DRY NEEDLING

Have you heard about dry needling? Maybe through a friend who has tried it, seen it on social media or even been suggested to try it by another healthcare provider? Whether you have or haven’t heard of it, I want to really get down to the nitty gritty behind why this is by far my favorite tool in my toolbox when addressing pain.  I hope by the end of this you have a better understanding of not only WHAT it is, but why the STYLE of the treatment matters, WHO benefits from it, WHEN it is appropriate, WHAT to expect, and WHY I love it so much as a Doctor of Physical Therapy.  

WHAT IS DRY NEEDLING:

First off, what even IS Dry Needling? Dry Needling is a treatment that uses a very small diameter needle that is inserted into the skin and underlying tissues such as muscle, fascia, tendons, joint capsules, and ligaments.  Why is the word dry in there, you may be wondering. Is there wet needling? Yes! Dry Needling utilizes a solid filament needle in contrast to wet needling which involves a hollow needle used to either inject or extract fluid.  For a size difference visual….you could likely stick 20-25 or so dry needles through a typical needle used to take blood (don’t quote me on that…but it’s a SIGNIFICANT difference). 

You may be thinking “Okay…a tiny thin needle inserted into the body…like acupuncture?” The answer is while it uses the same type of needle, it is NOT acupuncture at all. The school of thought, assessment, and treatment approach are entirely different.  Acupuncture uses Eastern medicine principles like meridians and qi that were developed thousands of years ago to treat physical, mental, and emotional pathologies.  Dry Needling utilizes Western medicine principles like neurology, physiology, and anatomy to treat neuro-physiological pathologies like decreased mobility, strength, function, and pain.

TECHNIQUE MATTERS:  

When it comes to Dry Needling, it is very important to understand that not all training and thus treatment styles are the same. There is a trigger point approach that educates primarily to needle into the symptomatic and subjectively reported painful area in the muscle tissue after assessing for tight bands of muscle fibers (As a side note, the term “trigger point” is hotly debated in the physical therapy field but that is a topic for a different day).  While this may yield positive outcomes, I personally feel it is missing a massive piece to the puzzle…the nervous system.  

The nervous system regulates our entire body. Without it, we would have no sensations or motor control of our muscles and joints. it is the electric grid running through our body, and I believe it should be taken into the utmost consideration when dealing with pain and dysfunction. Neurological dry needling in the style I was trained, teaches us to evaluate the status of a patient’s nervous system and use that information to know how your body will likely respond to treatment. Not only do we treat tight-feeling muscles; but we effectively manage the root cause of neuromuscular conditions. This approach treats soft tissue inflammation and positively influences the nervous system, improves, blood flow, decreases tension in muscles, increases range of motion, decreases pain, and even increases muscle strength by way of improving muscle fiber recruitment. 

WHAT IS THE PROCESS LIKE?

As a patient at HiFLEX, we want you to have a good understanding of the logic and process before you are poked with needles. We want you to know what to expect and be comfortable with it as this typically means the experience will be much more comfortable and less intimidating.  We begin these sessions just like any first visit, with a detailed subjective history of what is going on that led you to seek treatment from us in the first place. Often the patient’s description of what they are going through gives the best roadmap to establishing a treatment plan. An assessment is performed to gauge the overall sensitivity of the nervous system, which helps us determine the dosage of needles, as well as the recommended number of sessions. 

No matter the body part we are treating, we always needle three types of points. One point will be along the spine that corresponds to the spinal level that supplies that area with motor and sensation. The next point will be the closest neurological point that we call “homeostatic trigger points”. A large study was conducted and found that across all bodies they tend to have the same top 25 points that will become most tender when the peripheral nervous system is sensitized. These are used as locations to impact peripheral nerves. The third point is a symptomatic point where the patient is experiencing discomfort. When we take this approach, we are making sure to be treating the entire nervous system from the spinal cord and central nervous system to the peripheral nervous system as well as the musculoskeletal area of complaint. 

If those last two paragraphs seem a bit over your head… Think of it this way: if you are going to try and fix an issue with any of your pieces of technology like a phone or computer, what is the age-old recommendation? “Have you tried turning it off and resetting it?”  This style of dry needle treatment helps to reduce resting tension levels and acts as a reset button. Another study has been conducted to prove that the metal needle simply being near a zone that has heightened neural build-up will actually depolarize the area.  This is often seen and felt as a muscle twitch. Another example I like to give my patience is that of static electricity. When you build up static electricity and you finally touch something that offloads that electricity, you will feel a small shock. It is a very similar concept of the needle helping to act like a lightning rod. Cool, right?

Often patients would like to know why we needle points that are farther down their arm or leg than they experiencing pain and yet another example I like to give to explain my answer has to do with food dye and a water hose. If I put food dye in one end of a water hose you’re eventually going to see color change at the other end.  Inflammation of the nervous system will eventually travel the distance of that peripheral nerve. To get the most effective treatment, we like to treat as much of that nerve as possible from the spine to the tip of your fingers, toes, and back. 

When we are dealing with chronic cases of pain or widespread pain, such as fibromyalgia, or chronic low back pain, we must take into account the central nervous system. This is what controls whether we are in fight or flight versus rest and digest. Often people dealing with chronic pain are stuck in a cycle of fight or flight system responses. With these cases, I take a much more spine-based approach and try to get as much impact and regulation of the sympathetic system which can be treated, particularly in the thoracic spine.

WHAT DOES IT FEEL LIKE?

Generally speaking about eight out of 10 patients do not find dry needling to be a painful experience. Some patients feel nothing at all while others may feel a mild, aching sensation, mild tingling sensation, or a temporary superficial burning sensation. The sensations are often very short-lived and can be mitigated with some fine-tuning of the needle. Once the  needles have been placed most patients no longer feel them

.  Very frequently when the treatment application is done well and accurately, the patient will feel a reproduction of their pain. The more we can accurately reproduce the patient’s familiar pain the more we know we are accurately treating the root cause. The needles are so small that very rarely is there even a speck of blood at removal; however, we do leave a finger at the exit point just to ensure there are small capillaries that may be bleeding, which can result in a small temporary bruise.

WHO BENEFITS?

Do I need therapy can be beneficial for any neuromuscular or orthopedic condition if a transfer therapist has done a thorough assessment and deems it to be appropriate. Dry Needle therapy is not for everyone. People with needle phobias are extremely averse to the therapy and not good candidates.

Common conditions that we treat are acute or chronic low back pain, radiculopathy, headaches, arthritis pain, plantar fasciitis, post-concussion syndrome, fibromyalgia, ankle sprains, post-surgical cases, and general athletic performance patients who would like better muscle recruitment before activity. 

WHEN IS THE BEST TIME TO BE NEEDLED? 

Ideally, the sooner you can address pain and discomfort the better. Dry Needle therapy has been studied as a possible intervention to replace pain medication in an ER setting with a significant reduction in acute pain.  Needling can also be effective immediately after sprains to help mitigate swelling and pain.  

As far as when this therapy is performed within a physical therapy session, our preference is that a gentle warm-up is done prior and corrective exercises are performed after. Due to improved muscle recruitment and firing rate after a session, it can be beneficial for athletes to utilize this therapy before a training session for better mind-muscle connection. 

WHY I LOVE IT: 

A Doctor of Physical Therapy, I can confidently state that utilizing this style of Dry Needle Therapy is the most effective catalyst for pain relief that I have ever worked with. it initiates the cascade of events in the natural healing process by creating a good and useful inflammatory response to help the body heal itself. it was also very helpful and connecting the brain back to body parts that may have disassociated slightly due to significant discomfort or chronic pain. There is a concept called neural smudging, which basically means that the area of the brain that talks to a certain body part does not have as crisp of a signal. An example I like to use is trying to read a roadmap without your glasses on. You can generally tell where things are but once you put your glasses on everything is more fine-tuned and crisp. Dry needling helps to decrease neural smudging and improve the mind-body connection.

The results speak for themselves. As stated earlier, not all patients are good candidates for this therapy; however. when someone is an appropriate candidate and the therapy is utilized by a skilled clinician, the outcomes of decreased pain and improved function are incredible and lasting. 

SOME EXAMPLE CASES:

A patient presented with 20 years of chronic low back pain that was initiated when he was in the armed services. Had been seeking physical therapy for pain relief, as well as to satisfy his physician’s request before a prescription of pain medication renewal. This patient was needle through the lower back, as well as Into the corresponding homeostatic points for his pain. He experienced significant fatigue after his first session, to the point of taking a four-hour nap in the middle of the day. The next day he reported his pain level had diminished by more than 90%. He was able to perform his home exercise program and sleep significantly better. After four sessions, the patient reported 100% resolution of his discomfort. He was unable to return to exercise as he wished.

Patient presented with significant weakness of grip as well as numbness and tingling in his pinky and ring finger. He had a painful shoulder as well as neck. After a thorough assessment, he was needled through the cervical spine, the homeostatic points of his upper extremity, as well as into his area of reduced sensation and strength. After six sessions, which also included various other treatments, the patient was able to regain full strength of grip as well as sensation in the hand.

Patient presented with significant headaches around the eye, sockets, and temples. The patient was needled through the cervical spine, as well as the base of the skull along with nerve points on the face. Within 15 minutes of needle application, while the needles were still in the patient reported a significant reduction in headache sensation. The headache had fully dissipated by the end of the session.