One of the techniques employed by physical therapists to alleviate pain and impairment of movement, dry needling involves inserting an acupuncture needle into the skin and muscle. The process of dry needling is also known as trigger point dry needling and intramuscular manual therapy.
A band of skeletal muscle found within a larger muscle group is called a trigger point. As the name suggests, a trigger point could cause pain to other parts of the body when it is touched.
While dry needling shares similarities to acupuncture, which is a traditional Chinese practice, it is considered a part of modern Western medicine practices and is supported by research.
To perform dry needling, a therapist uses thin filiform needles that penetrate the skin and stimulate the myofascial trigger points and muscular, as well as connective tissues underneath. Because of their thinness, filiform needles allow the therapist to pinpoint tissues that are not palpable when done manually.
Benefits of Dry Needling
Pain relief is one of the major benefits of dry needling. In fact, the results of a 2007 study showed that dry needling can reduce pain and sensitivity in a specific myofascial trigger point.
Many patients who undergo dry needling report relief right after their first dry needling treatment. Consequently, the therapy is included in a treatment package to hasten recovery in cases where patients respond poorly to other physical treatment. For example, an Australian study was conducted on chronic whiplash, which does not respond well to exercise. However, when therapy included dry needling, it increased the healing process, which also resulted in reduced pain.
Improving movement is another benefit of dry needling. In the research, scientists studied 14 patients suffering from bilateral shoulder pain as well as active myofascial trigger points. Dry needling therapy increased the pain threshold of the trigger points and improved the range of motion of shoulder internal rotation.
To demonstrate how the therapy improves range of motion, four international volleyball athletes underwent an intense dry needling therapy for a month. At the end of the treatment, the athletes showed improved strength and pain tolerance, along with improved movement. The study also established that dry needling does not result in functional weakness.
Superficial vs Deep Tissue Dry Needling
Dry needling can be performed at a superficial or deep tissue level.
Superficialdry needling or SDN involves inserting needles to 5-10mm over a myofascial trigger point (MTrP) for only 30 seconds. To determine the level of response and ensure that needle stimulation is sufficient to relieve MTrP pain, palpation of the MTrP is performed. Palpation is done by the therapist by simply feeling the area for tenderness.If the area is still sensitive after the 30 seconds of initial dry needling, the needle is re-inserted in the same area for 2 minutes.
The goal of superficial dry needling is to relieve the sensitivity of the trigger point through short intervals of therapy, which is repeated until the therapist notices a difference. Because the needle is inserted for short periods, SDN is the preferred treatment for patients who become stiff or cramp easily or those who cannot tolerate deep dry needling.
Deep dry needling or DDN is performed when the main MTrP activity leads to muscle shortening that is enough to compress the nerve roots. The same is true when there is pain due to nerve compression from disc prolapse or spondylosis that develops into a secondary MTrP activity. DDN is a painful process that produces much soreness after treatment.
Conditions that can be treated with Dry Needling
The American Physical Therapy Association indicates that trigger points have been associated with the following diagnoses:
- Carpal tunnel
- Computer-related disorders
- Disk pathology
- Joint dysfunction
- Nocturnal cramps
- Spinal dysfunction
- Whiplash associated disorders