Dry Needling

 Dry needling is a treatment strategy that physical therapists can use in the management of muscular-related impairments that can impact the nature and behavior of their symptoms.

Dry needling is another treatment method under the umbrella of other soft tissue (muscle) treatments in the pantheon of hands-on soft tissue mobilization, and device mobilization (foam rolling, therapy guns) but instead of the treatment being indirect, we bypass all other tissue structures that overlay the muscle of choice to target the tissue directly. By inserting a needle directly into a trigger point identified we are trying to release muscle tension. The term dry comes from the concept that there is no fluid transmission. Needles are not hollow, like a syringe for injections. They are solid, similar to needles also used for acupuncture. 

One important clarification is that dry needling is NOT acupuncture.

Dry needling does not subscribe to Eastern medicine philosophical approaches that are rooted in traditional acupuncture. Instead, dry needling is simply based on the notion of treating and manipulating myofascial trigger points within a muscle belly itself to help either modulate pain or improve the range of motion/mobility that is coming from the level of irritability of the target muscle.

How does Dry Needling actually work?

For all my bookworms out there, there are four proposed mechanisms that occur in response to dry needling a taut band within a muscle to help alleviate related pain and/or mobility restrictions.  Chemically, the micro-trauma from the needle itself may help to stimulate a healing response by restoring Acetylcholine levels in the muscle and dropping bradykinin, serotonin, substance P, and CGRP levels. Secondly, it can help to settle or quiet the spontaneous electrical activity within the taut band of muscle that is responsible for trigger point manifestation. Mechanically, dry needling will help to physically length muscle sarcomeres and reorganize fibers to aid in the range of motion restoration. Finally, on a neural level, dry needling can stimulate A-nerve fibers which will help to block noxious stimuli at the dorsal horn, thus helping to reduce pain response. WHEW!

Treatments are fairly simple and quick.

There are a variety of treatment options that a therapist can choose to do with needles to help with outcome responses. Some include pistoning the needle in/out of the trigger point, leaving the needle in the muscle for a time, and even running an electrical current to and through the needle. One of the objectives of dry needling is to elicit a local twitch response, which is the phenomenon where the taut band within the muscle needled will involuntarily contract, “twitch” due to the interaction of the needle in the muscle. While local twitch responses do not have to happen in order for treatments to be effective, any one of these varieties of treatments can help to elicit one or numerous twitches.

Treatment plans that include dry needling are a complement to other items in a plan of care.

While not the sole item of treatment, dry needling can often act as a catalyst for improving the behavior of a muscle (pain and mobility) in the short term, but it needs to be paired with a plan that works on treating the etiology of why the trigger point is active and creating the behavioral dysfunction. Quality therapists will look to identify the “why” behind the scenes, which could be due to poor movement quality, an overuse-type situation, an imbalance of strength/flexibility, and/or habituation due to either a sustained and/or repeated posture/movement….all creating a dysfunctional muscular state.

For my own practice methods, I tend to look for trends with respect to the response from dry needling. I will tend to give a plan of two to three attempts/sessions before I would consider the use of dry needling a success or not necessary; constantly assessing patients’ responses to each treatment session.

What to expect as a client?

Dry needling can elicit soreness and bruising focally at treatment sites very similarly to intramuscular injections…think vaccination shots! It is acceptable for the muscle region to feel sore for up to 72 hours, and to have bruising that can last a similar duration.  Regarding activity post-needling, clients are not restricted in any way. They can go back to their typical daily activities, including exercise/sport. Sometimes, dry needling is used to see if the exercise/sport or movement of question actually feels better!

Dry needling is a fairly safe treatment with few precautions.

Care needs to be taken when needling areas near the lung field to avoid needles inadvertently entering the lung space. Needles can nick vessels, including veins, arteries, and nerves, but this is safe and not likely to cause any damage to these tissues. While most people can be candidates for this treatment, women who are pregnant, clients with active blood clotting disorders, and/or cancer are typically contraindicated for care. In those cases, I would seek outside counsel from their primary medical provider or specialist if I wanted to still consider dry needling as a treatment option. 

In addition to our three-year doctoral degree in physical therapy, clinicians must complete APTA and state practice act accredited post-graduate training in order to legally perform dry needling.

In my nineteen years of experience, this is one of the treatment advancements within physical therapy that has stood the test of time, and can be a great tool in our tool box to help treat patients! 

Dr. Daniela and Dr. Chris are both certified in dry needling - Dr. Daniela has capability to do pelvic floor dry needling.