What is Dry Needling?
Dry needling is a skilled technique performed by trained Chiropractic Physicians and Physical Therapists aimed at managing neuromusculoskeletal injuries and pain while addressing movement dysfunction. Dry Needling utilizes a thin filiform needle to penetrate skin, fascia and muscles to address adhesions, trigger points and connective tissue to speed healing and relieve pain. Functional application focuses on decreasing muscle hypertonicity, increasing joint range of motion, and correcting movement dysfunction.
YOU STICK A NEEDLE INTO A TRIGGER POINT? WHAT IS A TRIGGER POINT?
A trigger point is a spot of muscle/fascia that is hypersensitive, painful when compressed, composed of a taut muscular/fascial band that restrict oxygenated blood flow, and can refer pain and tenderness while causing motor dysfunction.
Dry Needling vs. Acupuncture:
The only similarity between the two is the tool...the difference includes everything else.
Acupuncture is an ancient traditional Chinese technique that utilizes the knowledge of meridians. This focus allows an acupuncturist to work on a person's inner balance, energy, qi, and one's life-force. Work up and exam includes tongue and pulse examination. Traditional acupuncture has been in practice for thousands of years.
Dry Needling relies on the practitioners expanded knowledge of skeletal and neuroanatomy. This knowledge allows one to identify damaged and sensitive tissues, taut bands, and trigger points as well as injured and overused tissues. Dry needle practitioners utilize an extensive examination that includes movement analysis, orthopedic evaluation, and a neurological workup that includes myotomal and dermatomal testing.
Dry needling technique often requires needle insertion to be much deeper than traditional acupuncture with bone commonly being used as a backdrop. After inserting the needle, practitioners can utilize such ‘moves’ as pistoning, tenting, and EMS (intramuscular stimulation via electrical current). Dry needling is based on past and current data, with new research currently being conducted.
What are we Accomplishing?
Breaking the cycle: Energy Crisis Theory
Through years of study, we have put much focus into what happens to a tissue after it is injured, resulting in the Energy Crisis Theory. This theory postulates that a tissue injury causes a increased calcium release at the neuromuscular junction, resulting in a long-standing muscle contraction. This contraction compromises oxygen in the muscle tissue, delaying recovery and leading to a taut muscle band full of ischemic by-products that sensitize the sensory nerves...initiating more tissue injury and pushing the circle onward.
Increased Range of Motion through Decrease Banding:
With any treatment, our goal is to disrupt the energy crisis cycle, restore sarcomere (muscle) length and increase range of motion to restore proper movement. When a dry needle is inserted into a tissue, the result includes increased blood flow to the taut muscle fibers, allowing increased oxygen to infiltrate, releasing the band and increasing the muscle extensibility and joint range of motion. Proper function can not happen when pain is involved.
Dry Needling treatment can also cause a biochemical change. We already know that dry needling can deactivate a trigger point but it also fights the hypersensitivity by lowering nociceptive (pain) generators, such as substance P and CGRP, via segmental inhibition at the dorsal root. Simply put, studies have shown that dry needling can lower pain generators and block pain at a central nervous system level.
Who Can Benefit From Dry Needling?
While there are a few contraindication (1st trimester pregnancy, infection, over a pacemaker, etc.) most patients are good candidates for dry needling therapy.
Clinically, we have utilized dry needling in cases ranging from tension headaches to plantar fasciitis...and everything in between. Where we see the greatest success is where most other treatments fail; such as tendinopathy cases, overuse injuries, and chronic tightness.
- Carpal Tunnel Syndrome,
- Hip Pain,
- IT Band Syndrome,
- Patellofemoral Pain Syndrome (runner's knee),
- Medial Tibial Stress Syndrome (Shin Splints)
- Achilles Tendinopathy,
- Plantar Fasciitis
- Ankle Sprains.
Conditions that respond well include:
- Neck Pain
- Low Back Pain
- Knee Pain (Osteoarthritis)
- Shoulder Dysfunction (adhesive capsulitis, impingement, rotator cuff strain)
- Tennis/Thrower's Elbow
In summary - Anyone wanting to decrease their pain, increase range of motion and restore function.
Post Treatment Care:
It is common to experience a dull/deep/ache the night of treatment, and possible up to 24 hours post treatment.
Exercise is encouraged, but don’t over do it because you feel better.
We stimulated a mild inflammatory response that is a normal part of the healing process, use ice for pain relief sparingly and avoid NSAIDS.
What Does The Research Say?
Researchers looked at patients complaining of Low Back Pain with confirmed disk herniations. The subjects were divided into two groups: 1. Standard Therapy, 2. Standard Therapy with Dry Needling. What they found was that both had a decrease in pain and an increase in function but the group receiving dry needling had a more significant improvement in pain and disability both at post treatment and follow-up marks.
- The Effect of Dry Needling on the Radiating Pain in Subjects with Discogenic Low Back Pain: A Randomized Controlled Trial.
Chronic upper-quarter (neck/upper back/shoulder) headaches and spinal movement dysfunction have all been associated with myofascial pain syndrome (trigger points). Kietrys et. al. published a meta-analysis on the effectiveness of dry needling on this syndrome. Based on their research and findings, they recommend dry needling as an effective option for treatment of upper quarter myofascial pain syndrome. They found that pain measures decreased for most patients immediately after treatment and at the 4 week follow up meeting.
- Effectiveness of Dry Needling for Upper-Quadrant Myofascial Pain: A Systematic Review and Meta-analysis. http://www.jospt.org/doi/pdf/10.2519/jospt.2013.4668
A 2015 study looking at ankle sprain rehabilitation found that adding trigger point dry needling, of the lateral lower leg peroneus muscle, to a rehabilitation plan of proprioceptive/strength exercise the four weeks following an acute lateral ankle sprain, had greater improvements in function and pain than the controlled group of just exercise.
- Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. http://dx.doi.org/10.1155/2015/790209