Sports Medicine

Dry Needling: More Than Just a Fad?

Posted March 28, 2018

It appears Dry Needling is officially here to stay. It has been a bit of a tumultuous few decades for this new modality, filled with controversy, intrigue, and misconception. Controversy regarding its safety and legality, with equal parts intrigue and misconception regarding its background and efficacy.

If you haven’t heard of it, you will. Since its explosion on to the mainstream about a decade ago, it has seen substantial increases in popularity and research. Go ahead, type in “dry needling” into Google, I’ll wait…. As you can see, the internet has exploded with courses, advertisements, testimonials, litigation, and information. With the new age of information access, it can be really difficult to sift through it all.

So, Does it work? Who can do it? Is it safe? What it is really doing? Have no fear….. We’re here to help!

 

What Is It?

Let’s first start by tackling what it’s NOT. Although dry needling is the use of small, filiform needles with the intention of improving neuro-musculoskeletal problems, it is certainly NOT acupuncture. No doubt they look similar; they use the same tool! But that’s just a small portion of it. Dry Needling does not identify with its Eastern Medicine cousin’s ideas on yin/yang, lines of flow, or energy meridians. It focuses much more on tangible, neuro-musculoskeletal problems, such as trigger points, flexibility, muscle recruitment, and pain reduction. Acupuncture, having been around for much longer (centuries), is a popular modality for a variety of conditions, including things like the common cold or depression, and is only within the scope of practice of a licensed acupuncturist.

Quite simply: the tool does not define the profession. Holding a hammer certainly does not make me a carpenter just the same that a calculator does not make me an accountant! Long story short: We’re different, but both effective! It is important to keep that in mind.

Book Definition: “Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. [It] is a technique used to treat dysfunctions in skeletal muscle, fascia, and connective tissue, and to diminish persistent peripheral nociceptive input, and reduce or restore impairments in body structure and function, leading to improved activity and participation.”1

Although dry needling is the use of small, filiform needles with the intention of improving neuro-musculoskeletal problems, it is certainly NOT acupuncture.

Part of Your Plan of Care!

After an evaluation from a licensed professional, he or she may determine you would be a good candidate for dry needling. In many cases, it allows health professionals to get to places that would otherwise be difficult to reach. Deeper tissues, like the deep gluteal muscles or back stabilizers, pose a real problem due to the amount of pressure and contact force it takes to get to them. This can bring about a very uncomfortable experience… think about that aggressive sports massage you got when you were already sore…. ouch!

Dry Needling can be a bit more specific and targeted to tissue that is dysfunctional. However, it is ALWAYS part of a broader, more comprehensive approach. Dry Needling can be exceptionally supportive for managing pain or dysfunction, but it should always be incorporated with follow up and reinforcing behaviors or exercise. 2,3  

 

What Does it Do and How Does it Work?

Without completely boring you to death with fancy, and confusing, 5 syllable words with over-the-top medical connotations, I am going to give you the cliff note version of how it all works. Essentially, it comes down to 3 concepts:

1. Trigger Points and Myofascia

2. The Nervous System

3. The Brain

Ultimately, all work together, but you might hear various treatment impacts depending on the training and beliefs of the health care practitioner you see. Inserting the needle into areas of pain, limitation, or dysfunction has been shown to change the chemical environment of the tissue (helping normalize things!) This might include increases in tissue blood flow, which might help with a healing response.

It also affects the nervous system and the brain! In the same manner that we rub our elbow when we bump it on the coffee table, the needle provides a stimulus to the brain which can override or occupy it from the current state of pain it is perceiving.

Lastly, it can improve nutrition to the nervous system. Your nerves are a pipeline to and from the brain bringing information and also nutrition. There is some evidence to support that needles close to nerves or in muscles close to nerves, can improve the quality of that transportation. This could be pain reduction, improved strength or muscle quality, or relaxation. Something like a reset provided to a locked-up computer!

The research out there says it works, although the research depth isn’t quite enough to say so completely. As with many medical tools, theorems, and practice patterns, more research is needed to study the variables at work! The land of research has not quite caught up yet to give use exact specifications about all the variables being impacted by the needle!2-4

How about an example? It is marathon season after all, and that usually means no shortage of runners with foot or ankle pain due to the mileage and beating imposed on their lower bodies. Dry Needling is very helpful in managing things like shin splints, ankle sprains, tendonitis, etc. Each of these would be evaluated first, but certainly would fall within the umbrella of management options.

 

Although dry needling is certainly an invasive procedure, it is typically done in the clinic. It is strongly encouraged your health care professional practice clean environment techniques, and always practice sterile needle technique.

Is This Done in the Clinic?

Yes! Although dry needling is certainly an invasive procedure, it is typically done in the clinic. It is strongly encouraged your health care professional practice clean environment techniques, and always practice sterile needle technique. Essentially, be diligent you observe them use brand new, unopened needles and dispose of them into a sharps container. Proper hand sanitation and clean work space should also be a must! Practitioners with proper training and education will adhere to these rules without question! Be diligent and ask plenty of questions. Any health care professional should have training and experience with dry needling outside of basic school education.

 

What Risks Should I be Concerned About?

Dry Needling is actually very low risk when performed by a person with training and in compliance with appropriate safety concerns. The most common reactions include bruising, soreness, or a small hematoma. Chances of infection are substantially small (assuming the use of clean environment and sterile needle); and the risk of serious events (things like organ damage) are very very low when dry needling is done by an educated and experienced clinician.5,6 Expect to feel sore, like workout sore, but that usually goes away in a few hours. In the meantime, keep moving! Light aerobic exercise, like riding a bike, is helpful for the soreness afterwards.

 

Take Home

The primary goal of Dry Needling is to desensitize supersensitive structures, to restore motion and function and to possibly induce a healing response to the tissue. For seasoned practitioners, Dry Needling is extremely beneficial for quick and tangible results on top of other movement remediation. I realize the above it not dense with research, references, and huge data. The truth is, its lacking and this write up is to ultimately give you some insight into what is out there. I would very much encourage speaking to a practicing dry needler or seek out more information!

About the Author: Chris Juneau PT, DPT, SCS, CSCS, USAW-2

Chris is a Sports Specialist and Sport Performance Trained, Physical Therapist with Memorial Hermann Ironman Sports Medicine in Houston, Texas. Chris completed his sports training and education with The University of St. Augustine, The Ohio State University, and University of Louisville.

His background and training are rooted in sports medicine and performance, hip and knee preservation management, and on-field sports care. He has spent time working with multiple orthopedic physicians and surgeons to develop post-operative protocols and procedures, and now works very closely with Dr. Alfred Mansour and the Hip Preservation Program within the University of Texas and Memorial Hermann Healthcare systems. He is currently an employee of the Ironman Sports medicine clinic with the Memorial Hermann and is involved in sports residency and internal administrative function.  He also helps as an on-field responder, coaches Olympic lifting, and provides consultation and educational resources to local school sports and other agencies.

 

 

For further questions, comments or scheduling feel free to email me at christopher.juneau@memorialhermann.org or contact our clinic at 713-526-6143

References or More Information?

The “Dry Needling in Physical Therapy” page at  ww.apta.org/StateIssues/DryNeedling features resource papers describing what the intervention is, how it is used by PTs, APTA positions, evidence, and more. The site features state resources, as well, including attorneys general opinions.

1. APTA document Description of Dry Needling in Clinical Practice: An Educational Resource Paper. www.apta.org/StateIssues/DryNeedling/

2. American Physical Therapy Association. Description of Dry Needling in Clinical Practice. http://www.apta.org/StateIssues/DryNeedling/. Published February 2013. Accessed February 9, 2015.

3. Dunning, J, Butts R, Mourad F, et al. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014. 19(4): 252–265.

4. Mejuto-Vasquez MJ, Salom-Moreno J, Ortega-Santiago R, et al. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014:44(4):252-260.

5. Brady S, McEvoy J, Dommerholt J. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther. 2014; 22(3): 134–140.

6. Cummings T, White A. Arch Phys Med Rehabil. Needling therapies in the management of myofascial trigger point pain: a systematic review.  2001;82(7):986-92.