09 Nov What Is Dry Needling?
Do you have tight muscles, painful joints or trigger points, headaches, or other orthopedic pain issues? If so, maybe your doctor or other practitioner has suggested a trial of dry needling to treat your pain. Dry needling is the insertion of fine filament needles into the body, specifically neuromuscular tissue, with the goal of decreasing pain and spasm. There are many conditions and symptoms that can be treated with dry needling, as well as many methods of delivery for this modality. In this article, we will explore some of the most commonly asked questions about dry needling, methods of delivery and treatment, and how dry needling can work to decrease musculoskeletal pain.
Dry Needling: Methods and Regulations
As stated above, dry needling is defined as the insertion of fine filament (very small) needles into the human body, with the purpose of treatment for pain, “trigger points”, and soreness. There are many methods of delivery for dry needling treatment, and one must receive adequate training on how to implement this modality safely and effectively. Currently, laws and regulations that govern a physical therapists’ ability to perform dry needling treatment vary by State. If you would like to learn more about state laws in relation to dry needling, you can visit the APTA Website!
Dry Needling: What are “trigger points”?
As mentioned above, and widely mentioned in the literature, we hear that dry needling is often used to treat “trigger points” in the musculature. Just what are these “trigger points” and why is dry needling thought to be beneficial for them?
It is important to note that among clinicians there is varied discussion on “trigger points”, if they exist, if we can palpate them, and what material they consist of. There is a lot we don’t know yet, and with more research coming out every day, we are bound to learn more!
“Trigger points” are thought to be defined as points in the muscles that experience sharp, pinpoint pain or feelings of “muscle knotting” when pressed on. (1,2) Patients can experience them as taught “bands” of tissue and also often experience what is known as ‘referred pain’, or pain that travels to an area away from the origin. It is unclear what causes “trigger points”, but some ideas proposed by the research are (2):
- Injury sustained from a trauma or fall
- Lack of exercise
- Impaired posture
- Muscle overuse from weightlifting
- Chronic stress condition
- Vitamin deficiency
- Sleep disturbance, or
- Joint problems/hypomobility
Symptoms (2) often caused by these painful areas are:
- Lack of range of motion
- Losses in strength
- Muscle weakness or imbalance
- Tension headaches
- Postural instability and abnormalities
Given the overwhelming prevalence of the above-stated impairments in our world today, we are always looking for new and innovative ways to treat and help people manage their symptoms. Dry needling is often suggested as a treatment for “trigger points”, to help ‘release’ them and decrease pain.
Anecdotal and case study research supports dry needling as a tool for decreasing ‘trigger point’ pain. For example, in a case study by Matsel et al, ‘trigger point’ dry needling was utilized on patients with shoulder pain in the outpatient PT setting (4). This was used separately from AND in addition to therapeutic exercise and manual therapy interventions. This study concluded that while dry needling assists patients in short term pain relief, it could not conclude that it was any more beneficial than exercise and manual therapy in the setting of long term pain relief and that either modality could be effectively utilized.
In another study by Gerber et al., 52 active trigger points were treated utilizing dry needling three times per week. Symptoms were reduced in the study participants, however, 11 trigger points were still painful to palpation (active), 26 were non-painful to palpation (non-active), and 15 points were eliminated (non-palpable) (6). Here again, it is suggested that dry needling is a tool in the therapy toolbox, and when used in conjunction with exercise and other therapies, can be very effective in treating pain and associated symptoms.
Dry needling: Is it acupuncture?
One of the most commonly asked questions about dry needling is: is it the same thing as acupuncture? The answer is ‘no’ – but the two methods of treatment do overlap in a couple of ways.
Think of it this way: you have a hammer in your hand. Most likely you are going to use this hammer to drive in a nail on your latest project; this is a hammer’s most common use. But, did you know you can also use a hammer to split wood, dig a hole, or (in times of desperation) as a back scratcher? The same concept applies to dry needling. The TOOL (needle) we use is exactly the same for both acupuncture and dry needling, however, the way we USE the tool differs greatly.
Acupuncture is rooted in Eastern philosophy, while dry needling is rooted in Western medicine. Acupuncture use has been thought to date back over 2000 years ago, and has been used to treat a wide variety of conditions, including musculoskeletal pain, weight loss, gastrointestinal issues, headaches, and mental health related conditions (3,5). The filiform needles are usually inserted superficially (shallow), and are used to clear up ‘meridians’, also known as vital pathways in the body with which energy is said to flow freely. Acupuncturists may also emphasize ‘di qi’ sensation to direct their treatment, also known as local muscle twitches or free-flowing of sensation when the needles are inserted. (3,5)
Dry needling was documented to be ‘discovered’ in the 1970s, and utilizes the same type of needles (filiform) as acupuncture to deliver treatment. It is most often utilized to treat musculoskeletal conditions and painful trigger points, which are identified through direct palpation of body structures. (3,5) Needles used can be inserted EITHER superficially or deep, depending on the structure you are trying to treat. The needles are sometimes left in the body statically, or can be manipulated, based on the training and confidence of the practitioner who is treating. One method, known as ‘pistoning’, happens when the needle is inserted into the painful structure and then moved quickly up and down.
Dry needling: Is treatment safe for you?
Before receiving dry needling treatment, you will want to make sure you are an appropriate candidate for treatment, and that you have been screened for any health conditions that may prevent treatment from being safe and effective. Finding a highly trained, educated, and qualified therapist can help you do just that!
Just like any other modality or treatment, dry needling may not work or be appropriate for everyone. The most common contraindications for treatment include:
- Metal allergy
- Severe needle phobia
- True lymphedema
- Skin lesions, rashes, and spray tans
- Blood and systemic diseases such as leukemia
- Clotting disorders
- Cancerous tissue
- Inability to communicate
- Areas of implants/prosthetic tissue
- HIV, AIDS, or hepatitis
A discussion with your physcian and/or therapist is best for coming to a mutual decision on whether dry needling is appropriate based on your medical history.
What conditions are treated by dry needling, and what are the benefits?
There is an extensive amount of musculoskeletal conditions that can be treated with dry needling in addition to other therapies. Patients who present with pain syndromes, neuromusculoskeletal disorders, and movement impairment syndromes can all benefit from dry needling. Simple muscle tightness, strains and sprains, an overworked body needing recovery (such as in athletic or competitive populations), muscle activation, swelling reduction, and pain modulation are all examples of clinical use of dry needling. Healed and chronic scarring from trauma and other injuries can also be treated successfully with dry needling. Tissues contributing to neuromusculoskeletal dysfunction can be dryneedled, including muscle, fascia, tendon, capsule, ligament, peri-neural structures, and microvascular structures.
The benefits of dry needling have also been demonstrated in recent research and patient case studies (4). Dry needling has been shown to reduce local and systemic pain effects, decrease trigger point sensitivity and pain, improve range of motion in a joint, speed up the recovery process in the athletic population when an injury is present, and can reduce overall pain sensitivity response (4).
So what are some specific conditions that are commonly treated by dry needling? As we have discussed in this article, dry needling is a modality, or tool, utilized during treatment and it has been demonstrated to be most effective when COMBINED with therapeutic exercise and manual techniques delivered by physical therapists. Therefore, below we have provided specific exercises that you can utilize in addition to your needling sessions to help get you moving and restore optimal muscle function! First, we will show you a video demonstration from Tayrn of how dry needling is performed.
Dry Needling Video Demonstration
Conditions Treated With Dry Needling: HEADACHES
Dry needling can be used at the cervical spine musculature to assist with headache management; tension headaches in particular. The needles are usually inserted into the cervical spine musculature and assist with loosening the tissues and muscles, causing them to relax, which lessens overall pain and spasm.
Cervical Spine Dry Needling
Here are some great follow up exercises to pair with your cervical spine needling treatment!
Cervical Spine Exercises: Chin Tuck
- HOW: In a seated position, focus on tucking your chin towards the front of the upper part of your neck. Think about creating a “double chin”.
- FEEL: You will feel the muscles in the front of your neck activating. You may feel a stretch in the back of the neck at the base of your skull.
- COMPENSATION: Try minimizing excessive neck motion, realize this is a smaller motion focused on moving the skull on the cervical spine. There will be some cervical motion, but not excessive motion. For instance, do not let your entire neck bend forward (chin to chest).
Cervical Spine Exercises: Self Neck Stretch
Place one hand on your chin with the opposite hand on the back of your head. Create a passive chin tuck using your hands, bend your head to one side, then rotate your head up towards the ceiling, and hold this position. If I bend my head to the right, then I will rotate to the left and visa versa.
Learn Other Exercises To Get Rid of Neck Pain!
Conditions Treated With Dry Needling: LOW BACK PAIN
Many people experience low back pain, for multiple reasons. Dry needling has been shown to help improve lower back pain and stiffness and help restore balance and optimal muscle function.
Low Back Dry Needling
Are You Currently Dealing With Low Back Pain?
The Shoulder [P]Rehab Program is a physical therapist developed, step-by-step program that teaches you how to optimize your shoulder health. This 4-phase program will expose you to various scapula and shoulder strengthening and stabilization exercises supported by science. This program will bulletproof your shoulders for anything life throws at you! Learn more HERE! Below are some great follow up exercises to pair with your low back treatment!
Low Back Exercises: Seated Cat/Cow
Get set up seated upright with your hands supported on your thighs. Begin the exercise by rounding your upper body and head/neck forward, letting your spine bend forward as your hands slide down your thighs. Reverse the motion to sit upright nice and tall and let your back/spine arch and extend. Repeat.
Low Back Exercises: Scorpion Stretch
Begin by lying on your stomach with your arms straight out to the side. Keep your upper half on the ground as you lift one leg up and over the other leg tapping the toe, and returning. Alternate each leg going back and forth for the prescribed amount of reps.
Low Back Exercises: Bird Dog/Bear Position
Start on all fours with your knees under your hips and your elbows under your shoulders and hands on the ground. Push your toes into the ground, then push into it lifting your body slightly off of the ground. The wider you are, the easier to balance, the more narrow, the more challenging this will be. Keep your back flat and your core engaged. Bring one arm and the opposite leg up until your leg is straight out from your hip and your arm is straight out from your shoulder.
Conditions Treated With Dry Needling: LATERAL EPICONDYLITIS (tennis elbow)
There are many types of tendinopathies that can be treated with dry needling, tennis elbow being one of them. The needles are usually inserted into the muscles of the outer elbow and sometimes into the top of the forearm, depending on how tight the muscles are.
Tennis Elbow Dry Needling
Here are some great follow up exercises to pair with your tennis elbow treatment!
Tennis Elbow Exercises: Elbow Band Pull Apart
With a resistance band in both hands, simultaneously pull the resistance band on one end with your biceps and on the other with your triceps. Hold for a second at the end before slowly allowing your arms to come back to center. Once the band has completely lost its tension, repeat.
Tennis Elbow Exercises: Forearm/Wrist/Arm Circles
In a standing position with your arms at your side and your shoulder blades squeezed back, bend your elbows and rotate your arms out to the side as far as you can. From here, face your palms forward, point your fingers facing back as far as you can extend them, and extend your wrist back. After this, bring your arms up putting your thumb in your hand making a fist as you point your palms to the front while bringing your arms back to the starting position.
Tennis Elbow Information
Listen to Craig here as he gives you information on Tennis Elbow!
Dry Needling: How does it work?
Without delving into a complex anatomy and physiology lesson, there are a few ways in which introduction of a dry needle to the skin may work to help heal our tissues.
Release of ‘healing agents’: Our body is a SMART system. We have pathways in place to help us recognize sensations – pain, light touch, hot/cold, and pleasurable sensations. When our body recognizes ‘injury’ or ‘tissue trauma’, a cascade of healing materials are sent to that specific area to start the process of restoration. A similar process happens when we introduce a dry needle to a tissue area – the body recognizes a VERY SMALL amount of insult to the tissue, and kicks in the cascade of healing agents. The lesion created by the dry needle is SO SMALL that the healing agents can override it, helping to bring good, healthy blood flow to the area where the needle is inserted.
Want to know more about tissue healing and how it occurs?
Activation of ‘pain pathways’: Our body is equipped with several tracts, including our nerves, that are able to sense different types of pain. Broadly, these are known as A-Delta, A-beta, and C-fibers. A-beta fibers sense our touch and pressure sensations, A-delta fibers respond to hot, cold, and sharp touch, whereas C-fibers are slow moving and respond to our dull touch sensations. With local insertion of a dry needle into a body area, these receptors are “turned on”. When this occurs, a couple of things can occur. Vasodilation starts to kick in – meaning our vessels are opening and there is increased blood flow to the needled area. Also, nerve growth factor is released, assisting with nerve regeneration and therefore, leading to decreased pain sensations.
Dry Needling: Closing Thoughts – What else should I know?
Not all insurances will cover dry needling treatment. Oftentimes, patients will be charged a cash price by the facility they are receiving the treatment from. It is important to check with your State Practice Act, as well as call your insurance provider directly to see if this modality is a covered service. Your provider’s office can assist you with this process if needed.
How do you connect with your physician quickly and easily, especially during a pandemic? Telehealth services are rapidly growing around the country, and are a great way to bring questions and concerns to your provider. Check out our podcast on providing services via telehealth and how it may be able to help you!
It is important to reiterate that those receiving this treatment may respond differently than expected, and that not every person with pain is appropriate for this treatment. Just as with every treatment, new medication, or procedure, it is imperative to be well educated about the potential adverse reactions and side effects that you may experience. Utilizing a trained practitioner, as well as considerations of the guidelines above are important when deciding if dry needling will benefit you.
Dry needling is a ‘tool in the toolbox’, if you will, to treat acute and chronic pain syndromes. We hope that this article has been informative and helpful to you in your journey to pain-free and functional living!
4. Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014;19(4):252-265. doi:10.1179/108331913X13844245102034
6. Gerber LH, Shah J, Rosenberger W, Armstrong K, Turo D, Otto P, et al. Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects With Chronic Myofascial Pain. PM&R [Internet]. 2015;7(7):711–8. Available from: https://dx.doi.org/10.1016/j.pmrj.2015.01.020