What You Need to Know About Dry Needling

By Dr. Sean Nixon, PT, DPT, LAT, ATC

Dry needling is an effective treatment for people with musculoskeletal pain, whether they’re a high-level athlete or someone dealing with chronic pain. We get a lot of questions about dry needling, so without further ado let’s discuss what dry needling is.

What is Dry Needling?

Dry needling is a technique that uses a small sterile solid filament needle to treat trigger points. In order to understand dry needling, it is important to know a little bit about trigger points. Though the exact definition of trigger point is debatable, they can generally be thought of as tender points in a taut band of muscle that can cause local pain or referred pain. They can also cause movement dysfunction by not allowing a muscle to do its job properly. Trigger points can be caused by repetitive overuse, by a single over-exertion of a muscle, or by muscles trying to protect an injured or painful joint. Dry needling can be used to relax or deactivate trigger points in order to decrease the pain signals they are sending. Dry needling a trigger point can also return a muscle to its normal firing pattern and strength, which, in turn, can improve movement. The reason the treatment is called dry needling is to differentiate it from wet needling, i.e. giving an injection. It is also important to note that dry needling is NOT acupuncture.

What is a Dry Needling Session Like?

If your physical therapist determines that dry needling could help you, then the treatment will be done during your regular physical therapy session. During a dry needling treatment, the needle is inserted directly into the trigger point in the muscle. All treatments are performed with universal precautions, which means the area to be treated is always swabbed with alcohol, gloves are worn, and individually packaged sterile single-use needles are used. Most people do not feel the needle being inserted. Once the needle enters the trigger point, the muscle may twitch, a phenomenon called a local twitch response. The local twitch response is a good thing and often means the trigger point is being released or inactivated. This may cause a very brief painful response that has been described as a sensation like a small electric shock or a cramping/achy sensation. Generally a single needle is in the muscle for no longer than 20 seconds, but could stay in for a minute or so based on the goal of the treatment. After treatment, many patients report muscle soreness, similar to you might experience after working out. If there is soreness, it usually lasts for a few hours, but on occasion can last up to two days.

How Does Dry Needling Work?

The exact mechanism of how dry needling works is still being researched. One of the more prominent theories is that is when the solid filament needle is directed into the trigger point, it causes a chemical change in the muscle that allows the muscle to relax. Once the trigger points are released, the muscle can begin to return to normal function and length, which results in decreased pain and improved movement. Most people report some degree of immediate change after one session of dry needling. If you do not see a change after four treatments, dry needling may not be the treatment you need. Dry needling, in conjunction with other physical therapy treatments, is very effective in the treatment of a variety of musculoskeletal issues.

An Example of Dry Needling

Dry-Needling-Physical-TherapyTo give a more concrete example of how dry needling might look in the clinic, let’s look at a hypothetical case and treatment session: John comes to physical therapy for neck and shoulder pain experienced while sitting and driving as well as stiffness and limited range of motion to check his blind spot while driving.

An image of the Trapezius muscle along with common referred pain patterns shown in red.

After going through a full evaluation and movement screen (see our previous blog post about the Selective Functional Movement Assessment), it is determined that John’s symptoms are related to trigger points and increased muscle tone in his upper trapezius muscle. The trigger points and increased tone are likely caused by prolonged static posture with rounded shoulders and a forward head while sitting at a desk and driving. He also has some weakness in his shoulder, shoulder blade, and upper back muscles. After explaining the findings to John and going over dry needling and how it can help his symptoms, he lies on the table. The area to be treated is swabbed with alcohol, the trigger point in the upper trap is located by the therapist with gloved hands, and the needle is inserted into the trigger point. After eliciting several twitch responses John sits up and his range of motion is re-checked. His neck range of motion is improved and the trigger points are “softer” when touched. He does report some soreness, but this is normal. He is then taken through some stretches and postural strengthening exercises to reinforce the gains he has made. The stretches and strengthening will be important going forward because these will be the interventions that limit the return of the trigger points and increased muscle tone going forward.

Summary

Dry needling can be very valuable in the treatment of musculoskeletal pain and movement dysfunction. It is generally not used as a stand alone treatment and the gains made with dry needling should be reinforced with exercises that address the cause for the development of trigger points. If you have any other questions about the treatment you can read more on our website or contact us today!

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References:

  1. Dommerholt, Jan, and Cesar Fernandez-de-las-Penas. Trigger Point Dry Needling: An Evidence and Clinical-based Approach. New York: Churchill Livingston Elsevier, 2013. Print.
  2. David M. Kietrys, PT, PhD, OCS, Kerstin M. Palombaro, PT, PhD, CAPS, et al. Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 2013 Volume:43 Issue:9 Pages:620–634 DOI: 10.2519/jospt.2013.4668

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