What is dry needling?
Dry needling is the process of inserting thin monofilament needles without the use of injectate to treat a variety of neuromusculoskeletal conditions. The needles are inserted into muscles, ligaments, tendons, fascia, scar tissue, and neurovascular bundles to create a response at a chemical and cellular level. Once the needle is inserted, it is manually and/or electrically stimulated to elicit the desired tissue response.
Is dry needling the same as acupuncture?
The word acupuncture translates to “needle penetration.” The methods and procedures of acupuncture and dry needling are actually quite similar; however, the terminology, theoretical constructs, and philosophies are different. Dry needling is prescribed based on western musculoskeletal diagnoses, not within the theoretical framework of traditional Chinese medicine. Dry needling is used to create biomechanical, chemical, and vascular changes within the body. Unlike traditional Chinese acupuncture, the needles are not inserted with the intention of altering qi/ energy along traditional Chinese meridians. Dry needling is an evidence- based practice supported by local tissue response, how the nervous system relays this response to the brain, and how the brain interprets and responds to those signals.
What kind of needles are used?
A thin, monofilament needle is used to pierce the skin and enter the desired tissue. Each sterile disposable needle comes in an individual plastic guide tube to provide a clean and safe treatment. Patients typically experience minimal pain from the needle breaking the skin due to pre-contact from the guide tube. The needles come in a variety of lengths ranging from 15 mm to 75 mm and are selected for use based on depth of target tissue.
How does Dry Needling work?
Dry needling creates biomechanical, chemical, and vascular changes throughout the body that ultimately reduce pain and restore function.
♦ Stimulate tissue healing
Insertion of the needle into a dysfunctional tissue causes microtrauma within the tissue stimulating the inflammatory process. Acute inflammation is the first step in tissue repair. Therapists will often wind or twirl the needles after they are inserted. This mechanical stimulation is transduced to a biochemical signal which stimulates a series of events for cellular remodeling.
♦ Increase blood flow
Chronic injuries or areas of pain such as myofascial trigger points and tendinopathies develop fibrous adhesions otherwise known as scar tissue. This scar tissue blocks neurovascular bundles inhibiting muscle function due to limited oxygen supply. Dry needling stimulates vasodilation and microcirculation to the surrounding area increasing blood supply, oxygen, and healing factors.
♦ Reduce pain
Needle penetration creates a tissue response that activates descending inhibitory pathways in the brain that sends signals to decrease pain. The mild localized pain from inserting the needle stimulates the brain to upregulate production of endogenous opioids which also contributes to reduction of pain.
Is it painful?
Some areas of the body are more sensitive than others, but the piercing of the skin generally is not very painful. The pressure from the plastic guide tube dampens the feeling of the needle penetrating the skin. Once moderate pressure of the guide tube is applied to the skin, the monofilament needle is quickly tapped in. If the area being treated is more sensitive, there are other manual therapy techniques your physical therapist can use to decrease the sensation of the needle breaking skin. Once the needles are inserted, it is the therapist’s intent to create a deqi response. Literature describes deqi as a feeling of dull achiness, heaviness, distension, numbness, tingling, cramping, pressure, fullness, spreading, warmth, or coolness. This sensation may be felt right away or may be elicited by winding the needles or applying electrical stimulation to the needles.
How many sessions does it take to work?
Dry needling is a component of the physical therapy practice. It is used in conjunction with other manual therapy techniques and therapeutic exercise to treat neuromusculoskeletal conditions. Research has yet to determine the optimal dosage including number of sessions per week or month and number of needles inserted. Studies do suggest needles that remain in situ, or in position, for 15-30 minutes are more effective than immediate removal. Do not expect one session to solve all your pain or muscle tension. Just like one workout will not make you stronger, one dry needling session will most likely not completely heal you either.
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Written By Hannah Sweitzer, DPT, OCS, CSCS
Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014 Aug;19(4):252-265. doi: 10.1179/108331913X13844245102034. PMID: 25143704; PMCID: PMC4117383.
Butts et al., Int J Phys Med Rehabil 2016, 4:2 DOI: 10.4172/2329-9096.1000327
Langevin, H.M. and Yandow, J.A. (2002), Relationship of acupuncture points and meridians to connective tissue planes. Anat. Rec., 269: 257-265. https://doi.org/10.1002/ar.10185