According to the American Physical Therapy Association (APTA) Dry Needling is a skilled intervention used by physical therapists that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues for the management of musculoskeletal pain and movement impairments.
Trigger points are taut bands palpated within muscles and surrounding fascia. Often thought of as “knots” these trigger points often induce pain, limit everyday muscle function and inhibit progress towards physical therapy goals. When a trigger point is released via dry needling a reflexive response known as a “twitch” occurs and this allows for a break in the pain cycle. This is done without medication.
How does it work?
Stimulation of trigger points with the needle causes a brief twitch response in the muscle (a small, quick contraction) resulting in a softening of the taut band and an immediate decrease in the sensitivity of the trigger point. Research indicates that this happens from mechanisms that change the sensory message of pain from both a mechanical and biochemical standpoint at the trigger point as well as within the central nervous system. The motor response from the central nervous system is then inhibited and there is a relaxation of the muscle contraction or taut band. In using this method, the therapist first feels, localizes and starts treating restrictions or knots within muscles and fascia with methods of soft tissue mobilization and myofascial release. As they find areas that are more tender and perhaps not changing quickly, they will apply the needing techniques specifically to these areas, and then continue with further manual tissue mobilization. After creating more mobility, the therapist follows up the manual work with stretching, movement training and strengthening the body with their hands on the patient; as well as training and instructing in exercises that will further enhance the improvement of the patient’s function.
Evidence based studies have shown that treatment by dry needling is important as it uses much smaller needles than those that are required when treating trigger points and pain by corticosteroids, anesthetic, saline or Botox. Research has found that the smaller needle is not as traumatic to the body and it is the needle itself that is effective and causes the change.
Dry needling vs Acupuncture
Dry needling performed by physical therapist is not acupuncture. Though they both use the same type of small diameter solid filiform needles, they are based on different philosophies. Dry needling is strictly based on Western medicine’s principles and research. Acupuncture is based on traditional Chinese medicine, focusing on restoring balance and function using the body’s meridians and is performed by those trained in acupuncture. Acupuncture may use many multiple needles during a session going from head to the feet. Dry needling is usually more local and a small section of the body is treated at a time, with fewer number of needles used.
Conditions treated by Dry Needling
Dry needling has successfully been used to treat a variety of conditions including:
- Head, Neck and Jaw Pain – including whiplash, headaches, migraines, poor posture, chewing and/or grinding
- Shoulder Pain – including rotator cuff muscle tears, bursitis, adhesive capsulitis (frozen shoulder), tendonitis and impingement syndrome
- Elbow Pain – including lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow)
- Hand and Wrist Pain – including gamekeeper’s thumb, De Quervain’s syndrome and carpal tunnel syndrome
- Back and Hip Pain – lumbar degenerative disc disease, arthritic changes and herniated discs may cause the back and hip pain and may be positively affected by dry needling
- Knee Pain – treatment of the soft tissue around the knee can positively impact degenerative joint disease or osteoarthritis
- Shin / Ankle / Foot Pain – including shin splints, gout, metatarsalgia and Morton’s neuroma
- Plantar Fasciitis (Heel Pain)
- Acute and Chronic Tendonitis
- Athletic and Sports-related Overuse Injuries
- Post-surgical Pain
- Post-traumatic Injuries, Motor Vehicle Accidents (MVA), and Work-related Injuries
- Other Chronic Pain Conditions – including myofascial pain and myofascial pain syndrome (MPS)
- Degenerative Disc Disease, Degenerative Joint Disease and Osteoarthritis are not directly treated by Dry Needling but treating the surrounding tissue these conditions may positively affect these conditions by allowing improved circulation, better movement patterns and increased range of motion to an affected area