Friday, June 12, 2020

Getting to the Point: All About Dry Needling

by Meg Crowley, PT
Though it seems like the newest kid on the block when it comes to physical therapy interventions, dry needling has actually been around since the 1940s as a treatment for pain and myofascial (muscle) trigger points. It utilizes very thin solid needles inserted into symptomatic tissue, primarily skin, muscle and connective tissue. When inserted, the needle creates a micro-lesion, which increases circulation, helps to normalize the inflammatory response, can cause a disruption in shortened tissues (trigger points), and provides input to the nervous system. These effects help to balance the environment within your body to promote healing with the end goal of reducing your pain.

While you may be envisioning the kinds of needles used for vaccinations, dry needling needles are actually extremely thin in diameter and flexible. This allows the needle to be pushed through the skin - instead of cutting the skin - which helps reduce discomfort upon insertion of the needle and makes it almost painless. Some patients do report feeling a dull ache, which is a common and positive response to needling. Other patients report feeling a muscle contraction: this is called a local twitch response, and is normal with needle insertion into pathological tissue. The technique for dry needling is a clean technique, with single-use sterile needles utilized to minimize risk of infection.

This may sound a little like acupuncture, but it is distinctly different: while acupuncture does use needles, its purpose is to change the path of Qi (or energy) along traditional Chinese meridians. Dry needling, on the other hand, is a modern, evidence-based intervention for the treatment of pain and movement dysfunction in common musculoskeletal conditions. All entry-level physical therapists receive extensive education in anatomy and the body’s movement systems, and in order to dry needle, physical therapists in the state of Illinois undergo postgraduate education and training specific to the application of dry needling, with emphasis on neuro-anatomy and how that impacts needle placement. 

So, how does it work? Well, since the body is a highly integrated system - with the nervous system, circulatory system and lymphatic system being primary connectors within the body - the insertion of the needle into tissue can have effects both locally and systemically. Locally, it can help improve circulation and reduce pain. This sets off a systemic chain reaction: the changes in muscle after needling, through the release of potential trigger points, can help improve movement patterns. Improved movement patterns lead to more efficient and effective movements. This in turn equates to less pain and improvement in your ability to perform the tasks you like to do on a regular basis.

As with any procedure, there are potential side effects. Many of these side effects are similar to what might occur after receiving any type of injection from a healthcare provider, with the most common being bruising and/or bleeding. The likelihood of bruising and bleeding is low, occurring in less than 15% of the cases. This is likely because of the small diameter of the needle used. Other adverse reactions that might occur less than 5% of the time include nausea, dizziness, drowsiness and worsening of symptoms, though again these are uncommon. In fact, multiple research studies have shown dry needling to be a very safe practice when performed by well-trained medical professionals.

Interested to see if dry needing can help alleviate your pain? We are now offering dry needling at our Illinois Center location.

APTA Public Policy, Practice, and Professional Affairs Unit. (n.d). Description of dry needling in clinical practice: an educational resource paper. American Physical Therapy Association.

Brady, S., McEvoy, J., Dommerholt, J., & Doody, C. (2014). Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. Journal of Manual & Manipulative Therapy, 22(3), 134-140.

McCutcheon, L., & Yelland, M. (2011). Iatrogenic pneumothorax: safety concerns when using acupuncture or dry needling in the thoracic region. Physical Therapy Reviews, 16(2), 127.

Sanders, N. (2020, Mar. 13-15).Pain management and sports rehabilitation: integrative dry needling foundation course. Integrative Dry Needling Institute.