Author: Mandi Roemmich
Dry needling has recently become a popular therapeutic technique used for pain management, particularly in athletes. The use of dry needling, primarily by physical therapists, began in the early 21st century, and has since become a popular treatment method for myofascial pain, with over twenty states approving the technique of dry needling by 2011 (Dommerholt, 2011). Dry needling is a therapeutic procedure using the insertion of thin needles through the skin into myofascial trigger points, muscular or connective tissue with the aim to reduce pain intensity (Kaljić, et al., 2018). Myofascial trigger points can be described as hyperirritable spots in skeletal muscle. Various techniques of dry needling, including number of needles used, depth of insertion, and length of treatment are used varying by individual preferences and circumstances. This treatment type is specifically recommended for treatment of musculoskeletal pain conditions caused by myofascial trigger points (Kaljić, et al., 2018).
My interest in the benefits of this technique stems from my own experience with dry needling and a desire to understand how the process decreases pain. In my experience, dry needling is most effective when two to three needles are inserted deep into the muscle body, typically one to two inches into the body. The sites of needle entry are best determined by feeling around the area of pain for tightness. These areas of tightness are the easiest way to locate myofascial trigger points. When the needles are inserted into the muscle, the muscle will twitch if a trigger point is located, indicating a successful placement. This twitch is more surprising than painful, though a minimal amount of pain is associated with the insertion of a needle in a myofascial trigger point. Needles are then left in the muscle for approximately five to ten minutes before removal. Soreness from the process typically lasts for a day before benefits are felt.
Physiological Aspects: How does it work?
An in-depth understanding of trigger points, their location, and their role as peripheral nociceptive input leading to sensitization led to the development and necessity of the dry needling technique. Dry needling, when performed correctly, has the ability to reduce peripheral and central sensitization (the response to stimuli, specifically pain in this circumstance) by inactivating trigger points (Dommerholt, 2011). These trigger points are characterized by tight junctions of skeletal muscle, and the dry needling technique releases the tightness and minimizes the trigger point, leading to the overall reduction in pain. This can also effectively increase muscle range of motion. This is why feeling the muscle for tightness is a good indicator for trigger points.
The end result of an overall reduction in pain does not mean that there is no pain or soreness associated with the treatment. Patients often have feelings of muscle stiffness and soreness in the immediate hours following the treatment due to the specificity and depth of the treatment. Manual trigger point release therapy is much less specific and is more limited to surface-level fascia (Dommerholt, 2011).
Since this process involves needles, it is often compared to acupuncture. Dry needling is more specific than acupuncture in trying to locate these specific trigger points and reduce tightness, while acupuncture is used to increase the release of endorphins in the area of pain (Dommerholt, 2011). Endorphins are hormones, which are often associated with stress relief, happiness, and the reduction of pain.
Results and Benefits
Dry needling has been used as a treatment option for various muscle injuries and issues. A case study looked at the benefits of dry needling in a patient with muscle dysfunction, a common problem following a muscle injury, resulting in functional and strength limitations. The study shows that dry needling can lead to benefits such as increasing muscle thickness and force production (Cross & McMurray, 2017). Increasing muscle thickness and force production is important because strengthening the muscle helps to heal the muscle and decrease the pain associated with injury.
Another case study reflected the treatment of shoulder pain due to the pathology of the long head of the biceps tendon. This pathology resulted in tendinopathy, a tendon disorder resulting in pain, swelling, and impaired function, often due to overuse. If rest is not an option, as with professional or collegiate athletes, physical therapy is the main treatment option, where dry needling is then used. Dry needling has been found to be a minimally invasive, effective method of reducing pain and increasing range of motion (McDevitt, et al., 2018). Cases such as these shows that dry needling is a useful tool in pain management and treatment, but not necessarily a long-term problem solver. Athletes with injuries such as tendinopathy use dry needling in a way similar to a band aid, when long term solutions are not realistic due to physical needs.
One particular study compared the benefits of dry needling combined with exercise therapy with the benefits of exercise therapy on its own. This study found significant results that dry needling enhances rehabilitation and decreases pain (Zarei, et al., 2019). This shows the importance of manual therapy targeting trigger points, as done in dry needling therapeutic techniques.
While slightly different techniques are used for dry needling treatment, such as depth of needle insertion and time of insertion, studies have shown that these different techniques are almost equally effective (Kaljić, et al., 2018).
Most importantly, these studies continually show that while the degree of benefit may vary with each individual case, dry needling techniques do not cause farther harm when performed correctly.
As indicated by the numerous case studies, the therapeutic technique of dry needling leads to the benefits of pain reduction, muscle thickness increase, and increases in range of motion. These benefits, however, are difficult to quantify and isolate. Difficulties in determining effectiveness of dry needling center around the lack of an effective placebo. Placebo versions of dry needling are difficult to mimic, as placing needles in non-trigger point regions in still likely to have a physiological effect (Dommerholt, 2011).
I can personally attest to the benefits of dry needling. Dealing with tendinosis as a collegiate athlete, pain relief is very important as rest is not typically an option to solve this chronic overuse injury. This therapeutic technique of dry needling has provided me more relief than any other method of manual therapy, and I have tried nearly all.
For athletes dealing with symptomatic pain and soreness, dry needling is an effective option that should be considered to provide trigger point release and improvement of symptoms. Dry needling may only be performed by those certified in the dry needling technique. Not all licensed physical therapy providers are certified to perform dry needling, as it is essential to receive extended training and contain knowledge of locations of nerves, arteries, veins, and other important tissues.
Cross K, & McMurray M. Dry Needling Increases Muscle Thickness in a Subject with Persistent Muscle Dysfunction: A Case Report. International Journal of Sports Physical Therapy. 2017; 12(3), 468-475.
Dommerholt J. Dry needling – peripheral and central considerations. The Journal of manual & manipulative therapy. 2011; 19(4), 223–227.
Kaljić E, Trtak N, Avdić, D, Bojičić, S, Katana B, Pecar M. The role of a dry needling technique in pain reduction. Journal of Health Sciences. 2018; 8(3), 128-139.
McDevitt A, Snodgrass S, Cleland J, Leibold M, Krause L, Mintken P. Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. Physiotherapy Theory and Practice. 2018; 1-11.
Zarei, Bervis, Piroozi, Motealleh. Added value of gluteus medius and quadratus lumborum dry needling in improving knee pain and function in female athletes with patellofemoral pain: A randomized clinical trial. Archives of Physical Medicine and Rehabilitation. 2019; S0003-9993(19)31000-7.