Dry Needling - your questions answered

The practice and evidence base for ‘Dry Needling’ has increased substantially over the past decade. Most clients, knowing the remarkable effects it can have on pain and muscle tightness, come back for more (despite initial soreness!). However, many still have questions about what exactly Dry Needling is, how it works and what is involved. This month’s Blog is to help clear up any questions surrounding the topic.

 

What is a ‘myofascial trigger point’?

Before we start discussing Dry Needling, it is important to understand what a myofascial trigger point is. The definition is “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is tender when pressed and can give rise to characteristic referred pain, motor dysfunction and autonomic phenomenon”(1). In simpler terms it is a sore, tender spot within a tight muscle which can refer pain to other neighbouring areas of the body, and furthermore cause movement dysfunction.

Trigger points can be active (causing your pain, can refer to other areas) or latent (non-painful, can be sore when pressed, have the potential to become active)(2,3). Research has shown that these active trigger points have elevated levels of pro-inflammatory chemicals (norepinephrine, serotonin, bradykinin, CGRP, substance P)(4).

Active myofascial trigger points can be released with remedial massage, self-release with a trigger ball or foam roller, or if stubborn – Dry Needling!

Upper Trapezius trigger points referring pain into the head. Courtesy of: http://www.triggerpoints.net

What actually is Dry Needling?

Dry Needling is the insertion of a very fine, sterile needle into a myofascial trigger point. The aim is to reduce pain caused by this trigger point, and reduce tightness/spasm in the targeted muscle.

Insertion of the needle will usually elicit your pain and/or provoke a local twitch response (a little spasm or twitch in the muscle). Usually the needle is left in for a minute, or several minutes. The physiotherapist may also ‘fan’ or move the needle to elicit a twitch. Most clients describe a cramping sensation, or a small electric shock feeling – some find it hard to describe, others don’t feel the needle go in at all!

Dry Needling can be effective for a wide range of musculoskeletal problems, including (but not limited to): low back pain, tension headaches, shoulder pain, tennis elbow, buttock pain, calf tightness/spasms. 

How old is Dry Needling?

A historical summary of the use of Dry Needling:

  •  >4000 years ago – the origins of Acupuncture (Chinese Medicine) where stone needles were used in ancient China.
  • 1940s – Dr Janet Travell first introduced the term ‘Trigger points’ and the practice of Dry Needling. Initially she injected local anaesthetic into trigger points. Later she found out that using a hypodermic needle without injecting any substance had similar positive effects.
  •  1977 – Dr Chann Gunn first described Dry Needling, labelling it as intramuscular stimulation (IMS).
  • 1979 – Dr Karel Lewit (a Czech Physician) performed a study confirming the efficacy of dry needling by showing its analgesic effects. He was one of the pioneers in using dry needling for pain relief.
  • Late 1980s – Dr Gunn and Dr Peter Baldry adopted the use of the acupuncture needle we use today.

What is the difference between Acupuncture and Dry Needling?

Acupuncture is a form of Traditional Chinese Medicine (TCM) based on Taoist spiritual models. In TCM the body is approached as a system where energy flows along specific channels or ‘meridians’. The free flow of this energy is known as ‘Qi’. Diseases or disorders can imbalance or block this energy system, or the ‘Yin/Yang’. Acupuncture is used to restore the balance, and as a result relieve tension, reduce pain and normalise function. Acupuncture is alternative medicine, and involves the treatment of the whole person – local and distal points. For example there is a point in the index finger that is linked to toothache. Acupuncture is commonly used in chronic pain, hormonal issues, nausea and vomiting, and migraines.

Acupuncture acu-points.
Courtesy of: http://www.richardhousemd.com

 

On the contrary, Dry Needling is more anatomical in nature – based on neurophysiological principles. The needles are inserted locally into the trigger point of the tight muscle.

How does it actually work?

In simple terms it helps to de-activate trigger points, release tight muscles and reduce pain.

The exact science behind Dry Needling is complex, and still being researched. But for the more scientific brain, here are a few widely supported theories:

  • Increases blood flow to the area (via vasodilation). There are healing benefits of increasing blood flow including bringing in nutrients to the tight muscle, and flushing out the inflammatory chemicals (mentioned above) in that muscle.
  • Nerve pathways are stimulated to release natural opioids within the body (endogenous opioid peptides). Opioids have a muscle relaxing and pain relief effect (5).
  • Pain Gate Theory (local segmental effect) – needle insertion activates mechanoreceptors, and inhibits nociceptive (pain) pathways conducted in smaller C fibres (6). Or in short, dry needling can stimulate nerve fibres that block the pain message reaching the central nervous system.
  • Needle insertion stimulates the release of serotonin in the central nervous system. Serotonin helps to inhibit pain (via nerve pathways).
  • Diffuse Noxious Inhibitory Controls (DNIC) – pain information can be blocked by the application of a second new noxious (pain) stimulation which then activates centres in the brain-stem and descending modulatory pathways (7). Complex stuff, but basically "pain inhibits pain" via brain signals. 

Are there side-effects?

You may feel a temporary ache (or sometimes tightness) in the area – this should dissipate within 24 hours. Side effects are usually mild, and may include bruising, fatigue and a temporary increase in pain. Dry Needling is a safe technique, and the side effects are minimal compared to drugs or surgery.

Often people ask about the risk of infection. Strict regulations require an aseptic procedure, involving a sterilised needle, with single use (per client), alcohol swab wipes, adequate practitioner hygiene (hand washing) and correct disposal of needle (sharps bin). Infectious status must be declared via the client (usually via a New Client form) and likewise the practitioner is responsible to have no infectious status.

Trained health professionals have the anatomical knowledge and practice to avoid any areas of the body which may impose more risk. So yes, Dry Needling is very safe!

Can everyone have it?

It is best to ask your Physiotherapist if you have any concerns to whether Dry Needling is appropriate for you. Usually Dry Needling isn’t performed on clients who have any of the following:

  •  Infectious tissue, blood borne diseases.
  • Unstable epilepsy.
  • Needle phobia or metal sensitivity.
  • Severe clotting disorders, haemorrhagic diseases, taking anti-coagulants.

FYI – you can donate blood 24 hours after Dry Needling if sterile, single use needles were used (which is definitely the case at Embody!).

What to do after Dry Needling?

Heat (heat-pack, hot water bottle, warm shower) can help with post treatment soreness. Light stretching may also be recommended by your Physiotherapist, and stay hydrated! Some clients may need only one Dry Needling session, but more often several will be needed for adequate muscle release. Often there is a reason for a trigger point to develop, and so the physiotherapist may additionally work on posture and/or strengthen particular muscle groups.

Written by Courtney Kranz, Physiotherapist and Pilates Practitioner at Embody Physiotherapy + Pilates.

REFERENCES:

  1. Simons DG, Travell JG, Simons LS. Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol1 . Upper Half of Body. 2nd ed. Baltimore, Md: Williams & Wilkins; 1999.
  2. Hong, C. Z., & Simons, D. G. (1998). Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Archives of physical medicine and rehabilitation, 79(7), 863-872.
  3. Huguenin L K 2004 Myofascial trigger points: the current evidence. Physical Therapy in Sport 5:2-12
  4. Shah, J. P., Danoff, J. V., Desai, M. J., Parikh, S., Nakamura, L. Y., Phillips, T. M., & Gerber, L. H. (2008). Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archives of physical medicine and rehabilitation, 89(1), 16-23.
  5. Terenius, L. (1985). Families of opioid peptides and classes of opioid receptors. Advances in pain research and therapy, 9, 463-477.
  6.  Bogduk, N., (1989). Understanding pain pathways. Current Therapeutics, 30(1):25-40
  7. Le Bars, D., Dickenson, A. H., & Besson, J. M. (1982). Opiate analgesia and descending control systems. In: Bonica J J, Lindblom V, Iggo A (Eds) Advances in pain research and therapy. Raven Press, New York, Vol 5, 341-372