Dry Needling

Dry Needling

Article by John Miller

What is Dry Needling?

Dry needling is a treatment technique whereby a sterile, single-use, fine filament needle (acupuncture needle) is inserted into the muscle to decrease pain and improve function through the release of myofascial trigger points (knots in muscle).

What is the Difference Between Dry Needling and Acupuncture?

dry-needling

The main difference between dry needling and acupuncture is the theory behind why the methods work. Dry needling is not the same as acupuncture, although there are similarities between the two techniques. Dry needling’s primarily focused on reducing pain and restoring function through the release of myofascial trigger points in the muscle. In comparison, acupuncture focuses on treating medical conditions by restoring the flow of energy (Qi) through critical points in the body (meridians) to restore balance.

What is a Myofascial Trigger Point?

A myofascial trigger point, also known as a knot in the muscle, is a group of muscle fibres that have shortened when activated but have not lengthened back to a relaxed state after use. A myofascial trigger point develops a sensitive nodule in the muscle (Simons, Travell & Simons, 1999). In addition to this nodule, the remainder of the muscle also tightens to compensate (Simons et al., 1999; Simons, 2002). This hypersensitivity occurs as the muscle fibres become so tight that they compress the capillaries and nerves that supply them (McPartland, 2004; Simons et al., 1999). As a result, the muscle cannot frequently move, obtain a fresh blood supply containing oxygen and nutrients, or flush out additional acidic chemicals (McPartland, 2004; Simons et al., 1999). The presence of a myofascial trigger point in a muscle can lead to discomfort with touch, movement and stretching, decreased joint motion, and even a temporary loss of coordination (Simons et al., 1999).

How Does Dry Needling Work?

Dry needling assists with decreasing local muscular pain and improve function by restoring a muscle’s natural ability to lengthen and shorten by releasing myofascial trigger points.

What Does Dry Needling Do?

When the delicate filament needle inserts into the centre of a myofascial trigger point, blood pools around the needle, triggering the contracted muscle fibres to relax. This reaction, in turn, leads to the decompression of the local blood and nerve supply. It also helps to provide those fibres with fresh oxygen and nutrients and flushing away any additional acidic chemicals.

What Causes a Myofascial Trigger Point?

A myofascial trigger point develops as part of the body’s protective response following:

  • injury – the muscle will tighten in an attempt to reduce the severity of an injury;
  • unexpected movements, e.g. descending a step that is lower than initially anticipated;
  • quick movements, e.g. looking over your shoulder while driving;
  • change in regular activity or muscle loading, e.g. an increase in the number or intensity of training sessions for sport;
  • sustained postures e.g. prolonged sitting for work or study;
  • nerve impingement – the muscle will tighten to protect the nerve;
  • stress;
  • illness (bacterial or viral);
  • nutritional deficiencies, or;
  • metabolic and endocrine conditions.

(Simons, et al., 1999)

When Is Dry Needling Treatment Recommended?

Dry needling can assist in treatment:

  • to help release myofascial trigger points (muscle knots);
  • to assist with pain management, and;
  • to restore movement at a joint if inhibited by myofascial trigger points.

What Will You Feel During Dry Needling Treatment?

During a dry needling treatment, you may feel a mild sensation as the needle inserts and withdraws. Patients don’t report any discomfort during needle manipulation.

A brief muscle twitch may occur during a dry needling treatment. This twitch may happen when the needle directly stimulates a myofascial trigger point.

Where Does Dry Needling Fit Within Your Rehabilitation Program?

Dry needling is one of many techniques that your physiotherapist can utilise to assist with your rehabilitation. We combine dry needling with other physiotherapy techniques, including massage, manual therapy, and exercise prescription.

What are the Side Effects of Dry Needling?

Every form of treatment can carry an associated risk. Your physiotherapist can explain the risks and determine whether dry needling is suitable for you based on your injury and general health.

When dry needling occurs, single-use, sterile needles are always used and disposed of immediately after using a certified sharps container.

Is Dry Needling Safe?

Everybody is different and can respond differently to various treatment techniques, including dry needling. In addition to the benefits that dry needling can provide, some side effects may occur, including spotting or bruising, fainting, nausea, residual discomfort or even altered energy levels. However, these symptoms should last no longer than 24 to 48 hours after treatment.

Can You Exercise After Dry Needling?

We recommend avoiding strenuous or high impact activities immediately after dry needling to allow the body time to recover and maximise the treatment benefits.

At PhysioWorks, most of our physiotherapists are qualified and skilled in dry needling and would be happy to discuss your treatment options.

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Acupuncture & Dry Needling

What Conditions Could Acupuncture or Dry Needling Help?

Acupuncture or dry needling may be considered by your healthcare professional after their thorough assessment in the following conditions:

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Article by John Miller

What is a Trigger Point?

trigger point release

Doctors' Travell and Simons defined a myofascial trigger point as a hyperirritable spot in a skeletal muscle. A trigger point is usually painful on compression and may give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena. Myofascial trigger points occur in both acute and chronic pain conditions. Hendler and Kozikowski suggest that myofascial trigger points as the most commonly missed diagnosis in chronic pain patients.

What Causes a Trigger Point?

According to Dr Gunn, 'Shortening in muscles acting across a joint increase joint pressure, upsets alignment, and can precipitate pain in the joint, i.e. arthralgia.' There is also a theory that permanent muscle contraction is abnormal and can create an ischaemic muscle pain due to the restriction decreasing normal muscle blood flow.

How Are Your Trigger Points Treated?

It is possible to deactivate triggers points by various methods such as acupressure, dry needling, muscle stretching, trigger point massage devices or injecting them with different substances, including saline (saltwater) placebo.

How Do You Release a Trigger Point?

Trigger Point Therapy is a form of Remedial Massage Therapy. Direct pressure is applied to specified points on tender muscle tissue to reduce muscle tension and pain relief.

Trigger point therapy is for almost everyone. Muscles with active trigger points are always weaker than healthy muscles and cannot move through their full range of motion. Because they cannot perform their normal function, you recruit alternative muscles to perform the compromised muscle activity. These secondary muscles can develop trigger points themselves if you don't treat the original hypertonic muscle.

Dry Needling

Dry needling may help decrease local muscular pain and improve function by restoring your muscle's ability to elongate and shorten. When your therapist inserts a fine filament needle into the centre of a myofascial trigger point, blood pools around the needle, triggering the contracted muscle fibres to relax by providing those fibres with fresh oxygen and nutrients as by flushing away any additional acidic chemicals. This reaction leads to the decompression of the local blood and nerve supply.

How Does Dry Needling Work?

The needle sites can be at the epicentre of taut, tender muscle bands, or they can be near the spine where the nerve root may have become irritated and supersensitive. Penetration of a healthy muscle is painless. But, a shortened, supersensitive muscle may 'grasp' the needle or trigger the muscle.

Dry needling of the 'shortened' muscle band causes an immediate, palpable relaxation. The patient often experiences a sense of release and increased range of motion. The trigger point release obtained from dry needling can be long-lasting when used in conjunction with motor control retraining and postural and movement behaviour retraining. The result is a stimulation of the stretch receptor within the muscle (muscle spindle), producing a reflex relaxation or lengthening response.

Dry Needling vs Trigger Point Injections

Researchers have studied trigger point injections using placebo saline and drug therapy. They have concluded that the only consistent factor is the pain relief from the needle's stimulation for the infusion itself rather than the drug or saline solution used. While the jury is probably still out on the effect of trigger point injections, it is perhaps fair to suggest that the trigger point's mechanical needle stimulation without the use of a drug  (dry needling) does positively affect hyperstimulated trigger points. If you are interested in dry needling, most of our PhysioWorks physiotherapists are dry needle trained.

What Conditions Could Acupuncture or Dry Needling Help?

Acupuncture or dry needling may be considered by your healthcare professional after their thorough assessment in the following conditions:

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What is Acupuncture?

Acupuncture originated in China over 5000 years ago.  Acupuncture works on the belief that a balanced flow of qi, the vital life energy present in all living organisms, determines your health status. According to acupuncture theory, chi circulates in the body along twelve major pathways, called meridians, each linked to specific internal organs and organ systems.

By inserting very-fine gauge sterile single-use needles at specific points along the meridians, your acupuncturist can redirect and reposition the flow of energy (qi) to relieve tension, stress, and pain. The uninterrupted and balanced flow of energy along these meridians contributes to one's overall health.  However, blockages and imbalances result in pain and illness.

What Conditions Could Acupuncture Help?

In Western Medicine, acupuncture is mainly used as a pain relief treatment option. Acupuncture may provide short-term pain relief and is commonly used in combination with other treatment options such as exercise.

Research evidence supporting acupuncture as a treatment modality is variable with most researchers noting that additional research needs to be undertaken to fully understand and support the clinical effectiveness of acupuncture. (See References below for more information)

Acupuncture may be considered by your healthcare professional after their thorough assessment in the following conditions:

For specific advice regarding your pain or health condition, please consult with your trusted healthcare practitioner. They will be able to discuss the appropriateness of acupuncture based on your clinical assessment.

Do Acupuncture Needles Hurt?

No. The insertion of acupuncture needles should be painless. You may feel a slight tingling or heaviness after they are inserted. This is a very common effect that will be monitored by your practitioner during the consultation. At PhysioWorks, we only use single-use, individually wrapped and sterilised needles that we discard immediately after use.

Children and Acupuncture

Parents and guardians permission is required for children under the age of 18. Older children are usually comfortable with acupuncture. However, for small children or patients who fear needles, needle acupuncture is not recommended.

How Much Acupuncture Treatment Will You Need?

The response to acupuncture treatment varies from person to person. Obviously, your treatment schedule will vary depending on your condition. Your healthcare practitioner will discuss your treatment plan during your consultation based on your clinical assessment.

Private Health Fund Rebates

Most private health funds offer rebates on acupuncture or dry needling treatments as a component of your physiotherapy or acupuncture consultation.

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Acupuncture References

Deare JC, Zheng Z, Xue CCL, Liu JP, Shang J, Scott SW, Littlejohn G. Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD007070. DOI: 10.1002/14651858.CD007070.pub2

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001351. DOI: 10.1002/14651858.CD001351.pub2

Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft WJJ. Acupuncture for lateral elbow pain. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD003527. DOI: 10.1002/14651858.CD003527

Green S, Buchbinder R, Hetrick SE. Acupuncture for shoulder pain. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005319. DOI: 10.1002/14651858.CD005319

Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin B, Vickers A, White AR. Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD007587. DOI: 10.1002/14651858.CD007587.pub2

Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DAWM, Berman BM, Bouter LM. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic Reviews2010, Issue 1. Art. No.: CD001977. DOI: 10.1002/14651858.CD001977.pub2.

Ning, Z. and Lao, L. (2015). Acupuncture for Pain Management in Evidence-based Medicine. Journal of Acupuncture and Meridian Studies, 8(5), pp.270-273.

Villarreal Santiago, M., Tumilty, S., Mącznik, A. and Mani, R. (2016). Does Acupuncture Alter Pain-related Functional Connectivity of the Central Nervous System? A Systematic Review. Journal of Acupuncture and Meridian Studies, 9(4), pp.167-177.

What is Dry Needling?

Dry needling is an effective and efficient technique for the treatment of muscular pain and myofascial dysfunction. Dry needling or intramuscular stimulation (IMS) is a technique that Dr Chan Gunn developed. Dry needling is a beneficial method to relax overactive muscles.

In simple terms, the treatment involves the needling of a muscle's trigger points without injecting any substance. Western anatomical and neurophysiological principles are the basis of dry needling. It should not be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture. However, since both dry needling and acupuncture utilise the same filament needles, the confusion is understandable.

In his IMS approach, Dr Chan Gunn and Dr Fischer, in his segmental approach to Dry Needling, strongly advocate the importance of clearing trigger points in both peripheral and spinal areas.

Dry needling trained health practitioners use dry needling daily for the treatment of muscular pain and dysfunction.

dry needling

What Conditions Could Acupuncture or Dry Needling Help?

Acupuncture or dry needling may be considered by your healthcare professional after their thorough assessment in the following conditions:

Private Health Fund Rebates

Most private health funds offer rebates on acupuncture or dry needling treatments as a component of your physiotherapy or acupuncture consultation.

More Info