Individuals that are highly active in any activity will likely require outside management of injuries to be able to sustain their activity level. This is true for many dedicated athletes as repetitive movements of the body often lead to overuse injuries or even a serious injury that can become a chronic issue. Such injuries prevent individuals from participating in activities they enjoy and want to get back to. Luckily, there are many options out there to help manage pain, improve range of motion and blood flow for healing. One option that has recently begun to be used by physical therapists, sports medicine doctors and some chiropractors is dry needling. Dry needling is a relatively new service, its use began in 1979 and now it is used for pain relief, improvements in range of motion and increased blood flow which can be helpful when recovering from an injury.
Dry needling is a technique performed by a qualified care giver where filiform needles are inserted into the underlying tissues with the hopes of eliciting changes in the underlying structure for evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability. Dry needling is most effective if the patient remains relaxed, if the patient is tense especially at the site of needle insertion the muscle in question will not be able to be activated properly and benefits will not be maximal. Patients often experience little pain but some discomfort is common, the most common sensation is a temporary feeling of cramping in the muscle that quickly subsides Once the treatment is over the patient may feel some muscle soreness but within 24 hours experience a decrease in pain and an increase in range of motion of the treated area. Although scientists don’t yet have a full understanding of how dry needling leads to reduction in pain, improved range of motion and blood flow it has been demonstrated that dry needling may influence the spontaneous electrical activity by eliciting a local twitch response. Studies suggest that the insertion of the needle into the endplate region of a muscle may lead to increased discharges that cause an immediate reduction in Ach stores which leads to less spontaneous electrical activity in the muscle.
Dry needling can increase blood flow by releasing sustained contractures of the taunt muscle bands which lead to ischemia and hypoxia in the core of the MTrPs. The role of dry needling in the management of pain is not completely understood but it has been found that after a local twitch response is elicited in a muscle the levels of CGRP (a peptide important in pain transmission) become significantly lower than their pre-local twitch response levels. It is now commonly accepted among scientists that the reduction of pain results from the disruption of various pain pathways within the nervous system. Stimulation of the muscle through dry needling results in an increased production in beta endorphin which suppresses neuronal release of SP (another peptide important in pain transmission) and reduces pain. Scientists believe that the biggest reason dry needling reduces pain is because of hyperstimulation analgesia which is the relief of pain through the stimulation of large-diameter nerves. Dry needling can trigger both large myelinated fibers and C-fibers which then send signals to the dorsolateral tracts of the spinal cord and activate the supraspinal and higher centers involved in pain processing.
Dry needling techniques have been cited in the APTA Board of Directors policy Guidelines: Physical Therapist Scope of Practice as a therapeutic intervention for "alleviating impairment and functional limitation" and listed among valid manual therapy techniques. Dry needling is a quick and specific treatment choice that is a new tool in our tool box as a profession. Dry needling can give patients with chronic pain a new option for pain management where they used to have to turn to medications to manage their pain. Dry needling is just one of many options for people, and in the right hands, has proven to be very powerful; at times, occasionally addressing chronic pain (sometimes years old) or helping those that have been given no other options for pain management.
APTA Public Policy, P. a. (2013). Description of Dry Needling in Clinical Practice: An Educational Resource Paper. American Physical Therapy Association, 1-7.
Barbara Cagnie, Vincent Dewitte, Tom Barbe, Frank Timmermans, Nicolas Delrue, Mira Meeus. (2013). Physiologic Effects of Dry Needling. Current Pain and Headache Reports.
Leonid Kalichman, PT, PhD and Simon Vulfsons, MD. (2015). Dry Needling in the Management of Musculoskeletal Pain. Journal of American Board of Family Medicine. Retrieved from Movement Physical Therapy.
Ries, E. (2015, May). PT In Motion. Retrieved November 2015, from American Physical Therapy Association: http://www.apta.org/PTinMotion/2015/5/DryNeedling/
Seguin, P. (2015, November 13). PT, DPT, COMT, Dry Needling Certified, Facility Manager, VTA Regional Contact. (B. Galassi, Interviewer)