A treatment involving the shoving of a very slender needle into the skin in order to activate a pressure point, dry needling is type of alternative treatment that’s used to relax tight bands of muscle associated with hard “knots” in a muscle or trigger points that result in pain over a certain part of the body. Because every time the affected site is touched these trigger points cause pain, it can be difficult to perform everyday tasks. The pain may even travel to areas near the affected site.
Dry needling entails the use of a solid needle pricked into scar tissue, subcutaneous fascia, tendons, ligaments, and muscles as opposed to wet needling that uses hollow-bore needles to inject sclerosants, anesthetics, corticosteroids, and other agents into the body. Also, dry needling is not the same as acupuncture, a treatment used to release obstructed energy channels or meridians and restore or maintain balance into the bodily systems. Dry needling works by activating a specific trigger point that causes disability and pain; acupuncture, on the other hand, addresses energy flow issues around the bodily organs and body.
The Journal of Orthopaedic & Sports Physical Therapy published a study in which researchers examined the outcomes of the highest quality clinical ytials that have been done so far to test whether dry needling is able to relieve arm and neck pain, two areas where trigger points commonly develop. The conductors of the study saw that dry needling is able to effectively alleviate pain caused by painful muscles, trigger points, and myofascial pain syndrome. When a physical therapist uses this procedure especially when it’s combined with exercise or other techniques, it serves as an extremely beneficial treatment.
One very typical form of pain is caused by a myofascial trigger point. The term myofascial is a combination of two words: myo refers to muscle tissue and fascial refers to the connective tissue within and surrounding the muscle. A myofascial trigger point often comes about due to an injury to the muscle, like repetitive strain and typical running injuries. When pressure is applied, it is painful and can generate pain in other areas of the body as well. This is known as referred pain.
Trigger points, say, in the face, neck, and shoulder muscles, can often cause headaches due to the fact that the pain is referred to the head by the trigger point (thus the term, referred pain). The Current Pain and Headache Reports published a study showing that direct muscle trauma or overtraining the muscle can result in the rise of trigger points. When muscle use is greater than muscle capacity, it disrupts normal recovery, which usually happens in sports, recreational, and occupational activities trigger points develop. Because dry needling focuses on the stimulation of these trigger points and frees up the tension for the relief of pain, it differs from the approaches of other types of physical therapy.
This Is How Dry Needling IS Basically Done
Dry needling uses a solid filamentous needle that the physical therapist inserts into commonly affected tissues (such as the pterygoid, lateral, iliacus, and subscapularis muscles).
The following are the basic steps of a deep dry needling technique:
For the treatment of trigger points using dry needling techniques, the physical therapist palpates the target muscle to identify the hyperirritable spot and a taut band (an area were tense muscles are located). This will confirm that a trigger point exists and that treatment is needed.
A tube is oftentimes used to guide the needle and held by the non-needling hand through flat palpation or a pincer grip against the trigger point based on the orientation and location of the muscle. Palpation means that the physical therapist uses his or her hands or fingers to pinpoint the site(s) of tenderness. The needle is released gently from the tube with the needling hand. The physical therapist gently flicks or taps the top of the needle, which forces the needle to enter the skin.
In a deep dry needling treatment, the physical therapist guides the needle towards the trigger point until resistance is felt or if the therapist sees that the patient has a localized twitch response. This type of response is a reflex action or an involuntary contraction on the part of the spinal cord that can be set off with a penetration of a needle or by a snapping palpitation. Studies demonstrate that the localized twitch reaction is due to a mitigation or alleviation of some sort that comes about as a result of automatic electrical activity, inflammation, or a release of certain chemicals associated with the immune system. When an involuntary twitch reflex occurs, this means that the needle was able to simulate the appropriate spot.
When a trigger point is hit with a needle, as manifested by the localized reflexive twitch, the physical therapist maneuvers the needle back toward the tissue layer directly underneath the skin without pulling it out of the skin to target a specific area or other surrounding areas.
The needle will then be used to target the remaining trigger points until the patient cannot tolerate the needling any longer or until all the local twitch responses have stopped. Pressure is directly applied to the skin over the site of insertion after a needle is taken out of the skin to prevent soreness or swelling.
Superficial Dry Needling Technique
The needle is merely inserted into a muscle within the vicinity of a trigger point in a superficial dry needling procedure,. This does not induce any localized twitch response. The needle stays inserted in that area for around 30 seconds and then removed. If after the first round, the trigger point still feels sensitive, the needle will be inserted into the same site once more for a couple of minutes.
In a superficial dry needling procedure, the aim of the physical therapist is to relieve the sensitivity of the trigger point by utilizing shorter treatment intervals, repeating this process until a difference is observed. This type of dry needling is preferred by patients who become stiff or cramp easily or who can’t stand deep dry needling.
What Can Dry Needling Treat?
A slender filiform needle is used in dry needling procedures to enter the skin and activate underlying connective tissues and muscular and myofascial trigger points in order to treat movement impairments and relieve pain.
In numerous diagnoses, the American Physical Therapy Association has identified certain trigger points, including:
• Joint dysfunction
• Disk pathology
• Phantom pain
• Nocturnal cramps
• Complex regional pain syndrome
• Post-herpetic neuralgia
• Urologic syndromes such as pelvic pain
• Spinal dysfunction
• Disorders associated with whiplash
• Computer-related disorders
• Carpal tunnel syndrome
• Tension headaches
It is also used to address musculoskeletal, connective tissue and fascia dysfunctions. Dry needling helps restore body function and lessens structure impairments resulting in improved participation and activity.
The Three Greatest Health Benefits of Dry Needling
1. Enhances Movement: Studies have shown that patient experienced more fluid movement after receiving dry needling treatment, in conjunction with movement-based therapy. The Acupuncture in Medicine published a case report in 2010 that showed four international female volleyball athletes getting dry needling therapy during a month-long intense competitive phase. Before and after treatment, pain, strength, and range of motion were evaluated and all scores showed improvement post treatment. Dry needling has proven not to cause reduced range of motion immediately after treatment and functional weakness as seen by these athletes’ ability to continue with their overhead activities.
This study proves that dry needling is justified in elite athletes for improved function in shoulder injuries and short-term pain relief during a competitive phase.
2. Relieves Pain: Numerous research efforts have shown short-term or immediate improvements in disability or pain in dry needling treatment of trigger points. The American Journal of Physical Medicine and Rehabilitation published a 2007 study implying that dry needling treatment of a trigger point significantly relieves shoulder pain. Fourteen patients were involved in the study all of whom had myofascial trigger points in both muscles and bilateral shoulder pain and were treated with dry needling therapy; the control group received no treatment at all.
Dry needling used in physical therapy led to the enhancement of the pressure pain threshold of the trigger points and both passive and active range of movement of the internal rotation of the shoulder. The magnitude of pain of the treated shoulder significantly went down as well. Proof that dry needling of a specific myofascial trigger point results in the treatment of sensitivity and pain is provided by this study.
3. Accelerates The Process of Recovery: Patients who’ve experienced dry needling therapy felt relief of pain quickly; after their first treatment, almost all patients actually experience the benefits immediately. The Journal of Orthopaedic & Sports Physical Therapy published reports stating that when incorporated as part of the total treatment plan dry needling led to the quick recovery of the patient’s function.
The University of Queensland in Australia conducted a study that observed how effective dry needling is for the treatment of chronic whiplash, an injury related to sensory hypersensitivity typically responds poorly to exercise and other physical treatments. To boost the results of an exercise therapy to address the sensory hypersensitivity of whiplash, dry needling was used in combination with exercise. The physical therapists integrated dry needling into the treatment plan since exercise programs alone were not able to fully treat the symptoms after three months of treatment. The integration led to a reduction in disability and pain, a cheaper cost of treatment, and a quicker process of recovery for the patient.
Is Dry Needling Safe?
It is safe and all patients can avail themselves of this treatment provided they do not have an anxiety about being treated with needles or have a phobia to needles. Dry needling, as with any treatment, may cause inadvertent side effects, such as bruising, fatigue, muscle soreness, and pain at the site of the needle insertion. It is a very effective and safe treatment in the hands of a skilled physical therapist. Patients will experience a quicker use of their joints and fast improvements in range of motion.
Sometimes multiple dry needling treatment sessions are required before the muscle returns to its full functionality. The reason for this is that trigger points are situated under the muscles’ deepest layers, and several sessions are needed before the changes take full effect. The patients will nevertheless notice some differences right after each treatment.
No pain should be felt during a dry needling procedure. When the needle is inserted the localized twitch reflex only elicits a very short pain response; this “pain”, feels more like a cramping sensation or a shock. If you experience a local twitch response this is a good sign since it means that the trigger point has been hit by the needle, which means the therapy is working.
Dry needling, according to empirical evidence, is not recommended for children less than 12 years of age. So, with younger patients caution is strongly advised. The child’s and parent’s consent is needed If the child needs to undergo dry needling. Before treatment commences, the child should have fully understood the procedure.
Patients should expect immediate improvements in joint use and range of movement when they try dry needling. It is an extremely effective and safe choice of treatment for patients who are not scared of needles. Several sessions may be needed in order to remove the trigger point completely.
Ni Nan Gilbert is a licensed acupuncturist in Bellmore, NY with certification in Chinese Herbology and over 16 years experience in traditional Chinese medicine.