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Dry Needling

What Is Dry Needling?

Dry needling is an invasive (superficial or deep) technique used to treat myofascial pain syndrome. This is a regional muscular pain condition. Myofascial pain syndrome has been recognized by medical practitioners as contributing to or causing sensory, motor, and autonomic impairments. It is normally associated with palpable muscle “knots” or taut bands known as myofascial trigger points, which can be addressed with dry needling. Dry needling is a low risk, inexpensive intervention, and can only be performed by physical therapists who are certified by their state board.

History

Dr. Janet Travell and Dr. David Simons pioneered the field in the 1940s by their discovery that injections of analgesic medication into trigger points caused a decrease in symptoms, pain, and sensitivity to touch. Through the natural continuation of their research, it was discovered that the mechanical insertion of the needle into the muscular tissue was as effective as a needle that applied medication. This evolution of trigger point dry needling research has provided an alternative to injected medication for pain relief. Research demonstrates that the physical insertion of the needle alone is sufficient enough to cause a therapeutic benefit via pain reduction or an abatement in abnormal muscular tone. Dry needling has gained popularity steadily since these discoveries, particularly with a resurged interest by healthcare professionals in the 2000s. It was strengthened by the mapping of pain patterns associated with different trigger points, and their interactions or influences on myofascial pain syndromes.

Conditions That Benefit from Dry Needling:

  • Ankle pain
  • Elbow pain
  • Hip pain
  • Knee pain
  • Shoulder pain
    • Rotator cuff disorders
  • Spinal pain including:
    • Cervical pain
    • Thoracic pain
    • Lumbar pain
    • Postural dysfunction
  • Plantar fasciitis
  • And other myofascial/muscle injuries

How Does Trigger Point Dry Needling Work?

Dry needling uses a small, thin, and solid monofilament needle, similar to an acupuncture needle. It is inserted directly through the skin and muscle into an active or latent trigger point. No chemical agents are used. The mechanical stimulation created by the needle elicits a twitch response, causing the tissue to disengage and “release”. Enabling the trigger point to deactivate in the dysfunctional muscle will often result in reduced symptoms and improved mobility. Dry needling should be used in conjunction with additional interventions as part of a comprehensive plan by a licensed provider.

What Is a Trigger Point?

A trigger point is defined as a focal, hyperirritable nodule located in a band of skeletal muscle that results in local or referred pain with mechanical stimulation. Trigger points are palpable knots most commonly found in the center of a muscle belly. Any skeletal muscle in the body is susceptible to develop trigger points, which can be caused by acute trauma, or repetitive muscular stress. Trigger points are also often linked with chronic musculoskeletal disorders. Symptoms can include local/referred pain, increased sensitivity, muscle spasm, muscle stiffness, muscle weakness, decreased range of motion, and autonomic dysfunction. Common causes of trigger points are:

  • Acute trauma
  • Chronic stress conditions (anxiety, depression, psychological stress)
  • Dietary deficiencies
  • Lack of exercise
  • Muscle overuse/overtraining
  • Repetitive muscular stress

Is Dry Needling the Same as Acupuncture?

The short answer is no. Despite utilizing similar instruments, the two techniques have different methods and different philosophies. Acupuncture is a recognized alternative treatment technique that follows the principles of Traditional Chinese Medicine and looks to re-balance altered energy flow believed to go through “meridians” (pathways) in the body. Acupuncturists will evaluate the energy flow in patients, often by assessing their pulses. They associate impaired flow with poor health, dysfunction, medical conditions, and disease. Dry needling is a specialized therapeutic skill that focuses purely on the musculoskeletal system to treat a variety of myofascial pain syndromes. A physical therapist who is certified in the technique will assess the patient for trigger points, tone, or other palpable findings. Once a trigger point is identified, a thin needle is inserted into the affected tissue. Common needling techniques can include a pistoning motion (up and down), twirling motion, or leaving the needle within the muscle tissue for a designated period of time. The goal of dry needling is to mechanically address active trigger points, reduce muscular tone, reduce pain, and improve patients’ movement patterns.

How Many Treatments Does It Take To Be Effective?

This is dependent on the primary condition being treated and the tissue involved. Effectiveness is measured by how your body shows improvement in your functional movements, and not by pain reduction alone. There currently seems to be no link between the number of sessions and pain relief — 5-6 sessions can have similar effects in terms of pain relief to 1-2 sessions. It generally takes a few sessions to have a positive effect, but it is possible to have an immediate decrease in pain and an increase in mobility. Applying dry needling 3 times per week appears to have comparable effects as once a week for 2-4 weeks. Responses can vary from no difference to a significant decrease in pain intensity. Effects of dry needling remain up to 4 weeks after the intervention. However, to meaningfully reduce a patient’s pain long-term requires sustained improvement in the patient’s functional movements. This usually requires a comprehensive treatment plan to include manual therapy, targeted exercises, neuromuscular re-education, and addressing biomechanical dysfunctions.

What Should I Do After Dry Needling?

It is common and expected to have soreness in the tissue that was needled to last 24-48 hours. It should dissipate each day.

Following dry needling treatments, someone should:

  • Promote circulation in the muscle/tissue that was needled.
    • Keep moving! Frequently and repetitively move the part of the body that was needled.
    • Avoid prolonged postures or sedentary positions.
    • Use heat.
    • Avoid ice. This causes restricted circulation.
  • Stay hydrated.
    • Drink lots of water for better cellular circulation.
    • Limit diuretic drinks such as caffeine and alcohol.
  • Stretching gently.

For further information regarding Trigger Point Dry Needling and to find out if this treatment is appropriate for you, please reach out to one of our physical therapists who will be happy to discuss this option with you.


Resources

  1. Segura-Orti E, Prades-Vergara S, Manzaneda-Pina L, Valero-Martinez R, Polo-Traverso J. Trigger point dry needling versus strain-counterstrain technique for upper trapezius myofascial trigger points: A randomised controlled trial. Acupuncture in Medicine. 2016;34(3):171. https://search.proquest.com/scholarly-journals/trigger-point-dry-needling-versus-strain/docview/1793871810/se-2?accountid=41004. doi: http://dx.doi.org/10.1136/acupmed-2015-010868.
  2. Espejo-Antúnez L, Jaime Fernández-Huertas Tejeda, Albornoz-Cabello M, et al. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement Ther Med. 2017;33:46-57. https://search.proquest.com/scholarly-journals/dry-needling-management-myofascial-trigger-points/docview/1922855935/se-2?accountid=41004. doi: http://dx.doi.org/10.1016/j.ctim.2017.06.003.
  3. History of Dry Needling | Integrative Dry Needling Institute
  4. Acupuncture | Johns Hopkins Medicine

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