Treatment Toolbox: Dry Needling

PT Blog   •   August, 2017

“A good tool improves the way you work. A great tools improves the way you think.”

– Jeff Duntemann

What is dry needling?

The APTA defines dry needling as “a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscle, and/or connective tissues for the management of neuromusculoskeletal pain and movement impairments.” Based on some principles and evidence from the acupuncture literature, dry needling in the United States can be attributed to the work of doctors Janet Travell and David Simons who used small needles for trigger points and myofascial pain in the 1990’s. Since then, it has become a hot topic in the physical therapy world. Let’s take a closer look at the science and application involved with this treatment tool.

How does it work?

The effects of dry needling continue to be researched, but evidence exists to support several peripheral and central mechanisms by which dry needling can modulate and eliminate pain.

  1. Suppression of spontaneous electrical activity (SEA) at myofascial triggerpoints (MTrP), reducing sustained cellular muscular contraction, which alleviates localized ischemia and hypoxia.
  2. Local microtrauma resulting in a release of vasoactive substances causing vasodilation, angiogenesis, and increased blood flow and oxygenation, all of which improve circulation in local muscle.
  3. Neurophysiologic effects, namely hyperstimulation analgesia from mechanical stimulation of the extracellular matrix and segmental inhibition via the gate control theory.
  4. Centrally mediated pain modulation by activating areas of the brain involved in acute and chronic pain states, specifically the anterior cingulate cortex, the insula, and the cerebellum.

The application for the use of dry needling is numerous and continues to expand. Several neuromusculoskeletal conditions support the use of dry needling as an effective treatment approach.  Let’s explore some of the applications [This is not an exhaustive list]:

  • Myofascial pain syndrome. In a seminal study by Lewitt in 1979 “the ‘needle effect,’ or immediate analgesia, was obtained in 86.8% of painful structures” and he concluded that “dry needling is highly effective in the therapy [treatment] of chronic myofascial pain.”
  • Headaches. In a study by Vickers et al. on chronic headaches in primary care, “mean headache scores with significantly lower in the acupuncture group, with a 34% reduction compared to 16% in controls… with scores continuing to be lower at 12 months.”
  • Carpal Tunnel Syndrome. In a study by Yang in 2009, needling was compared to steroid injection with the needling group’s Global Symptom scale improving by 70% compared to 64.7% in the steroid group. The author concluded that dry needling exhibited “superior efficacy when compared with steroid treatment not only in objective changes in nerve conduction but also in subjective symptoms.”
  • Low Back Pain. In a study by Yeung in 2003, “when compared to [exercise alone], there was a significantly greater reduction in pain and disability in the [exercise + electric dry needling] group.
  • Knee Osteoarthritis. In a study conducted by Vas et al in 2004 “12 sessions of electroacupuncture + diclofenac was more effective than placebo electroacupuncture + diclofenac for the treatment of pain, stiffness, and function in patients with osteoarthritis of the knee.”

The arrival of dry needling is a new and exciting frontier for the future of physical therapy. Although ample evidence exists for its benefit and some of the underlying biomechanical and neurophysiological mechanisms are understood, new information and understanding is needed to further the effectiveness of this treatment. New and exciting tools are just that – new and exciting – for a time.  The best tools, that stand the test of time, are those of sound clinical reasoning grounded in a framework of evidence-based practice focused through the lens of patient-centered care.

Contributing Author Credit: W. Evan Stringfellow, PT, DPT, CSCS, Cert. DN

References

  1. Hsieh YL, Chou LW, Joe YS, et al. Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle. Arch Phys Med Rehabil. 2011;92(7):1098–105
  2. Kubo K, Yajima H, Takayama M, et al. Changes in blood circulation of the contralateral achilles tendon during and after acupuncture and heating. Int J Sports Med. 2011;32(10):807–13.
  3. Melzack R. Myofascial trigger points: relation to acupuncture and mechanisms of pain. Arch Phys Med Rehabil.1981;62(3):114–7.
  4. Chu J, Schwartz I. The muscle twitch in myofascial pain relief: effects of acupuncture and other needling methods.Electromyogr Clin Neurophysiol. 2002;42(5):307–11.
  5. Biella G, Sotgiu ML, Pellegata G, Paulesu E, Castiglioni I, Ferruccio F. Acupuncture produces central activations in pain regions. Science Direct. 2001; 14(1):60-66.
  6. Lewit K. The needle effect in the relief of myofascial pain. Pain. 1979; 6(1):83-90.
  7. Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R. Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial. BMJ. 2004; 328(7442):744. Epub 2004 Mar 15.
  8. Yang Cp, Hsieh CL, Wang NH, Li TC, Hwang KL, Yu SC, Chang MH. Acupuncture in patients with carpal tunnel syndrome: A randomized trial. Clin J Pain. 2009 May; 25(4):327-333.
  9. Yeung CK, Leung MC, Chow DH. The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low back pain. J Altern Complement Med. 2003; 9(4): 479-490.
  10. Vas et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomized control trial. BMJ. 2004 Nov 20; 329(7476):1216.

Review Question

What is the difference between dry and wet needling?

Answer

Wet needling involves a liquid substance, whereas dry needling has no liquid or medication when applied.

2018-08-11T18:17:55+00:00

About the Author:

Ashley Theobald, D.P.T. – Ashley was born and raised in a small town in Alabama. She attended the University of South Alabama and was an advanced undergraduate student completing her Bachelor of Science degree in pre-professional health sciences in 2012. She then graduated with her doctorate in physical therapy in 2014. During her first year of PT school she met and married her husband, Ben. They moved to Nashville, TN where she worked for 3 years in an outpatient clinic full time and at Vanderbilt Stallworth Rehabilitation Hospital PRN. She is now working for ATI Physical Therapy full-time in Greenville, SC. She has been an avid health and fitness fan playing softball growing up, tennis in high school, and completing 2 half-marathons in college. She enjoys traveling overseas and has completed 2 short-term medical mission trips for physical therapy in the Dominican Republic (2013) and Haiti (2015), with intentions of returning yearly.
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