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Dry Needling - Pain Free - Sports Medicine

Dry Needling

What is Dry Needling

Dry needling is a treatment that involves a very thin needle being pushed through the skin in order to stimulate a trigger point. This form of therapy is used to release tight muscle bands that are associated with trigger points, or hard “knots” within a muscle that can cause pain and decreased range of motion over a large area or joint.

Sometimes these trigger points can make it difficult to perform everyday tasks because there is pain every time the area is touched or has to stretch with movement, and the pain can even radiate to nearby areas of the body.

While “wet” needling involves needles that deliver corticosteroids, anesthetics, and other agents, dry needling involves the insertion of a solid needle without the use of injection into muscles, ligaments, tendons, and scar tissue. 

Dry needling is a form of acupuncture used by Jay Palladino L.Ac., who is an acupuncturist specializing in sports medicine. Dry needling will be applied to the tissues involved after the patient’s complaints have been evaluated and examined. This type of needling focuses on stimulating a specific trigger point that could be causing symptoms such as: pain, decrease range of motion and decreased strength.

Myofascial trigger points are a common type of pain.

The word myofascial means muscle tissue (myo) and the connective tissue in and around it (fascia). These trigger points are usually the result of a muscle injury, such as repetitive strain. Trigger points can be painful when pressed on and can create pain in another areas as well, which is called referred pain.

It can even generate something called hyperalgesia, which is an increased sensitivity to pain and which is often the result of damage to nociceptors or peripheral nerves. Needling into these painful trigger points can help create a ‘reset’ to the pain feedback system in your body.

Trigger points can develop during occupational, recreational or sports activities when muscle use exceeds muscle capacity and normal recovery is disturbed. Dry needling differs from other types of therapy because it focuses on stimulating these trigger points and releasing the tension in order to alleviate pain. Another big difference is that the needle is an extremely precise tool allowing the practitioner to affect tissues that cannot be reached with hands or other common physical therapy tools.

How Does Dry Needling Work? 

A solid filament needle is the tool used in dry needling. This thin needle allows the therapist to reach into the body to address the trigger point were it lies (instead of trying to access it by manipulating at the skin level).

Here are the basic steps of deep dry needling therapy:

  1. When using dry needling techniques for the treatment of trigger points, the therapist will palpate the target muscle for a taut band (or area of tense muscles) and identify the hyperirritable spot, thereby confirming the trigger point that needs to be treated.
  2. The needle is typically in a tube and it is fixed with the non-needling hand against the trigger point using a pincer grip or flat palpation depending on the location and orientation of the muscle. A palpation is when the therapist feels with their fingers or hands to pinpoint areas of tenderness. With the needling hand, the needle is gently loosened from the tube and the top of the needle is tapped or flicked, allowing the needle to penetrate the skin. This process occurs so fast, and the needle is so thin, that the nerves at the surface of the skin don’t register pain.
  3. With deep dry needling, the needle is guided toward the trigger point until the therapist feels resistance or notices that the patient has a local twitch response. A local twitch response is a spinal cord reflex that creates a small involuntary contraction that can be triggered with the insertion of a needle. Research shows that the local twitch response is the result of an alleviation or mitigation of some sort. This can be due to a release of immune system related chemicals, inflammation or even spontaneous electrical activity. When the patient has an involuntary twitch response, that suggests that the needle has hit the right spot.
  4. When the needle has located the trigger point, it will be left in the point for a short time (about 10 minutes) and the therapist will go on to needle the other tissues involved to treat the patient’s complaint(s). When necessary, the therapist may apply electrostimulation to the trigger points creating more twitch responses which can increase the effectiveness of the treatment.

What is Dry Needling Able to Treat? 

Dry needling involves using a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues in order to relieve pain and movement impairments.

According to the American Physical Therapy Association, trigger points have been identified in numerous diagnoses, including:

  • tension-type headaches
  • carpal tunnel syndrome
  • computer-related disorders
  • whiplash associated disorders
  • spinal dysfunction
  • complex regional pain syndrome
  • tendonitis
  • disc pathology
  • joint dysfunction

Top 3 Dry Needling Benefits

1. Reduces Pain

Several studies have demonstrated immediate or short-term improvements in pain or disability by targeting trigger points with dry needling. A 2007 study published in the American Journal of Physical Medicine and Rehabilitation suggests that dry needling significantly reduced shoulder pain by targeting a trigger point. In the study, 14 patients with bilateral shoulder pain and active myofascial trigger points in the bilateral muscles underwent dry needling therapy on one side and no therapy on the other side, which served as the control.

Dry needling physical therapy increased both active and passive range of motion of shoulder internal rotation, and the pressure pain threshold of the trigger points. Pain intensity of the treated shoulder was significantly reduced as well. The study provides evidence that dry needling a specific myofascial trigger point does reduce pain and sensitivity in that area. (5a)

In a 2016 Manual Therapy study, dry needling was used to treat the upper trapezius latent myofascial trigger point, or MTrP —  pain in the upper back region — experienced by 60 females. All the participants experienced a reduction in pain. (5b)

2. Improves Movement 

Research shows that patients undergoing dry needling therapy, in conjunction with movement-based therapy, experience more fluid movement. In fact, dry needling can help mechanically disrupt a dysfunctional motor end plate.  A 2010 case report published in Acupuncture in Medicine treated four international female volleyball athletes during a month-long intense competition with dry needling therapy. Range of motion, strength and pain were assessed before and after treatment and all scores were improved post treatment. The athletes were able to continue with overhead activities, which proves that dry needling does not cause functional weakness and reduced range of motion immediately after treatment.

These cases supports the use of dry needling in athletes during their competitive phase (in season) with short-term pain relief and improved function in shoulder injuries. 

3. Speeds Up the Recovery Process

Patients who undergo dry needling therapy experience less pain quickly; in fact, most patients feel the benefits immediately after their first treatment. According to reports published by the Journal of Orthopaedic & Sports Physical Therapy, patient function is restored much more quickly when dry needling is incorporated as part of the total package.

A study conducted at the University of Queensland in Australia investigated the effectiveness of dry needling for chronic whiplash, which is associated with sensory hypersensitivity and has poor responsiveness to physical treatments such as exercise. In order to enhance the treatment outcomes of an exercise intervention, dry needling was used in conjunction with exercise to address the sensory hypersensitivity of whiplash. Because exercise programs alone did not fully eliminate the symptoms of whiplash after three months of treatment, the physical therapists added dry needling to the treatment plan in order to speed up the healing process, reduce the economic cost of treatment and minimize pain and disability. 

Is Dry Needling Safe? 

Dry needling is appropriate for nearly all patients who do not have a significant needle phobia or other anxiety about being treated with needles. Like any type of therapy, dry needling may deliver unintended side effects, such as pain at the needle insertion, muscle soreness, fatigue and bruising. In the hands of a skilled therapist, dry needling is a safe and effective treatment option and the patient will see benefits in range of motion and joint use right away.

It’s normal that it may take several dry needling therapy sessions before the muscle is fully functional again. This is because trigger points are located under deep layers of muscles, so it typically takes several sessions for the changes to take full effect. But patients will notice the difference right after each treatment. 

Dry needling is also known to be relatively painless. Generally, the needle insertion is not felt and the local twitch response only provokes a very brief pain response, feeling more like a shock or cramping sensation. A local twitch response is a therapeutic response that serves as a sign that the needle has hit the trigger point, so it’s actually a good and desirable reaction.

Dry Needling Takeaways

  • Dry needling is a effective treatment for pain, decreased function and sports injuries.
  • Dry needling involves a very thin needle being pushed through the skin in order to stimulate a trigger point that causes pain and disability.
  • During a dry needling session, the needle penetrates the trigger point, which is known when there is a local twitch response. This response suggests that the trigger point is being stimulated and there will be a therapeutic response.
  • Dry needling is a safe and effective treatment option for patients who are not afraid of needles.

Patients who undergo dry needling will see benefits in range of motion and joint use right away. Sometimes several sessions are necessary in order to fully eliminate the trigger point.