Course Review: GEMt Level 1: Intro/Intermediate Dry Needling
I recently had the privilege of attending a dry needling course hosted by GEMt (Global Education of Manual Therapists) in Auckland. GEMt provides courses for manual therapists world-wide as their company name suggests. We were in the market for a dry needling course, and GEMt was the course recommended to us by a few of our colleagues apart from the common “find the cheapest/most nearby” course. It was not the cheapest nor the closest considering we are based in Dunedin – but we don’t want it to be. So, was it worth it?
Soon after I registered, documents were sent to gain access to GEMt’s online content. The course begins here – online, even before I went to Auckland. The course consisted of 3 parts: Safety, Theory and Practical and each part has a test to ensure everyone is competent in them. Robert De Nardis, the presenter, made it very clear on the online modules and in person: Needling is an invasive procedure, and there are risks and contraindications involved; not only for the patient/client, but even more so for the clinician.
He made himself clear more than once: if a clinician gets a needle stick injury and that needle has a blood-borne disease, you as a clinician may die, and it may even affect people who love you the most. Safety – is by far the most emphasized aspect of this course. There is a lot of emphasis in performing the clean needle technique correctly, every time regardless of who is treating and whom is being treated.
As Robert put it, for every 1 patient that says they have a blood-borne disease, you’ve probably treated 10 people who didn’t say it and another 10 who didn’t know about it. The clean needle technique involves needle manipulation (including directions, holding, and which fingers), gloves, and sanitizing the area and gloves. Dry needling is a procedure and the procedure must be followed.
The theory aspect includes a number of scientific papers and several models of dry needling. Two models were introduced: Travell and Simon’s Trigger Point model that many manual therapists are familiar with, and Chan Gunn’s Intramuscular Stimulation (IMS) model. Along with the dry needling models, they also discussed the etiologies of trigger points: the energy crisis theory, motor end plate hypothesis and the radiculopathic model.
Some of the research papers presented also show there are biochemical difference between a trigger point and a normal muscle as well as showing that dry needling can change those chemicals. Same as the safety component, at the end of the theory component, there was a test to that participants must pass prior to progressing the practical component. We will cover more on the theories and models of dry needling in a later post.
After the hoops and hurdles of safety and theory, we finally get to the practical component. The practical component was held in AUT with a small group of 14. The first day of the practical component of the course we finally see a familiar face; having seen Rob in all the videos and then seeing him lead the course in person was a warm welcome.
The practical days once again review and emphasize the importance of safety in the whole dry needling procedure at every step of the way. Needling is an invasive technique and has risks associated with it: both for the practitioner and the client. Prior to the practical, they had already given a list of muscles that they will teach how to needle in the course. It is comprehensive, but does not include everything, as they have a level 2 and 3 course, which includes more difficult muscles to needle safely and accurately.
For each muscle, Rob always starts by reviewing the anatomy, attachments, innervation, segmental myotomes, function, and clinical significance based on his own experience as well. This gives and in-depth understanding of the muscle, rather than just “how to needle the muscle” but also “why would you needle that muscle”. He then goes through palpation and needling, putting emphasis on precautions and contraindications (e.g. beware of femoral triangle, how to avoid femoral artery/vein/nerve). After demonstrating how to do it, we then disperse and practice while Rob supervises and checks on everyone. The structure remains consistent for all the muscles on the list with more clinical reasoning and examples given throughout the 3 days. Over the 3 days, he also introduced more complex and effective needling techniques (e.g. threading, travelling, “fishing-the-hole” which required better needle manipulation skills – especially with longer needles.
Another interesting aspect of the practical component was the use of point stimulator in conjunction with dry needling. Rob introduced the point stimulator to be used in 2 different ways – as an assessment if you stimulate the inserted needle(s) using the point stimulator, you can observe the muscle contraction/movement and be certain what muscle you have needled and stimulated – which helps with our 3D anatomy.
Another use is as an intervention: with similar principles to dry needling but not as “aggressive” and he said some of his previous GEMt graduates have found it useful in populations that does not tolerate dry needling well: it serves as a gentler form/introduction to dry needling. A point stimulator can also be used if you are finding it difficult to manipulate the needle (e.g. depth/length of needle for the muscle). Rob explains that you can use a point stimulator for any muscle, but in his client population, he is able to do normal dry needling on a lot of cases.
Finally, at the end of day 3, as with the other components, there is a practical test for everyone to pass. This required anatomical knowledge, function and needling skills and safety along with clinical reasoning.
So, how does this course stack up to other dry needling courses out there? The main con of this course would be the cost, both in terms of time and money. At 900+ AUD, this course is not the cheapest course financially and it takes 3 days just to do the level 1. On top of that, while it is comprehensive, it does not cover every muscle in the body, to do that you need to do all 3 courses that they offer. They do not cover any acupuncture points as part of the course, they are very focused on dry needling.
However, this course does put a high emphasis on protecting yourself and the client in the safety of dry needling and puts a very comprehensive understanding of each muscle you needle and why you would needle it. Basically, if you just want to dry needle this course is overpriced for you, but – if you want to dry needle better this could be what you’re looking for. I have found that it will not only allow you to dry needle better, but the detail put into this course also improved my diagnosis (e.g. this pain is coming from trigger points in gracillis, not adductor longus) and treatment with other modalities (e.g. massage).
All in all, the 3-day course was very educational and the information from it does not only allow me to dry needle, but also improved other aspects of my clinical skills including specific diagnosis and other treatment modalities. It was definitely not just another dry needling course, it was about going through the basics on how to dry needle better – which serves as a good foundation for their Level 2 and 3 courses that I am already interested in.
To register for their Level 2 and 3 you need to complete their Level 1 course and a 100-episode log book of dry needling that you have done. This course was definitely structured very well: safety, theory, practical – all very comprehensive and you need to be competent in all of them to be a better dry needler.