Dry needling – What’s the point?

The first question usually asked is: What is it?  

By definition, dry needling is a skilled technique performed by a physical therapist using filiform needles to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability. 1

So, what exactly does that mean?

Dry needling uses very small monofilament needles that are “dry” meaning there is no medicine in or on the needle.  In contrast, a “wet” needle is usually a hypodermic needle used to give injections and are much larger than those used for dry needling. Dry needles are inserted into sub-dermal structures such as, muscles, tendons, ligaments, bone, scar tissue, peripheral nerves and neurovascular structures; to solicit a local and systemic response to aid in pain reduction and improved movement patterns.

Is it safe?

Dry needling is very safe; serious side effects can occur in less than 1 treatment per 10,000 (less than 0.01%)2. The most serious side effect from dry needling is pneumothorax (lung collapse due to air inside the chest wall). Other minor side effects include drowsiness, tiredness, dizziness, minor bleeding or bruising.

Does it hurt?

No, in general dry needling does not hurt. Some areas can bemore sensitive than others, but generally, after the initial needle insertion the needles are no longer felt. At times a deep ache is felt when the needle is inserted and while it is in place for the treatment.

What is the process?

There are different dry needling techniques that your therapist may use. One technique uses a quick in and out method with the goal of eliciting a twitch response from the tight muscle tissues. This technique will cause increased blood flow to the area. This increase in blood flow brings oxygen to the area of muscle holding, allowing the muscle to return to a more relaxed state3.

Another technique targets areas of teno-osseus junctions (where tendons attach to bone). This technique referred to as pecking uses the needle to tap around the insertion point of the tendon on a bony surface to break up adhesions or scarring and generate increased blood flow.

The third technique is the placement of needles in non-triggerpoint targeted areas (muscles, tendons, ligament or neurovascular structures) following protocols that have been established through many research studies. The needles are then left in place from 10-30 minutes and are either manually turned periodically throughout the treatment time or the needles are connected to a machine that will provide electric stimulation. The electro-dry needling technique has been found to give the best analgesic effect4. The electric current stimulates a better response by activation of more pain inhibiting centers in thebrain, as well as activating local changes in the muscles.

 

Who benefits from Dry Needling?

Dry needling is a modern, science-based intervention for the treatment of pain and dysfunction in musculoskeletal conditions such as neck pain, shoulder impingement, tennis elbow, neck pain, knee pain, shin splints, plantar fasciitis, or low back pain. Dry needling has also been found to be beneficial for arthritis, carpal tunnel syndrome, headaches, TMJ disorders, radiculopathies, and chronic pain.

 

References    

1. Caramagno, J. Adrian, L. Mueller, L. Purl, J.  (2015) Analysis of Competencies for Dry Needling by Physical Therapists. Analysis paper prepared for FSBPT by HumRRO organization. Alexandria, VA: Federation of State Boards of Physical Therapy.

https://www.fsbpt.org/Portals/0/documents/free-resources/DryNeedlingFinalReport_20150812.pdf

2.  Brady S, McEvoy J, Dommerholt J, et al. . Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapistsJ Man ManipTher 2014;22:134–40.
3. Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2014). Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews, 19(4), 252-265.
4. Butts R, Dunning J, Perreault T, Mourad F, Grubb M (2016) Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals. Int J Phys Med Rehabil 4: 327. doi:10.4172/2329-9096.1000327

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