What is Dry Needling?
Dry needling involves inserting a very thin needle through the skin to stimulate a trigger point. It can release tight muscle bands or “knots” within a muscle that can cause pain over a large area. Sometimes these trigger points can radiate pain or discomfort to nearby muscles of the body.
Dry needling is sometimes also referred to as intramuscular stimulation and does not involve injection of any corticosteroids or medication.
Most of our clients ask how is it different from acupuncture. Acupuncture intends to unblock energy meridians and help create balance within the body while Dry Needling focuses on stimulating a specific trigger point that is leading to pain and disability.
Although Dry Needling is becoming more well known recently, researchers in 2013 published in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) an analysis of the best clinical studies that had been conducted prior to 2013 to determine whether or not dry needling helps to reduce neck & arm pain (both common areas for trigger point development). It was found that Dry Needling can effectively relieve pain when it is caused by myofascial pain syndrome. When this technique is integrated with exercise it can be even more beneficial (IDN)
Myofascial trigger points are a common type of pain. The word mayofascial means muscle tissue (myo) and the connective tissue in and around it (fascial). These trigger points are usually the result of a muscle injury or repetitive strain.
Trigger points are painful when pressed on and can create pain in another area as well, which is called referred pain. It can even generate hyperalgesia which is an increased sensitivity to pain from damage to nociceptors or the peripheral nerves.
For example, trigger points in the muscles of the shoulder, neck and face are a common source of headaches because the trigger point refers pain to the head. Muscle overtraining or direct trauma to the muscle can lead to the development of trigger points. Trigger points can develop during occupational, recreational or sports activities when muscle use exceeds muscle capacity and normal recovery is disturbed. Dry needling focuses on stimulating these trigger points and releasing the tension in order to alleviate pain.
How Does Dry Needling Work?
Dry needling involves using a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues in order to relieve pain and movement impairments.
According to the American Physical Therapy Association , trigger points have been identified in numerous diagnoses, including:
- tension-type headaches
- carpal tunnel
- computer-related disorders
- whiplash associated disorders
- spinal dysfunction
- pelvic pain and other urologic syndromes
- post-herpetic neuralgia
- complex regional pain syndrome
- nocturnal cramps
- phantom pain
- disk pathology
- joint dysfunction
It reduces and restores impairments of body structure and function, leading to improved activity and participation. (APTA)
- Dry Needling may mechanically disrupt a dysfunctional motor end plate
- Needling results in a Local Twitch Response (LTR)
- The LTR results in an alteration to muscle fiber length as well as having an inhibitory effect on antagonistic muscles
- Stimulate A-nerve fibers (group III) for as long as 72 hours post needling
- Prolonged stimulation of the sensory afferent A-fibers may activate the enkephalinergic inhibitory dorsal horn interneurons, which implies that dry needling causes opioid mediated pain suppression
- Another possible mechanism of dry needling is the activation of descending inhibitory systems which would block noxious stimulus into the dorsal horn
- The LTR may also utilize the excessive ACh in the tissue which previously was triggering increased firing of localized fibers
- Increased levels of various chemicals at sensitized motor end plates such as: Bradykinin, Substance P and CGRP (regulator of Calcium and Phosphate balance). These chemicals were reduced immediately post a LTR.
- CGRP enhances the release of ACh from nerve terminals, which results in increased ACh receptors at the neuromuscular junction
- Needle penetration will cause micro-trauma and micro bleeding (localized inflammation) and hence the introduction of PDGF into the area to help promote healing
Top 3 Dry Needling Benefits
1. Reduces Pain
Several studies have demonstrated immediate or short-term improvements in pain or disability by targeting trigger points with dry needling. A 2007 study published in the American Journal of Physical Medicine and Rehabilitation suggests that dry needling significantly reduced shoulder pain by targeting a trigger point. In the study, 14 patients with bilateral shoulder pain and active myofascial trigger points in the bilateral muscles underwent dry needling therapy on one side and no therapy on the other side, which served as the control.
Dry needling increased both active and passive range of motion of shoulder internal rotation, and the pressure pain threshold of the trigger points. Pain intensity of the treated shoulder was significantly reduced as well. The study provides evidence that dry needling a specific myofascial trigger point does reduce pain and sensitivity in that area. (Am J Phys Med Rehabil.)
In a 2016 Manual Therapy study, dry needling was used to treat the upper trapezius latent myofascial trigger point, or MTrP — pain in the upper back region — experienced by 60 females. All the participants experienced a reduction in pain. (Man Ther.)
2. Improves Movement
Research shows that patients undergoing dry needling therapy, in conjunction with exercise experience more fluid movement. In fact, dry needling can help mechanically disrupt a dysfunctional motor end plate (IDN).
3. Speeds Up the Recovery Process
Patients who undergo dry needling therapy experience less pain quickly; in fact, most patients feel the benefits immediately after their first treatment. According to reports published by the Journal of Orthopaedic & Sports Physical Therapy, patient function is restored much more quickly when dry needling is incorporated as part of the total package.
A study conducted at the University of Queensland in Australia investigated the effectiveness of dry needling for chronic whiplash, which is associated with sensory hypersensitivity and has poor responsiveness to physical treatments such as exercise. In order to enhance the treatment outcomes of an exercise intervention, dry needling was used in conjunction with exercise to address the sensory hypersensitivity of whiplash. Because exercise programs alone did not fully eliminate the symptoms of whiplash after three months of treatment, the physical therapists added dry needling to the treatment plan in order to speed up the healing process, reduce the economic cost of treatment and minimize pain and disability. (BMC Musculoskelet Disord)
Is Dry Needling Safe?
Dry needling is appropriate for nearly all patients who do not have a significant needle phobia or other anxiety about being treated with needles. Like any type of therapy, dry needling may deliver unintended side effects, such as needle insertion site pain, muscle soreness, muscle fatigue and bruising. In the hands of a skilled Physiotherapist (IDN), dry needling is a safe and effective treatment option and the patient will see benefits in range of motion and joint use right away.
It’s normal that it may take several dry needling therapy sessions before the muscle is fully functional again. This is because trigger points are located under deep layers of muscles, so it typically takes several sessions for the changes to take full effect. It is very common for our clients to notice the difference right after each treatment.
Dry needling is also known to be relatively painless. Generally, the needle insertion is not felt and the local twitch response only provokes a very brief pain response, feeling more like a shock or cramping sensation. A local twitch response is a therapeutic response that serves as a sign that the needle has hit the trigger point, so it’s actually a good and desirable reaction.
- Dry needling is a common treatment technique in orthopedic manual physical therapy.
- Dry needling involves a very thin needle being pushed through the skin in order to stimulate a trigger point that causes pain and disability.
- During a dry needling session, the needle penetrates the trigger point, which is known when there is a local twitch response. This response suggests that the trigger point is being stimulated and there will be a therapeutic response.
- Dry needling is a safe and effective treatment option for patients who are not afraid of needles.
- Patients who undergo dry needling will see benefits in range of motion and joint use right away. Sometimes several sessions are necessary in order to fully eliminate the trigger point.
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