Dry Needling: It’s Not as Scary as it Sounds!
By Dr. Hannah Lattanzio PT, DPT, CMTPT/DN
This month's post is another topic dear to my heart – dry needling! When people hear the words “dry needling” many are curious, nervous, or just downright scared and I wanted to clear the air about this amazing intervention. Not only am I a certified dry needling provider but have also received dry needling myself for many aches and pains with phenomenal results.
I want this post to serve as an educational tool to determine how dry needling works and if it is right for you, to answer common questions, and to make it seem both less daunting and mysterious.
General Introduction
Dry needling is a skilled intervention that utilizes a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points. Dry needling is used to treat muscle, connective tissue and fascia to restore muscle function and reduce or eliminate pain.
Basics of Pain Science
Okay – without getting too nerdy here – to understand how dry needling works we need to understand pain. I will try my best to make this brief and easily digestible so we can get to the good stuff. If you find this section too brief, I would highly recommend doing further research as this topic is super complex but also very fun.
Dry needling is thought to influence a phenomenon called central sensitization. Central sensitization is an increase in the excitability or activity of your nervous system that happens over time due to injury, overuse, or inflammation. This results in:
Hyperalgesia: an exaggerated or higher pain response to a painful stimulus
Secondary hyperalgesia: an increased sensitivity or pain response to a site close to but not affected by the injury or tissue damage
Allodynia: pain from a nonpainful stimulus
Another symptom associated with central sensitization can be the presence of myofascial trigger points. A trigger point is a hyperirritable spot in a taught band of muscle – think of finding that tender knot in your neck or back muscles. A trigger point is a true and tested phenomenon that can be seen on imaging (ultrasound and magnetic resonance elastography). This chronic contracture of muscle can slow blood flow, making the muscle hypoxic resulting in a build up of harmful chemicals (i.e. acetylcholine, substance P, cytokines, etc).
Dry Needling: How it Works
So now that we know about the basics of pain science and associated trigger points how does dry needling fit in? While the exact mechanisms of dry needling are not yet known, dry needling is thought to mechanically break up the trigger point by deforming dysfunctional fascia and muscle. This improves blood flow and oxygen saturation while reducing the presence of maladaptive chemicals.
A hallmark of dry needling is the local twitch response (LTR). A LTR is a brief involuntary muscle contraction that occurs when a myofascial trigger point is being stimulated – so do not be worried if your muscle twitches during a dry needling session – this is what we want to happen! However, eliciting a LTR is not always essential for effective needling and may not occur at all.
It is thought that following dry needling as the chemical composition of the muscle improves, motor patterns and correct muscle recruitment will be restored. This results in better function and reduced pain over time.
How is Needling Different From Acupuncture?
This is the most common question I get about dry needling – and it is an important one! While PT’s (and other certified providers) and acupuncturists use the same needles, this is where the similarities end. Differences include:
While acupuncturists use meridian points, your PT will use myofascial trigger points to identify areas for needle placement
Dry needling involves pistoning or twisting the needle in muscle and fascia and does not stay in the superficial layers of the skin (although every provider is different and techniques vary)
Dry needling typically (varies by state) uses only one needle at a time
Acupuncture has been used to treat a variety of conditions from allergies to cigarette smoking cessation while dry needling is used for treating the musculoskeletal system
Is Dry Needling Right for You?
We have learned about pain, trigger points, how dry needling works and its differences from acupuncture – but is it right for you and your body? Like all things in the world of physical therapy, it depends.
The good news is dry needling is a safe and effective technique for reducing musculoskeletal pain and restoring muscle function across the body. Dry needling is used to treat a variety of conditions such as migraines, low back pain, post-surgical symptoms, sciatica, neck pain, tennis elbow, the list goes on! There are no hard and fast contraindications for dry needling but let your therapist know if you:
Are pregnant
Take blood thinners
Have implants around the muscle to be needled (breast, calf, chest, etc.)
Have a pacemaker if needling around the chest cavity
Are severely allergic to nickel or chromium
If you meet any of the above points don’t be worried, dry needling can be modified by changing the muscle to be needled or the technique to allow for successful needling. The most common adverse effects include fatigue or muscle soreness. If you find yourself sweating during dry needling this is also a common effect. This is because dry needling stimulates your autonomic nervous system which can result in sweating or fatigue, both of which are very common and harmless.
No aftercare is needed following dry needling although I do recommend my patients drink plenty of water to rehydrate their muscles and bodies to reduce muscle soreness.
Summary
Dry needling can be an effective intervention for most (if not all) individuals experiencing any dysfunction of their musculoskeletal system, which most physical therapy patients are of course. While the term sounds scary this intervention is safe and has been so successful in treating a variety of conditions with minimal effects. And yes I won’t lie – it doesn’t feel great but I think you will be surprised (and pleased) with the outcomes. Consult with your physical therapist if you think dry needling would be right for you. Still have questions? Contact us!
