Dry needling has become ever more popular over the previous decade and has been included as part of treatment practice in a growing number of physical therapy clinics. While it is becoming more common, there are still plenty of questions from most people about what this treatment entails, who can perform it, and the possible pros and cons of this.
What is Dry Needling?
According to American Physical Therapy Association, dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. Regulations vary from state to state but in Colorado therapists must complete additional coursework after finishing their degree, which is already a doctoral level degree.
Evidence for effectiveness
There are several ways in which dry needling can affect pain. Performing dry needling can help increase blood flow to the treated area. This is similar to the response that happens when tissue massage is performed. Dry needling can also decrease sympathetic nervous system hyperactivity. This is the “fight-or-flight” system in the body and having this system elevated for long periods of time can have a detrimental effect on pain response. Another finding from research is that dry needling can help increase endorphins. These substances are peptides which activate body receptors that have a pain relieving effect. Reading through some of the research on this can get very dry but the main takeaway is dry needling can help reduce excessive muscle activity associated with pain. For those who prefer information in list form, the bulleted section below has everything summarized.
- Increased blood flow to area
- Suppressed motor end plate activity (higher activity is associated with pain and irritability)
- Possible acetylcholine depletion (Acetylcholine is the neurotransmitter that signal for a muscle to contract)
- Decreased sympathetic hyperactivity (the fight-or-flight part of the nervous system)
- Reduced surface EMG activity
- Increased endorphins
Common areas treated
Any area where there is musculoskeletal pain or myofascial trigger points can be treated. Considering there are 600+ named muscles in the body, this includes just about everything. Most common areas treated coincide with common areas of pain: low back, neck, shoulders, hips, knees, etc. I utilize dry needling the most in the neck and back but this is because these are the most common areas of pain seen in physical therapy clinics.
Safety
At PTSC we will always go over any safety concerns using our informed consent form to make sure each person is receiving the most appropriate treatment. It is exceedingly rare to have complications. Most people have some soreness afterwards which is expected. There are instances where we cannot perform dry needling. Below are a few common contraindications
- 1st trimester of pregnancy
- Compromised immune system
- Local infection
- 6 weeks post op, 12 weeks for local area of surgery
What can I expect?
If you are wondering about dry needling as a treatment for yourself, it’s always a good idea to discuss this with your physical therapist. Not everyone is appropriate for dry needling. I utilize this on less than 25% of my patients but for those that can benefit from this type of treatment it can be a very useful tool to use along with manual therapy, specific exercise, and other treatment options. The most common worry from patients is whether the needling will be painful or not. This is difficult to know since everyone has a different response and relationship with pain. I often tell people we are looking for a reproduction of symptoms which lets us know we are in the correct part of the muscle. It’s common to have some soreness afterwards lasting for up to 72 hours. Some mild bruising can also occur but this happens in less than 10% of people.
Often I will utilize dry needling for 3-4 treatment sessions to get a good idea of the response for each individual.
If you are interested in this treatment or have further questions you can always contact PTSC or check out some of the resources available at choosePT.com.