Dry Needling, the Good, Bad and Ugly!
Dry needling has been a very hot topic for a while now and thought I’d discuss some of the positives and negatives from a treatment which includes “dry needling”.
Dry Needling, does it work?
The short answer is "It Depends".
Dry Needling alone will provide changes to the nervous system which will alter pain pathways, thus making the patient feel better. Although seeing that many physiotherapists get zero dry needling training in their degree makes me wonder if it should be used during practice especially as the first point of call. Most therapists e.g. chiropractors and physiotherapists will spend on a weekend course being “qualified” in dry needling, where most Myotherapists will spend a minimum of 6 months to a year.
We all know certain therapists which don't like getting their hands dirty so to speak. Without a take home program I don't believe dry needling should be used as a stand-alone tool.
The evidence for Dry Needling is still extremely vague and young although compared to acupuncture is slightly different. I believe the best approach to treatments should be a variety of different treatment options.
Such as a manual therapy, extensive listening skills, a certificate in basic strengthen and conditioning, progressive loading and having an understanding of biomechanics. Each client is seeing their therapist for pain relief or advice. Most clients will do anything to fix their issue or reduce their pain. It's like orthotics or tape for example, If you don't fix the underlying condition our source of pain how are you going to get better long term? You’re not!
But some therapists don't want you to get better so that they can have repeat business (this is true)....
This is why I believe myotherapy can be the most effective type of therapy if used correctly and depending on the therapist performing it.
Having a background In personal training, strength training, rehab focused as well as many years of manual therapy and joint mobilisations work perfectly together.
In all, dry needling has shown my clients some amazing results. Combined with a program to teach the individual how to self release their muscles and strengthen correctly leaves minimal room for error.
Dry needling is a technique that is fast gaining appreciation within the therapy world, with many practitioners throughout Australia now trained in the use of acupuncture needles to assist with their client’s pain and rehabilitation. I found myself interested in dry needling and its application from an early stage in my myotherapy career, and have undertaken dry needling courses including advanced dry needling with thousands of clients benefiting from it.
In this blog article I wanted to answer common questions about dry needling and express my opinion on the good, bad and ugly including:
1. What is dry needling? 2. What is the difference between acupuncture and dry needling? 3. How does dry needling work? 4. What will I feel during my dry needling session? 5. Is dry needling safe? 6. Where does dry needling fit into my rehabilitation plan?
1. What is dry needling?
Dry needling is a treatment technique designed to ease muscular pain. Its popularity is growing throughout elite athletes, crossfit games, AFL and the olympics.
Dry needling is a unique tool intended to specifically target and restore muscle function, with an emphasis on improving tissue healing and restoring normal tissue function. This is important as continued activity with poor muscle function may lead to further tissue damage and increased pain.
Dry needling is not meant to replace conventional medical procedures such as myotherapy, chiropractic, physiotherapy or surgery. However, when combined with conventional treatment options, dry needling can be an influential method to accelerate pain reduction, healing and the restoration of normal tissue function.
The exact mechanisms of dry needling are complex and not fully known.
Personally I believe that the length of time the needle is left in for doesn't matter it's more so releasing the trigger points and having a big emphasis on aftercare advice.
2. What is the difference between acupuncture and dry needling?
There are obvious similarities between dry needling and acupuncture in that the needles used are identical. Generally dry needling is based on Western anatomical and neurophysiological principles, which are not to be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture.
TCM is based on the use of “pulses,” “coatings” and “meridians” (or channels) derived from ancient Chinese philosophy and culture, with traditional acupuncture needles inserted into defined acupoints, intended to unblock energy meridians and help create balance within bodily systems. Advocates of traditional acupuncture promote its use for treating a range of physical and psychological problems.
Unlike the specific tissue targets used in dry needling, acupoints do not necessarily match our understanding of anatomy and the proposed treatment mechanism is largely inconsistent with modern medical science.
Modern dry needling is based on current medical science and research known and accepted by today’s primary care, orthopaedic, neurologic and pain management physicians. However, the positive effect on pain of inserting a needle is likely to be similar, whether administered as part of a dry needling or acupuncture treatment.
3. How does dry needling work?
As I mentioned previously, the exact mechanisms of dry needling are complex and not fully known. However, there is a growing body of scientific evidence that supports the positive effect inserting a needle has on the electrical and chemical communications that take place in our nervous system. These include inhibiting the transmission of pain signals in our spinal cord and increasing the release of our own pain relieving chemicals within our brains.
Dry needling uses a very fine, solid filament needle to cause a small, precise injury or “lesion” in the tissue when it enters the body. The tiny needle induces injury signals the brain uses to initiate a sequence of events to replace or repair the damaged tissue with new, healthy tissue. Needling in a painful ‘trigger point’ or muscular knot frequently provokes a “twitch” response from the muscle. This is both diagnostic as well as therapeutic, because healthy muscle tissue will not “twitch” when stimulated by the needle. Once a “twitch” response has been elicited, the muscle fibers in that area relax, ‘inflammation’ is reduced and circulation improves. As a result of these physiologic processes, dry needling can purposely address muscle, tendon and myofascial pain and dysfunction.
Personally, I feel dry needling has a complex effect on the body’s fascial make-up: with fascia being the connective tissue that surrounds muscles and joints, and keeps everything together. Originally fascia was thought to be an innate substance with minimal neural input/output, but on-going research has found that fascia is a highly innervated tissue (lots of nerves), and therefore would have a strong response to a slightly invasive treatment technique – such as dry needling.
4. What will I feel during my dry needling session?
Generally, needle insertion is not felt; the local twitch response or sudden slight contraction of the muscle may provoke a very brief pain response. This has been described as an electric shock or a cramping sensation. A therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.
During treatment, and depending on the dry needling technique used, patients commonly experience a pleasant feeling of relaxation. Following this technique some muscle soreness may be felt up to 24-48 hrs.
5. Is dry needling safe?
Dry needling can be safe if the therapist has lots of experience and is confident in their own skill set. This is why I believe that therapists should have to do a separate course which takes 6 months or longer to be confident in treating their clients and being very familiar with any contraindications.
Side effects are very rare but when they occur, the most frequent and the most serious is that of a pneumothorax. This is where a needle pierces the lung leading to a full or partial collapse. This happens mostly when a needle is inserted into the Trapezius muscle in a certain way and too deeply – generally due to poor practitioner technique. Many physiotherapists will not dry needle muscles of the thorax that may be deep and close to the inflated lung, but most physios have a deep understanding of the relevant anatomy and dry needling technique so the practice is very safe.
6. Where does dry needling fit into my rehabilitation plan?
Dry needling seems to be the modality of choice when it comes to treating acute injuries, muscle spasms or muscle pattern imbalances. It is very common to initiate dry needling at the beginning of your treatment program in order to break the pain cycle. Once that is achieved, other treatment options are introduced, such as working on improving mobility, strengthening and stability.
Typically, it takes several visits for a positive reaction to take place, as the needling is looking to cause mechanical and biochemical changes without any pharmacological means. Therefore, we are looking for a cumulative response to achieve a certain threshold after which the pain cycle is disturbed.
While dry needling can be very useful in relieving pain it does not necessarily address the source of the pain. For example, someone with advanced osteoarthritis of the hip or knee may have associated secondary muscular pain as the muscles compensate to avoid movement related with pain. Dry needling can be valuable in relieving the pain but it will not reverse the osteoarthritic alterations in the hip that are the source of the muscular pain.
The benefits of Dry Needling frequently include more than just relief from a particular condition. Many people find that it can also lead to increased energy levels, better appetite and sleep as well as an enhanced sense of overall wellbeing.
Overall, I believe Dry Needling can be useful for the right person at the right time.
I believe Dry Needling is not for everyone and that it should not be used in an initial consultation in most circumstances, I have seen great results combined with a strengthening and rehabilitation protocol.