and got certified in Pilates and  dance medicine training so that I could go into performing arts medicine. Very soon after that became interested  in chronic pain and trigger points. Went through seminars, dry needling courses in 2009 and 2010. I've been an  instructor with them for about eight years now. So I'm really enjoying that. I get to travel all over the country  and teach dry needling to physical therapists, chiropractors physicians, nurse practitioners. So that's been really  fun.  

02:08 

Amanda Blackmon 

My research interests really lie in hypermobility, performing arts medicine, pelvic floor dysfunction and dancers  and dry needling and chronic pain.  

02:18 

Linda Bluestein 

That is so awesome. What we really want to talk about today is dry needling. This is a subject that I think is  going to be so useful for people. Can you start out by telling us what is dry needling?  

02:30 

Amanda Blackmon 

Yeah, it's interesting because they call it dry needling because we're using a needle. That's not a hypodermic  needle with an injection. A lot of patients are familiar with pain injections, whether that be lidocaine or other  substances, even steroid injections. When we use dry needling, it's a solid thin filament needle, similar to an  

acupuncture needle. We find an actual trigger point or not in the muscle. We're looking for that trigger point to  twitch and almost release when we put the needle into the muscle. There's not an actual substance being  injected. Okay. And how is that different from acupuncture? Similar tool, but very different methodology in the  way of looking at a patient. Acupuncture really comes from a traditional Chinese medicine or Eastern approach.  I'm not an acupuncturist. I'll telling you what I know as far as the differences, but acupuncturists tend to look at  meridians or chi lines or energy lines.  

03:34 

Amanda Blackmon 

They're looking at the body very holistically and looking at a more Eastern based approach of balancing energy  or balancing chi. It's wonderful for a lot of different things. Whereas healthcare practitioners who practice dry  needling are typically coming from a more Western training. There are acupuncturists who also do dry needling,  but physical therapists, physicians, chiropractors, nurse practitioners that practice dry needling are typically  coming from a more Western training, looking at pain science, looking more specifically at pain referral patterns  that have been established in the literature. Also looking at other impairments that trigger points may cause like  range of motion, strength, motor planning issues, and using the needle to go after those more specifically.  

04:26 

Jen Milner 

You mentioned several different types of medical professionals that might use dry needling. It sounds like it's  something that crosses over a few different descriptors and is not just for physical therapists or just for  chiropractors, but as a tool that the larger medical community could make use of, is that fair to say?  

04:47 

Amanda Blackmon 

Okay, that's fair to say. Dry needling really came to the United States in the physical therapy world in the  nineties. My mentor is a Dutch trained physio-therapist and started during noodling here in the nineties and was  the first trainer, I guess, of dry needling. Now there are many schools, but it really varies state to state on which healthcare practitioners are allowed to utilize dry needling within their scope of practice. I believe right now, the  number for physios to use it is up to 36 states in the country. Sometimes athletic trainers can do it, like for  instance, where you are Jen in Texas athletic trainers can dry needle. There are a few states where chiropractors  can do it. Physicians and nurse practitioners, I believe across the board can do training.  

05:45 

Jen Milner 

Interesting. Not every state allows physical therapists to do dry needling. You said, I think 36 out of 50.  

05:52 

Amanda Blackmon 

Don't quote me on that number, but it's somewhere around there. There've actually been some pretty big  territory wars across the country. States like California, New York, I believe Oregon, Washington, Hawaii,  Pennsylvania for various and sundry reasons have not allowed dry needling. Some of that is acupuncturist or  chiropractors or physicians actually using political lobby to fight that. Other states, it's not as big of a battle. It's  just that there was originally written in their practice act that physical therapists can't pierce the skin. It's kind of  depends on what states have taken it up as a fight they want to fight. And, as a dry needling instructor, I'm  hoping we can get it passed in all 50 states in the near future.  

06:48 

Jen Milner 

So what issues might dry needling be used for then?  

06:54 

Amanda Blackmon 

Great question. Traditionally it's really thought of a technique to treat pain directly. So Dr. Janet Trevell and Dr.  David Simons wrote their very famous, dry needling texts in the eighties and established pain referral patterns  for almost every muscle in the body. A lot of people just think of using dry needling for pain, but more current  research has shown us that trigger points can actually have a greater effect on more impairments that healthcare  practitioners might see. For instance, it can limit range of motion and flexibility in a muscle. It can cause a  muscle to appear weak. It can make muscles or functional muscle groups have altered movement patterns. It can  actually cause more autonomic type symptoms like feeling of fullness in the ear, or even ringing in the ear or  vertigo or crying of the eyes. Sometimes we're using it a bit more holistically to address symptoms like that.  

07:59 

Jen Milner 

Oh, it sounds like there is some I think what you were saying with trigger points is that it starts musculoskeletal  for a lot of people in dealing with those issues, but it sounds like you're linking it also to possible nervous  system uses as well.  

08:13 

Amanda Blackmon 

Absolutely nervous system, but then also GI symptoms, vestibular symptoms. It can really kind of cross the  gamut as far as different presentations that patients are presenting with. I see that even more in our hypermobile  patients because they tend to have so many systems involved. A lot of times their trigger points can treating  their trigger points. I can get an even bigger effect because I'm addressing multiple systems at once.  

08:41 

Jen Milner 

If you're addressing multiple systems, whether advertently or inadvertently, right, it's really helpful to have a big  understanding of what population you're trying to work with specifically. You mentioned with hypermobility  because people with hypermobility often have multi-systemic issues. It would be really helpful to have a good  working understanding of people with hypermobility and their issues. How might the hypermobile population  react differently to dry needling in general?  

09:12 

Amanda Blackmon 

Great question. I think, I don't know that this is established in the literature, but anecdotally, because I work  with the population so much, I really think our hypermobile patients have more trigger points than the average  patient. I almost imagine it's like our muscles are working overtime to try to hold our joints together because the joints aren't doing their jobs. The muscles are, and I think that because they have more trigger points, they can  also have more of the pain complaints, more of the systemic effects. For instance, we know that trigger points in  the abdominal wall, whether it be rectus abdominis, the obliques transverse abdominis are typically indicative of  some kind of underlying visceral dysfunction. We know that our hypermobile population have a lot of  underlying, both gynecological and or GI issues. A lot of times those are going together and I might be  addressing trigger points in the abdominal wall, not only for their low back pain, but also to address low gastric  motility or endometriosis type symptoms.  

10:27 

Linda Bluestein 

How do you decide where to start? Because at least for my hypermobile pateints, like they have in general, like  so many symptoms, so many different things going on, and they all have trigger points, like tons of trigger  points. It seems like. Do you kind of go with, what is the biggest thing that they are presenting with on that day,  or once you've picked a course, you kind of stick with that course until you switch to something different, or  how do you approach that?  

10:54 

Amanda Blackmon 

That's a great question. Sometimes I'm totally going off instinct, but when I'm teaching this to students, I tell  them to start centrally. A lot of times when the hyper mobile patient that has widespread chronic pain, or maybe  even a CRPS or something like that, I think of needing a window into the system. A lot of times my go-to is  actually the thoracic spine. If you think about that, those thoracic segments are sitting over the sympathetic  chain can have huge responses from the autonomic nervous system. A lot of times I'll start there and think let's  just kind of calm this nervous system down. See if we can get that thoracic spine moving a little better, the  fascia around the thoracic spine moving better. A lot of times that's one of my go-tos we know from the  literature that upper trapezius is another great place to start with pain.  

11:53 

Amanda Blackmon 

There's actually some research studies that show in a more fibromyalgia population. I'm using finger quotes  there that a single injection into the upper trapezius is enough to calm down that nervous system and calm down  those pain pressure thresholds. A lot of times I'll extrapolate that to dry needling, but I'll start with upper trap.  Lumbar spine is another great place to start. If I'm looking at a patient that does have a lot of other visceral  complaints, I'll start on the abdominal wall and not always with dry needling. Sometimes I'll start with just  manual therapy and demonstrating to my patient, Hey, this is part of what's going on with you. It's going to be  part of our treatment plan.  

12:42 

Linda Bluestein 

How many places might you dry needle in one visit?  

12:48 

Amanda Blackmon 

I tend to start pretty low because you always want to kind of gauge your patient and see how well they respond  and make sure that you don't flare them up or exacerbate and make their symptoms worse. I've found that a lot  of my hypermobile patients really love the training and they can almost get a little addicted to it in the best  possible way. Dr. Bluestein really loves it. Gauging that response and making sure you're following up with  neuromuscular reeducation pain education. Good quality pain-free movement is really important as well,  because you can go in and just needle the heck out of a patient. They may feel really great for the time being,  but then they're going to flare right back up, because if you don't retrain the system, it's going to go right back to  its initial state. A metaphor I use for a lot of my patients is when you have trigger points in your muscle, it's a lot  like your computer going into the spinning wheel of death, right?  

14:00 

Amanda Blackmon 

Like the pin wheel that just spins and spins your computer, can't move forward. It can't move backward. It's just  stuck. For a muscle, the same thing, that muscle can't relax, it can't contract like it's supposed to, it can't stretch.  Like it's supposed to, it can't activate like it's supposed to. Taking a needle and getting rid of that trigger point is  like hitting control alt delete on the system. By the same token, if you just reset your computer and you don't do  a software upgrade, your computer's just going to go right back to where it was. That's how, kind of how I treat my patients and explaining to them the importance of regaining those motor movement patterns, finding good  pain-free movement that is helpful to them is of like their software upgrade. We can't just have them on the  table, dry needling. We have to make sure we're balancing that with other treatment modalities.  

15:01 

Linda Bluestein 

You mentioned myofascial release, which is another like passive modality, right? Dry needling is a passive  thing on the part of the patient. Right. So correct. You'll probably, that's also your, you want them actively  engaged. You want them re establishing a positive relationship with their body and okay. So all that makes  sense.  

15:19 

Amanda Blackmon 

Absolutely. I'm a big fan of Kinesio tape as well, or different kinds of taping methods. I think of following up  my dry needling and releasing those muscles with good movement education, which might be assisted by tape  or bracing or other kinds of external support as well.  

15:39 

Jen Milner 

That's so important what you have been talking about. I know anecdotally for me and the dancers that I work  with when they go get dry needling, I know there's several different providers that I work with in the area that  do dry needling and the ones who aren't used to hypermobility will get, I think, a little excited at all the tight  muscles that they find. They'll be like, oh, we're going to release this and this. I talk about how, when something  is released in the hypermobile person's body, it's like the rest of the things just do a runner and they just go,  they're like, we're afraid. Different muscles just grab on tighter to try to hold on. What you mentioned earlier  about how important it is for the body to stabilize the joints and how often we do that to the detriment of  overusing some muscles.  

16:28 

Jen Milner 

Once these muscles are released, there's no structure in place for them to use. It's so important from what I have  seen as a non-medical professional to approach the hyper mobile population, slowly, as you mentioned, and  starting with just a few things or else I have seen them bounce back the next day, maybe in a different part of  their body, much tighter and having some a flare. I love that you're recognizing that there is a difference in that  it does need to be approached slowly and with caution because it's such a valuable tool, but if a hyper mobile  person experiences it without that framework, without the software upgrade that you mentioned without that  retraining, then they may walk away going, oh, it was no good for me, really didn't work well. They were just  missing part of that experience. Part of that rehabilitation experience, they got the first part, but didn't  necessarily have the rest of it to go with it.  

17:27 

Jen Milner 

So thank you for that.  

17:29 

Amanda Blackmon 

Absolutely. And full disclosure. I've made that mistake even with my own business partner who has a very  hypermobile shoulder over needle that shoulder and the humeral head just falls out and it's like, no, that was a  little too much. I would encourage practitioners who are working with hyper mobiles to also be kind to yourself.  You will make that mistake. It's a very fine line of doing too little or too much. And, you know, tape helps  everything. You can just keep that right.  

18:01 

Jen Milner 

Well, so speaking of this, how do, how would someone find a practitioner, a good practitioner for, dry needling. 

18:10 

Amanda Blackmon 

It's a great question. There are now over 30 schools of dry needling in the United States and they all approach  things differently. I'm obviously biased because I've been with my particular company for a very long time, and they were the first company in the United States, but they're also excellent schools across the country. It kind of  depends on where you are. I think as to which training programs kind of have a hold in that region, the  American physical therapy association has a find a PT site. This is just findapt.org, I believe where you can  search and you can use dry needling is one of the keywords that you search for, which can be helpful. I also  think talking to other patients and getting a specific referral can be huge because I've had patients come in to me  and they say, oh, I've had dry needling.  

19:12 

Amanda Blackmon 

It didn't work. I say, okay, well tell me about that dry needling experience. They were dry needled by someone  who's trained completely differently than I am. Some of the dry needling schools use more, what we call  indwelling needles. They put lots of needles in, they might even hook them up to electrical stem, which is fine.  It's just not the style that I'm trained in. It might be a very different experience for that patient to see someone  who's trained differently or see someone who's accustomed to working with hyper mobile patients. A lot of  times it's word of mouth, but there are different websites you can go to look for a practitioner. I would say  asking the healthcare providers in your area or asking other patients where they've had positive experiences is  probably the most valuable.  

20:06 

Linda Bluestein 

That makes sense. Likewise, to find a physical therapist who is likely more knowledgeable about hypermobility,  do you have any suggestions for that?  

20:17 

Amanda Blackmon 

I think then looking at the performing our special interest group through the PTA, they have a provider search  engine. IADMS, the international association of dance medicine and science, has a provider search engine. A lot  of times it's cross-checking those like, okay, this person does dry needling. This person does hypermobility. And  where do those two intersect?  

20:42 

Linda Bluestein 

Sure. If a hyper mobile artist wants to try dry needling as a part of their care, what kind of information should  they share with their practitioner?  

20:53 

Amanda Blackmon 

They should make sure their practitioner knows that they're hyper mobile and how they've responded to other  manual therapy interventions in the past. Patients are very intuitive and I think especially our hypermobile tend  to know their bodies very well. I've had patients come in to me and say, Hey, if you're going to address my QL,  make sure you do it on both sides because it tends to throw me off. If you only do manual therapy one side, just  anecdotal, things like that. I think previous experiences with manual therapy or other types of intervention, as  much information as you can give your physical therapist or healthcare provider about that is only going to help  them. It's up to the PT or whoever you're seeing to actually listen and take in that information and try to apply it  to the patient that's in front of them.  

21:54 

Jen Milner 

Sure. And, and jumping on to that, you mentioned talking about your experience with dry needling in the past  for the hyper mobile person. You mentioned if so multi-systemic is sharing other information medically that you  think might be part of your hypermobility, also helpful talking about other issues that you might have.  

22:19 

Amanda Blackmon 

Absolutely. If you have autonomic symptoms or pots or GI issues or hero gynecological issues, all of those are  really important. For instance, if I have a patient on my table who has a history of pots and I'm needling cervical  spine, upper trap, any of those muscles that might be involved in that blood pressure regulation or vestibular  hyper or hypo function, I'm going to be extra careful. It's not that I'm not going to needle them, but I'm going to  go slow. I'm going to continually monitor their response to what I'm doing when we're done dry needling, we're  going to sit up very slowly. We're going to regulate our system. We're not just going to hop off the table andwalk across the room. I think having that knowledge and, just being a little more kid gloved with those types of  patients can be helpful for the practitioner and the patient that's on the table.  

23:28 

Linda Bluestein 

That makes sense. Are there situations where dry needling would not be helpful or might not be helpful?  

23:35 

Amanda Blackmon 

Absolutely. It's definitely not a cure. All right. I'm using it as an additional tool in my larger toolbox, but there  are patients that I do avoid. Some patients have metal allergies to the needles. That can be an issue if they have  really high skin sensitivities, localized or systemic infections are another issue where you may not want a dry  needle. You may want to use more manual techniques to you to address those trigger points. We typically don't  dry needle in the first trimester of pregnancy, just because even though there's no association with spontaneous  miscarriage, the incidence of miscarriage is so high in that first trimester of pregnancy that I tend not to dry  needle then unless it's a patient, who's had a lot of experience with dry needling before patients with bleeding  disorders. Whether they're have low clotting levels or they're on some type of anticoagulant medication, whether  it's related to hypermobility or not, there are certain muscles we tend to avoid just because we can't apply direct  hemostasis.  

24:51 

Amanda Blackmon 

We don't want to risk that patient having a bleeding episode, I'm trying to think of other contra-indications to  dry needling. Some patients are just afraid of needles, and if they truly have a fear of needles, treat them  manually. It's not worth battling that when we have other tools in our toolbox.  

25:17 

Linda Bluestein 

And, and that's a perfect lead into the next thing I was going to ask, which is, what about the patient who does  have concerns about breaking the skin or you have concerns about they're at higher risk for infection? How do  you, can you dive into that just more, especially in reference to, you mentioned about metal allergy and patients  who might have, a lot of allergies and potentially are in the mast cell disorder,  

25:48 

Amanda Blackmon 

There aren't a lot of incidences of infection being caused by dry needling. However, there have been some case  studies of say, a patient was dry needled and then put in a dirty whirlpool, they got a skin infection. We also  know that postoperatively, you always have the risk of that joint, say if it's a joint replacement, a total knee, total  hip, you always have a higher risk of that joint. You're becoming septic and getting an infection. Different  schools teach different timelines of say, you might avoid needling directly around a knee replacement for at  least six to eight weeks, or you want to make sure that skin and tissue is thoroughly healed and showing  absolutely no signs of infection, no redness, no warmth, no swelling, no fever, no streaking up the leg, et cetera,  before you would draw me in that area. I think it's really on a patient case by case basis.  

26:55 

Amanda Blackmon 

Most practitioners don't alcohol swab the skin anymore because some of the newer research is saying that's  actually taking away the external, the first barrier to infection, which is our natural oils on the skin and actually  drying out the skin. Other people say, oh my gosh, I feel so much better if you do go ahead and alcohol swab my  skin. Again, it's on a case-by-case basis and I'm treating the patient that's in front of me. I think it's really about  educating the patient, answering their questions thoughtfully and thoroughly to make sure they're completely  comfortable with the procedure.  

27:39 

Linda Bluestein 

It's really good that you mentioned about if someone like, for example, has had a knee replacement because  everything is connected in the body. I know, when I was doing anesthesia in the operating room and somebody  would come in for heart surgery and I would be talking to them and realize that they had a potentially infected  tooth that they had not mentioned to their surgeon. All of a sudden, now we have to revisit, are we going to put in this artificial valve? If you go in for a PT visit and you have an infected tooth, or you have some infection  going on elsewhere in the body, that's also a good thing to mention.  

28:12 

Amanda Blackmon 

Absolutely. Yeah. We want to know, like, even if my patient feels like they're coming down with a cold and has  swollen lymph nodes, I'm not going to needle them that day. There's just no reason to add in an extra layer,  potential infection or potential complication when we do have other tools available.  

28:33 

Jen Milner 

That's great. There, I feel like you have covered a lot of information in a short amount of time. Thank you for  being so clear, cut and succinct because I've definitely learned a lot. Was there anything else that you wanted to  share about dry needling and the hypermobile population?  

28:52 

Amanda Blackmon 

I would say that maybe not hyper mobile individuals in general, but dancers in particular have tend to have very  high pain thresholds and they, again, they tend to love the dry needling. You want to be careful not to overdo, to  really use your clinical reasoning skills as a healthcare provider and make sure that you're fully addressing that  patient and not just dry needling because some they'll come in just for that. I think that's going to help the  community at large, if we make sure that during needling is being used as only one piece of a larger plan of care  and treatment plan for that community, because they do tend to get a little addicted.  

29:45 

Jen Milner 

It just feels good.  

29:47 

Amanda Blackmon 

It does. It's great. I love it.  

29:51 

Jen Milner 

So let me ask you this. I have one more thought after you saying that is dry needling, something that a lot of  people use for chronic pain, or is it something that most people go to for musculoskeletal first? It's just now  being talked about for chronic pain or where is it with that?  

30:08 

Amanda Blackmon 

It's both. I think previously it was more of a chronic pain modality, and now we're really seeing in the literature  that it can be extremely useful for more acute injuries. There was actually a great study. They did in New Jersey  where they were using dry needling in an emergency room, along with, I think classical music I'll have to find it,  but they were able to reduce their opioid prescriptions by 50% by utilizing dry needling techniques for acute  type things. You figure the patient that throws their back out or has an acute migraine or acute neck pain. We are  seeing it starting to be used in a more acute population very effectively.  

31:02 

Jen Milner 

That's really cool. I have high hopes for where this is going to go for the general population. That's awesome.  Where can people learn more about you and your work?  

31:13 

Amanda Blackmon 

I have a website it's Mandydancept.com. I believe I'm also on Instagram and then my other business, along with  my business partner, Emma Faulkner. We just opened last September. So Atlantadancemedicine.com. We have  an Instagram as well and teach dance medicine courses. My company that I teach dry needling for is a great  source of information. myopainseminars.com is on the internet and there are some good frequently asked  questions and resources for patient information about chronic pain information about dry needling. There's also  a source there where you can see different rulings in different states where dry needling is allowed, which is really helpful. I think for patients because they can say, okay, I'm in California, it's not allowed by physical  therapist here. There a way for me to find maybe an acupuncturist that also does dry needling and find some  different resources that way.  

32:18 

Jen Milner 

That's great. That is very helpful.  

32:20 

Linda Bluestein 

On the myo pain website, they probably also have any practitioner that's certified specifically in myopain also,  right? Even if their physician or nurse practitioner or whatever, they would be on,  

32:35 

Amanda Blackmon 

We had a website change during COVID. So that functionality is there. It is not a hundred percent up to date,  but I am also really good at remembering who I've trained and where. If patients do, if they're having trouble  finding a practitioner, they're welcome to email me or find me on Instagram and I can try to find them  somebody based on their zip code.  

33:01 

Linda Bluestein 

I should have clarified at the beginning when I was raising my hand and saying that I am addicted to dry  needling. My physical therapist was trained by you and she is wonderful. And does it very selectively? I mean,  she's, it's definitely not at every session. It's just specifically certain times that she's like, I think today we should  dry needle and it's been very helpful. I think in some ways, I don't know if you find this with your patients,  Mandy, but it's almost like that acute pain of the needling, because it is painful.  

33:31 

Amanda Blackmon 

It can be very painful. It can.  

33:33 

Linda Bluestein 

Yeah. It, and depending on where they're going and stuff like that, but it's almost like then afterwards, the  release and there's something that changes afterwards where it's like, yeah, okay, now it's sore, but it feels better.  Some how I don't really, it's hard to put into words almost, but for me personally, I've, there's been times where  it hasn't really changed much, but there's been other times where it definitely has. I do believe that it matters  very much what all is being done surrounding that and how it's being utilized when it's being utilized and all of  that.  

34:09 

Amanda Blackmon 

Yeah. And how you're following up. And I think it's impatient. It's important for patients to know that too. You  do have a trigger point or a knot in the muscle, we know that there are actually excessive levels of pain  chemicals inside that knot. When you put a needle into the knot and that muscle twitches and then releases those  pain chemicals are dispersed into the surrounding tissue, which is why we think you get that yes, pain relief, but  also a post needling soreness or achiness that can be more widespread than the acute focal pain you may have  been having when you walked in. It's important for patients to know that's very normal. Typically it goes away  in 24 to 48 hours. Some patients don't have any soreness at all, but other patients will have soreness for a lot  longer. That can mean that maybe you were over-treated or even undertreated.  

35:08 

Amanda Blackmon 

Again, there's a fine line there of knowing how much to do, especially with a patient who's hyper mobile.  

35:15 

Linda Bluestein 

Right, right. Because we know that people that are hyper mobile are also more prone to anxiety. We don't want  people to be like, oh, I'm sore. Oh, this is bad. Getting more anxious, which is going to make the pain worse, which is going to make the anxiety worse. We want to use all of this education too, as a way of being able to  have all of these things as successful as they possibly can because we're armed with information that will help  reduce that anxiety and help really help us to understand what's happening in our bodies and all of that.  

35:52 

Amanda Blackmon 

Absolutely. Arming these patients with ways to treat trigger points themselves as well, because the needle is not  the only tool. Using foam rollers, using pinky balls, using theracane, there's all these different products and  ways to treat trigger points. I think giving patients that education is only going to empower them, to help treat  themselves as well, so that they're not completely dependent on the passive therapies of their PT or whoever else  is treating them.  

36:23 

Jen Milner 

I do see the dancers who that I work with, who get the most out of PT, dry needling are the ones where the PT  says, okay, remember this? So here's a lacrosse ball. You get into the middle of rehearsals or whatever. Here's  where you're going to try to address it yourself. If it comes up again. Now let's talk about why you keep having  this one spot, be an issue. Let's talk about what support system you've got in place. Let's say they have to have  their FHL needled all the time.  

37:01 

Jen Milner 

Let's talk about what might be happening instead and what we should be using instead. It's that piece of the  puzzle, as you mentioned earlier, and being, and empowering the patients to take over that self care as much as  they can. Right. And, and making sure that they're not just stuck or addicted, as you said to coming in and  getting the needles and running out the door without trying to effect a real and lasting change. Absolutely. Yep.  Well, we have really enjoyed today. I really appreciate this conversation. You have been listening to bendy  bodies with the hypermobility MD today. We have been speaking with Mandy Blackmon, Mandy, thank you so  much for taking the time to come on the bendy bodies podcast and to share your expertise with us today.  

37:46 

Amanda Blackmon 

Thank you so much for having me, ladies. This was so much fun.  

37:51 

Linda Bluestein 

We really appreciate it. We, I can say that I learned a lot, even though, like I've been needled, I've spoken with  you about dry needling for, I think four hours was our last conversation. Some of which was about dry needling.  Some was about other things, of course, but I still, I, yes, this was super informative. So we really appreciate it.  Thank you.  

38:10 

Amanda Blackmon 

Well, I've loved being here. Thank you for all the great work you do.  

38:14 

Jen Milner 

Thank you. Thank you. Thanks for being our guests. We'll see everybody next time. Bye.  

38:20 

Linda Bluestein 

Thank you for joining us for this episode of bendy bodies with the hypermobility MD, where we explore the  intersection of health and hypermobility for dancers and other aesthetic athletes. If you found this information  valuable, please share it with a colleague or friend and leave us a review on your favorite podcast player.  Remember to subscribe so you won't miss future episodes. If you want to follow us on Instagram, it's at bendy  underscore bodies and our website is www.bendybodies.org. If you want to follow bendy bodies, founder and  cohost, Dr. Bluestone on Instagram, it's at hypermobility MD, all one word and her website is  www.hypermobilitymd.com. If you want to follow co-host Jennifer Milner on Instagram, it's at Jennifer.milner  and her website is www.jenniferhyphenmilner.com. Thank you for helping us spread the word about  hypermobility and associated conditions. We want to hear from you. 

39:25 

Linda Bluestein 

Please email us at info@bendybodies.org to share feedback. The thoughts and opinions expressed on this  podcast are solely of the co-host and their guests. They do not necessarily represent the views and opinions of  any organization. The thoughts and opinions do not constitute medical advice and should not be used in any  legal capacity whatsoever. This information is not intended to diagnose, treat, cure, or prevent any disease as this information is for educational purposes only, and is not a substitute for medical advice, diagnosis or  treatment. Please refer to your local qualified health practitioner for all medical concerns. We'll catch you next  time on the bendy bodies podcast.