Physical therapy
What is Dry Needling?
Dry needling may not have been a physical therapy that you have considered or been offered in your rehabilitation, pain management or injury treatment plan.
However, it is proven to be a very effective technique to relieve injuries like tennis elbow, chronic muscle pain in places like your shoulder or your back and issues such as tension headaches.
In this post we are going explain more for you about:
- The technique of dry needling.
- What a treatment involves.
- How it differs from acupunture.
- What issues does it work best to treat.
- How it is done.
- Does it hurt?
- How many sessions might you need.
- The type of practitioner who gives this therapy.
Our physical therapist Elliot Theodore is a licensed practitioner who specialises in dry needling and often encompasses this treatment when caring for his patients.
We asked Elliot for his professional advice on the treatment.
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Related Topics
What is dry needling?
Dry needling is an evidence-based technique of invasive physical therapy for the treatment of myofascial pain using acupuncture needles.
While it was inspired originally by traditional acupuncture, it is considerably different.
The difference being in dry needling, the needle is introduced into a myofascial trigger point localised by palpation, not as with traditional acupuncture when according to meridians (energy lines), and then removed immediately.
It is called “dry” needling to distinguish it from other invasive techniques where a chemical substance is injected locally using a needle.
Dry needling is considered a manual, or passive, technique.
That is, a treatment that is administered by the physical therapist to the patient, where the patient does not actively participate.
Passive therapy treatment
Today, modern physical therapy treatments lean heavily on active participation by the patient, which has been proven beyond reasonable doubt, to be the best effective method of treatment, and generally most applicable.
However, dry needling remains amongst the few passive treatments with enough rigorous clinical and academic evidence to be considered highly effective to be included in a current multidisciplinary approach.
It is especially included in elite rehabilitation facilities that specialise in treatment programs for everyone from professional athletes to neurology patients.
Dry needling is most adequate for use at the beginning of the rehabilitation process.
To the patient it is a hands-on, deep intervention, often touching exactly on the source of pain or limitation.
To the clinician it is a quick but very accurate intervention, free of the accompanying risk of overuse injury implicated in physically taxing techniques.
Symptoms, pain, ailments or issues that dry needling helps
The use of dry needling has been shown to be beneficial for short term treatment of myofascial pain – “pain associated with inflammation or irritation of muscle or of the fascia surrounding the muscle.”
The insertion of the needle into a trigger point in the muscle causes an analgesic response of the nervous system, and helps relieve symptoms through several mechanisms, such as augmented circulation to the area and elevated localized pH levels.
Dry needling is best used to treat Myofascial Pain Syndrome, which is defined as the various symptoms caused by myofascial trigger points:
- referred pain
- muscle weakness
- reduced range of motion
- discoordination
- muscle fatigue
- delayed muscle relaxation
- delayed muscle recovery
- muscle spasm
It has also been found useful in various other conditions that involve the skeletal muscles:
- elbow epicondylitis (tennis elbow)
- shoulder pain
- back pain involving the sciatic nerve
- tension headaches
- temporomandibular pain (TMJ)
- bruxism (grinding and clenching your teeth)
- spasticity
How is dry needling done?
Your physical therapist should first conduct a physical examination and discuss your symptoms to evaluate that the treatment is adequate for your pathology and no contraindications apply.
In order to perform the technique, you will lie down and the site of needling should be exposed, sometimes this requires the removal of clothes.
The procedure and reasoning behind it should be explained to you first, and the therapist should not proceed without receiving your informed consent.
The site of needling is determined by the physical therapist according to their clinical hypothesis of the muscles involved in the pathology, and by digital palpation.
Once they have localised the trigger point, the therapist will apply necessary hygienic precautions such as disinfecting the surrounding skin and wearing gloves.
They will insert a needle into the myofascial trigger point, and might touch it with the needle 1-4 times.
This is likely to cause a short spasm or twitch response in the muscle.
Immediately afterwards, the needle is removed and disposed of.
After disinfecting the area, you will be asked move your body a little bit, and report the sensations.
Does dry needling hurt?
In short, yes. Dry needling is a painful technique.
Some people find dry needling disagreeable and very painful, but others find it as satisfying as a deep tissue massage.
Pain level varies between patients, and depends on a lot of factors:
- The specific muscle needled.
- The severity of the trigger point.
- The patient’s personal physical sensitivity to pain.
- The patient’s emotional relationships and beliefs about pain.
- The skill of the physical therapist executing the technique.
As well as other factors that affect pain levels including emotional state, cultural factors, placebo effect, etc.
During the needling, you are likely to feel a localised pain response in the trigger point touched by the needle.
During 12-48 hours after the session, most people perceive a light to moderate soreness which is considered adequate and normal.
When the technique is successful, it is often felt as an immediate relief from pain, muscle release, or lessening of the symptomes.
Sometimes an improvement is hard to notice immediately, as the sensation of the needling itself leaves a strong impression, so some patients may feel a delayed improvement response in up to 48 hours after treatment.
How long is a treatment?
A dry needling session may take anywhere between 15 to 60 minutes, depending on the individual and their particular pathology. At Studio Australia Barcelona our physical therapy treatment sessions are 60 minutes.
How many sessions will you need?
The number of sessions of physical therapy which include dry needling is completely individual and depends on:
- The pathology.
- The patient’s experience and preference.
- The patient’s activity in daily life.
- Their lifestyle.
- Their adherence to treatment.
- The clinician’s reasoning and judgement.
While some issues may be resolved in a single session, others might justify repetition.
As a general rule in physical therapy, it is mostly the case that chronic conditions with a long progression are not solved within one session or using any single technique.
Where as minor issues, and usually more acute injuries tend to have a quicker rehabilitative trajectory, and may sometimes be dealt with in a single intervention.
Physical Therapist & Dry Needling Specialist
Elliot Theodore
From my personal experience as a clinician, dry needling is immensely effective. I dislike the idea of causing pain to my patients, and for me to include a painful technique in my treatment, it needes to be well based in evidence and results. I never insist on needling a patient who isn’t keen on trying it. For the people who do choose it, it is equally important to me they know they can opt out of the treatment at any moment, should they choose to for any motive.
I can see that often the feeling of the needle activating the exact source of pain and discomfort also has a reassuring effect for the patient: their therapist knows where its at. Physical suffering is often hard to explain, and many patients tell me about the frustration of failing to communicate their condition, not knowing what it is, not being understood or not being listened to.
When I needle the right spot, my patients often show a relief that has to do with more than just alleviating their physical pain.
I like the accuracy of dry needling. Since it isolates a single skeletal muscle, its use can also help me confirm or discard a clinical hypothesis by discerning whether a particular structure is involved or not.
I like its quickness, and the fact that I can apply it to various muscles in a single session, so I can address an entire kinetic chain if necessary.
Elliot
Photo acknowledgment: @valenbecker.ph
