Dry needling is a therapeutic technique in which a small filament needle is used to mechanically disrupt dysfunctional muscle, fascia and connective tissue. The most supported approach targets myofascial active and / or latent trigger points. Active trigger points can cause spontaneous pain, whereas latent trigger points elicit symptoms when compressed. A trigger point can be anywhere in the body in response to sudden injury, muscle overload, or repetitive microtrauma. These trigger points negatively alter the activity of the muscle causing scarring, myofascial pain, motor recruitment and muscle firing deficits. Many clinicians, including myself, are already using dry needling to treat a plethora of musculoskeletal disorders. The actual mechanism of effect of dry needling therapy (DNT) is being vigorously researched, and we are learning more and more to improve in this exploding field. Mechanically, dry needling targets the microscopic dysfunction of the muscle along with the nerves associated with it. The disruption produced by the needle also releases chemical and hormonal messengers that help balance the nervous system. Overall, the goal of DNT is to return the muscle and soft tissue structures to a “normal” electrical, chemical, and mechanical environment.
How to prepare?
It is important you are aware of the contraindications and precautions to dry needling therapy. Some, but not all of these contraindications include: acute cardiac arrhythmias, irregular heartbeat, spontaneous bleeding or bruising, anticoagulant therapy, unstable diabetes, HIV, Hep B or C, malignancy, recurrent infections, seizure induced by previous medical procedure. We strongly advise that you consult your medical doctor if you have any of these conditions to confirm that it is safe for you to receive DNT. The possible risks and adverse reactions to dry needling therapy are rare, and in many cases the benefits outweigh the risks.
How many sessions of DNT is normal?
If treatment zones are found and the correct muscle groups are targeted, sub-acute conditions will improve after three – four consecutive sessions, with chronic injuries requiring five – six consecutive needling sessions.
How large are the needles, and how many will you use?
Needle diameter and depth is selected according to the size and anatomy of target muscle, and surrounding tissue. More acute injuries can respond to more superficial stimulation using a short and small diameter needle. There will likely be multiple needles throughout the entire muscle. Chronic injuries with more extensive fibrosis may require deeper, longer and more closely spaced needles.
How should I feel after?
You may experience muscle soreness anywhere from 24 – 72 hours after dry needling therapy. Obtaining more than one or two twitch responses within a muscle during a session will undoubtedly cause post needling soreness. As mentioned, dry needling targets actin-myosin bonds of the muscle fiber to disrupt and reset the system with development of myofascial trigger points. Similarly, think of the concept behind muscle strengthening, and the principle of progressive overload. It is believed that weight training results in muscle unit breakdown in order to rebuild stronger more efficient motor fibers. The same theme carries over to Wolff’s law, which states healthy bone will adapt to the loads under which it is placed. There has to be adequate stress or mechanical loading on the system to influence a favorable response.
How is DNT different than acupuncture?
- While there are several philosophies of practice, acupuncture institutes are guided by the Daoist concept of yin and yang. Traditional Chinese Acupuncture teach the workings of the human body are controlled by an energy called “Qi” circulating between organs along channels called “meridians”, each corresponding to major functions. Energy must flow through each meridian in order to achieve and maintain equilibrium. To normalize the flow of Qi in the body an Acupuncturist would place a needle in the respective acupoint, or specific energy points on the body.
- There are positive clinical outcomes for both DNT and acupuncture. I am trained as a doctor of physical therapy, so will take a different approach as a movement specialist. The process always begins with a thorough examination to assess and address strength and flexibility deficits. My road map and target tissue will reflect your specific muscle imbalances and faulty or compensatory movement patterns.
- Dry needling techniques vary, and in most cases I use more than one technique for positive clinical outcomes. Usually, my sessions will look like this: (1) slow, steady motion in and out of the muscle to find a treatment zone (dynamic needling) (2) rotate the needle several revolutions in order to draw the taut fascia (3) leave the needle in situ (static needling). Once treatment zones are identified, I will have you relax for +/- 15 minutes with occasional manipulation of the needles throughout treatment time. As previously mentioned, there are many “schools of thought” as various approaches exist. Speaking to the trigger point model, dry needling therapy should not be the only intervention included in a patient’s plan of care. DNT should be used in adjunct with stretching, joint mobilizations, neuromuscular reeducation, strengthening, and other -related interventions.