For the treatment of muscular trigger points and myofascial dysfunction
Dry needling is a treatment that involves a very thin needle being pushed through the skin in order to stimulate a trigger point. This form of alternative therapy is used to release tight muscle bands that are associated with trigger
While wet needling involves hollow-bore hypodermic needles that deliver corticosteroids, anesthetics, sclerosants and other agents, dry needling involves of the insertion of a needle without the use of injection into muscles, ligaments, tendons, subcutaneous fascia and scar tissue. Dry needling is also referred to as trigger point dry needling (TDN) and intramuscular manual therapy.
Dry needling is also different than acupuncture, which is intended to unblock energy meridians and help create balance within the bodily system. While acupuncture focuses on addressing the flow of energy around the body and bodily organs, dry needling focuses on stimulating a specific trigger point that is leading to pain and disability.
In a study published in the Journal of Orthopaedic & Sports Physical Therapy, researchers analyzed the results of the best clinical studies that have been conducted thus far to determine whether or not dry needling helps to reduce neck and arm pain, both common areas for trigger point development. The researchers found that dry needling can be an effective means of pain relief when dealing with myofascial pain syndrome, or the presence of painful trigger points and muscles. When this technique is used by a Chiropractor or a PT, it serves as a beneficial treatment, especially when used in combination with other techniques such as chiropractic adjustments and corrective exercise. (A1)
Myofascial trigger points are a common type of pain. The word
In other words, 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 something called hyperalgesia, which is an increased sensitivity to pain and which is often the result of damage to nociceptors or the peripheral nerves.
For example, trigger points in the muscles of the shoulder, neck
How Does Dry Needling Work?
The very small solid filament needle used in dry needling allows the trained therapist to target tissues that are not manually palpable, such as the subscapularis, iliacus and lateral pterygoid muscles.
Here are the basic steps of deep dry needling therapy:
When using dry needling techniques for the treatment of trigger points, the therapist will palpate the target muscle for a taut band (or area of tense muscles) and identify the hyperirritable spot, thereby confirming the trigger point that needs to be treated.
The needle is typically in a tube and it is fixed with the non-needling hand against the trigger point using a pincer grip or flat palpation depending on the location and orientation of the muscle. A palpation is when the therapist feels with her fingers or hands to pinpoint areas of tenderness. With the needling hand, the needle is gently loosened from the tube and the top of the needle is tapped gently by the therapist, allowing the needle to penetrate in to the superficial layer of the skin.
With deep dry needling, the needle is guided toward the trigger point until the therapist feels resistance or notices that the patient has a local twitch response. A local twitch response is a spinal cord reflex that creates an involuntary contraction that can be triggered by a snapping palpitation or penetration with a needle. Research shows that the local twitch response is the result of an alleviation or mitigation of some sort. This can be due to a release of immune system related chemicals, inflammation or even spontaneous electrical activity. When the patient has an involuntary twitch response, that suggests that the needle has hit the right spot.
When the needle has located the trigger point, as suggested by the local twitch response, the therapist will focus on this specific area or other neighboring areas by drawing the needle back toward the layer of tissue directly under the skin without taking it out of the skin.
The needle will then be redirected toward the remaining trigger points until local twitch responses have stopped. Needles placed in deep treatment zones can be left in for 15 minutes. The goal is to invite the parasympathetic branch of the autonomic nervous system to take over and start healing the associated tissues.
During superficial dry needling therapy, the needle is placed just slightly into a muscle in the vicinity of a trigger point, but the local twitch response is not induced. The needle will be kept in place for about 30 seconds and then withdrawn. If the trigger point still appears to be sensitive after the first round, the needle will be placed in the same area again for 2 minutes.
With superficial dry needling, the therapist will try to alleviate trigger point sensitivity with these shorter intervals of therapy, repeating this process until he/she notices a difference. Superficial dry needling is the chosen technique for patients who cannot tolerate deep dry needling or who cramp or become stiff easily.
What is Dry Needling Able to Treat?
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
This alternative therapy is also used to treat dysfunctions in skeletal muscle, fascia and connective tissue. It reduces and restores impairments of body structure and function, leading to improved activity and participation. (C)
Top 3 Dry Needling Benefits:
- 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 physical therapy 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. (D1)
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. (D2)
- Improves Movement
Research shows that patients undergoing dry needling therapy, in conjunction with movement-based therapy, experience more fluid movement. In fact, dry needling can help mechanically disrupt a dysfunctional motor end plate. (D3) A 2010 case report published in Acupuncture in Medicine treated four international female volleyball athletes during a month-long intense competitive phase with dry needling therapy. Range of motion, strength and pain were assessed before and after treatment and all scores were improved post treatment. The athletes were able to continue with overhead activities, which proves that dry needling does not cause functional weakness and reduced range of motion immediately after treatment.
These cases support the use of dry needling in elite athletes during a competitive phase with short-term pain relief and improved function in shoulder injuries. (E)
- 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 such as a spinal manipulation and dry needling.
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. (F)
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 pain at the stop of needle insertion, muscle soreness, fatigue and bruising. In the hands of a skilled dry needle therapist, 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. But patients will notice the difference right after each treatment. (G)
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 or discomfort response, feeling more like a mild zap 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.
Caution is warranted with younger patients; based on empirical evidence, dry needling is not recommended for children younger than 12 years of age. If a child is undergoing dry needling, parent and child’s consent is needed and the child should fully understand the procedure before treatment begins.
Dry Needling Takeaways:
- Dry needling is a common treatment technique with orthopedic manual physical therapy and chiropractors.
- 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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