What is Dry Needling (DN)?
Dry needling, as defined by the Federation of State Boards of Physical Therapy, is “a skilled technique performed by a physical therapist using filiform needles to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability.”2 Dry needling is an evidence-based Western medicine modality that differs from traditional Chinese acupuncture through its own terminology, technique and clinical applications. Dry needling is widely used among physical therapists as a treatment modality and recovery tool.
How does DN help?
Evidenced-based research confirms that there are many physiological effects of dry needling, including how its implementation improves muscular function and contractility. The needle targets the release of trigger points, causes a physiological chemical change, and restores normal muscle length, which collectively relieves the pain you experience. Specifically, dry needling:
- Increases blood flow to the area of the muscles being needled (as shown by Doppler ultrasound).
- Allows for a more efficient contraction, as shown by decreased rigidity with palpation of the tissue and restoration of a normal muscle length-tension relationship.
Dry needling also causes biochemical changes at a cellular level, which indicate a return to proper muscular balance. The needle penetration causes a twitch response in the tissue. As a result, acetylcholine (a chemical messenger) levels normalize at the neuromuscular junction, leading to decreased neuropeptide (substance P, CGRP, increased B-endorphin) levels, which relate to muscular function, and reduced hypoxia (lack of oxygen in the tissue). Studies have even suggested that the changes may not be limited to local areas of treatment but could apply across a larger neurophysiological scale.
Why is DN used?
Dry needling can be widely effective as a recovery tool since it releases pain-producing active trigger points, restores chemical balance, and improves overall function of both individual muscles and muscular systems as a whole.
In specific, DN is an effective treatment of myofascial trigger point pain. This pain arises from one or more active myofascial trigger points (MTrPs), which are hyperirritable spots within skeletal muscle or deep nodules within a taut band. In a study of patients with musculoskeletal pain who were seen by a neurologist in a community pain medical center, MTrPs were the primary source of pain in 74% of cases.3 Characteristics of myofascial trigger points include: painful with compression, cause referred pain, muscle spasm, stiffness, muscle weakness, decreased range of motion, tenderness, and even motor dysfunction. In most cases, subjective information in combination with pain provocation, tissue tautness assessment and pain with palpation can determine a trigger point referral pattern. Oftentimes, a hyperirritable spot or taut band of skeletal muscle is the result of many factors including ongoing tissue damage from repetitive motion, postural dysfunction, psychosocial issues, metabolic imbalances, genetics, nutrition, hormones or central nervous system changes.
The intent of DN is to produce myriad physiologic effects, which include decreased pain, increased range of motion, and restoration of function.
When is DN used?
Dry needling, in combination with physical therapy treatment, has been effective in treating the following conditions:
- Acute and chronic tendonitis
- Athletic and sports-related overuse injuries
- Post-surgical pain
- Neurological symptom, such as Bell’s palsy and shingles
- Chronic pain conditions
- Headaches and whiplash
- Neck/lower back pain
- Frozen shoulder
- Tennis/golfer’s elbow
- Muscle spasms
- Hip pain
- Knee pain
- Plantar fasciitis
- Repetitive strain injuries
- Other neuromusculoskeletal conditions
As practitioners, we know that the restoration of function is crucial for the return to physical activity. A recent systematic review and meta-analysis concludes that DN performed by physical therapists was more effective than any other treatment (e.g., TENS, compression technique, superficial DN, conventional rehabilitation, massage, stretching, friction massage) for reducing pain, as shown by immediate and long-term follow-up.1 Pain reduction is an integral step in restoring musculoskeletal function and movement.
Is DN right for me?
When developing your personalized recovery plan, consider dry needling to alleviate the pain caused by mechanical constraints and to keep the muscle systems in balance as you pursue peak performance. Anyone interested in dry needling should first be evaluated by a physical therapist to determine if it is right for you. Please direct any questions to your SHIFT physical therapists Avis or Eric at firstname.lastname@example.org.
- Jorge Sánchez-Infante, PT, MSc, Marcos J Navarro-Santana, PT, MSc, Alfredo Bravo-Sánchez, PT, MSc, Fernando Jiménez-Diaz, MD, PhD, Javier Abián-Vicén, PT, PhD, Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis, Physical Therapy, Volume 101, Issue 3, March 2021, pzab070, https://doi.org/10.1093/ptj/pzab070
- Caramagno, J. Adrian, L. Mueller, L. Purl, J. (2015) Analysis of Competencies for Dry Needling by Physical Therapists. Analysis paper prepared for FSBPT by HumRRO organization. Alexandria, VA: Federation of State Boards of Physical Therapy. https://www.fsbpt.org/Portals/0/documents/freeresources/DryNeedlingFinalReport_20150812.pdf
- Gerwin RD. A study of 96 subjects examined both for fibromyalgia and myofascial pain [abstract]. J Musculoskelet Pain 1995;3(Supl 1):121.