If Brigid Jones ever had Dry Needling, I reckon her diary entries may have read something like this.
Dry Needling Day 1: Alcohol units 6, cigarettes 0 (yippee), calories 1784
Went to Physio on lunch break to get pesky shoulder pain sorted out. Dry needled. Physio warned “you may feel a little uncomfortable over the next 24 hours”. Just about got back to office to regale all – “no blood, but twitching horrendous and OMG, the size of the needles!!!!”
Dry Needling Day 2: Alcohol units 12 (purely medicinal), cigarettes 24, calories 3546, positive thoughts 0
Can’t believe I let someone stick huge needles into me! Shoulder feels more tender than thoughts I used to have for Mark D’Arcy. Still twitching like a newly landed salmon!
Dry Needling Day 3: Alcohol units 0, cigarettes 0, positive thoughts 148
Huzzah! Physio is genius and dry needling is greatest thing since Old Mr Brennan first got on radio.
Even if you haven’t experienced it yourself, you’ve probably heard somebody recount their version of Brigid’s dry needling story above.
Sometimes, it seems like Dry Needling is taking over the world.
Okay, that’s a bit of a reach. But it has become extremely popular with all sorts of therapists.
Dry Needling – if you’re not doing it, you’re not mapped
Within the community of therapists dealing with sporting and non-sporting injuries alike, every single professional appears now to be performing some form of “Dry Needling”, from GPs to Physiotherapists.
I once had a patient explain to me how he had left his previous physio because said physio could not perform dry needling. I therefore assumed this patient was a seasoned campaigner when it came to dry needling. Turns out he had never had dry needling before – but had heard from a colleague that it was the answer to all ailments! That’s mad, Ted.
So, is Dry needling the answer to all pain and dysfunction?
The short answer is ‘No, of course not’.
As a manual physiotherapist, Clinical reasoning underpins my whole philosophy. As a method of identifying the predominant mechanisms responsible for a patient’s injury, it allows me to decide how and where to intervene most effectively. This underlying principle does not change and should never change when it comes to applying dry needling. When applying needling techniques, it is essential to progressively target the physiology associated with the patient’s injury using the perceived effects of dry needling (we’ll discuss these later) on the central nervous system. This allows a targeted approach and prevents the “one size fits all” approach, all too often applied in a musculoskeletal setting these days.
When appropriate, this approach also allows me to apply Traditional Chinese Acupuncture (TCA) point selection, giving the optimal combined approach for the right patient (I’ll explain TCA further shortly – there’s enough to be done explaining Dry Needling for now!).
To properly explain the effects of Dry needling I must initially explain where dry needling comes from, what Myofascial trigger points are and how dry needling affects them.
What is the history of dry needling and where did it come from?
It is important to distinguish between the origins of acupuncture and the origins of dry needling. Traditional Chinese Acupuncture originates in eastern medicine and focuses on energy and meridian flow in the body, whilst Dry Needling is based upon western medicine’s scientific and research based principles surrounding physiology and anatomy and is solely used to influence musculoskeletal dysfunction. So, no, it’s not the least bit hippy dippy! (Only kidding – I believe there is a lot to recommend Eastern techniques.)
Travel & Simmons (Interesting sidenote: Dr. Travell actually became president JFK’s personal Physician in later years) first introduced the concept of injections into myofascial trigger points in the 1940s. However, they proposed the use of wet injections using substances such as corticosteroids and analgesic agents. The practice of wet injections continued for 35 odd years until a Czech Physician Carl Lewit discovered that the simple effect of the needle entering the trigger point caused a mechanical stimulation of the trigger point. He maintained that this was more effective to the patient’s outcome than the substance injected. Thus, Dry needling was invented providing a more cost effective, less invasive, low risk form of treatment for trigger point dysfunction without the need for unnecessary medication.
Trigger Points? You’ve lost me. What are Trigger Points??
Trigger points are localised irritable areas lying within a taut band of muscle. They are a common cause of muscle pain and tenderness in everyday patients. The underlying mechanism is thought to be a motor end-plate plate dysfunction, due to an excessive release of acetylcholine (Simons et al., 1999). Trigger points are initiated by soft tissue trauma or repetitive over-use and can be sustained until the trigger point has been successful ‘deactivated’ by physiotherapy.
Dry needling (or trigger point needling) is undoubtedly one of the most effective ways to resolve a painful trigger point. Dry needling often involves multiple advances of an acupuncture needle into the muscle in a region of a trigger point, aiming to reproduce the patient’s symptoms and achieve relief of muscle tension and pain. It is a commonly used technique that appears to deactivate trigger points. Despite its popular use, however, the exact mechanism of trigger point needling remains elusive (Dommerholt et al., 2006).
So how does it actually work??
As Jennifer Aniston said in the L’Oreal ad ‘Here comes the science’, so please try and stay awake for this bit! (Ok, I just wanted to include a picture of Jennifer here. And why not?!)
Numerous mechanisms have been identified to explain the therapeutic benefits of Dry Needling. Simons et al. (1999) indicated that the therapeutic effect of trigger point needling is achieved through mechanical disruption of the trigger point contraction knot using the needle tip. Alternative research proposed that a localised stretch to the contracted muscles is achieved by the acupuncture needle, restoring the sarcomeres (constituent units of the strands that make up muscle) to their resting lengths by reducing the amount of overlap between the actin and myosin filaments (in the sarcomere, actin and myosin filaments slide past each other to cause the shortening of a muscle fibre).
Interesting, Shah et al., (2005) observed high levels of inflammatory chemical markers within painful trigger points. They observed the noticeable reduction of these chemical irritants after 5 minutes of trigger point needling.
Still with me? Great! Here’s what I think happens in Plain English
In my opinion, the effects of dry needling are three-fold and involve all the above. My explanation is simple dry needling disrupts the trigger point knot which accumulates in the muscle causing a stretch reflex in the muscle tissue which restores some of the muscle’s Sarcomeres (fibres) to their resting length. However, we are undoubtedly causing minute amounts of damage to the tissue as we are putting a needle through the connective tissue, therefore we are inducing a chemical response in the tissue, as we have encouraged reengagement of the healing process. This explains the first 24-48 hours of tenderness associated with treatment which involves dry needling and the reduction in chemical irritants as observed above. This normalisation of the chemical environment of the trigger point could have a secondary therapeutic benefit.
Why is there a nerve-like response from the muscle as it twitches??
More recent studies have found Dry Needling to be most effective when local twitch responses are elicited, probably because of rapid depolarization of the involved muscle fibres, which manifests as local twitches. After the muscle has finished twitching, the spontaneous electrical activity subsides, and the pain and dysfunction decrease dramatically (Kalichman & Vulvsons, 2010).
In Summary: Dry Needling is a useful string to a Physiotherapist’s Bow
The take home message is that dry needling is undoubtedly effective as an adjunct to other treatments. It certainly should never be used in isolation but should be a part of an overall treatment programme. In other words, dry needling is another string to a Physiotherapist’s bow but it’s not the only weapon available at a good therapist’s disposal. It is not the answer to all ailments but may help resolve your problem a little sooner.
In which case, you may be exclaiming, like Brigid ‘Huzzah!, my physio is a genius!’
Why not pop into Platinum Physiotherapy and see if our expert Physiotherapists feel Dry Needling may be a useful tool in resolving your injury or dysfunction? Our only guarantee is that it won’t be the only form of treatment you will receive in Platinum Physiotherapy.