Dry Needling in Physical Therapy
Dry needling is a term that can be a bit frightening simply because of its title. However, it is quickly becoming a very important and effective part of treatment at Mountain View Pain Center. The American Physical Therapy Association established the definition for dry needling in physical therapy: A skilled intervention that is performed using a thin filiform needle to penetrate the skin and stimulate underlying myofasical trigger points, muscular and connective tissues for the management of neuromusculoskeletal pain and movement impairments.
Dry needling enables our doctors to not only defuse pain, but also to help heal various neuromuscular skeletal conditions. The direct disruption Dry Needling has on the tender point causes a rapid improvement in muscle physiology and function that no other modality can achieve. Needle penetration is one of the single most effective ways to improve clinical outcomes in both time and duration.
Dry needling does not involve injections of any kind, whereas ‘wet needling’ is the use of a hollow hypodermic needle injecting substances such as saline solution, Botox or corticosteroids. When it comes to dry needling, the needle is inserted about 5-10mm into the tissue above the trigger point. Dry needling is ever evolving and as a result, many different terms have emerged. At Mountain View Pain Center, we put our main focus on Functional Dry Needling (FDN) and Trigger Point Dry Needling (TDN).
When treating trigger points, dry needling is an invasive procedure where a filiform needle is inserted into the skin and muscle directly at the myofasical trigger point. The myofasical trigger point (or knot), is the area causing a patient pain. The practice of dry needling was first introduced by a Czech physician who noticed the success that injections had on targeting pain in trigger points.
Dry needling will target a myofascial trigger point and in doing so, it will elicit a local twitch response. A local twitch response is an involuntary spinal cord reflex where muscle fibers contract. The local twitch response will indicate exactly where the needle needs to be placed. Most of our patients experience such a great amount of relief from their pain upon dry needling treatments; the entire idea of a needle is taken out of the equation. We are very aware that needles can be a common phobia, but since the success rate is so high with this as a treatment, most everyone is open to trying dry needling at least once.
Dry Needling vs Acupuncture
When it comes to differentiating between dry needling vs acupuncture, the differences are evident in the evaluative tools, the assessment, the application itself and the overall intended goal. Acupuncture is a treatment based on eastern medical diagnosis with the overall goal being to restore normal flow of the life force.
Acupuncture contrasts drastically with the use of dry needling in physical therapy in that it is firmly rooted in western medical philosophy. Acupuncture is an Asian complete system of healing with theories that focus on the use of specific points, meridians, and the concept of chi. Dry needling (DN) is a physiologic therapeutic technique and procedure, which works to neutralize soft tissue and restore muscle and fascial function.
DN mechanically disrupts physiologically locked tissue. The soft tissue entities are influenced by the central and peripheral nervous systems. The DN procedure works with myofascial trigger points and tender points. It is mainly based on the Western concepts of anatomy, physiology, neurology and biomechanics.
As a physical therapy treatment at MVPC, DN gives our patients increased range of motion, it decreases pain and restores function of the body. We look to identify and treat the source of pain as well as what is driving the pain. Many of our patients at MVPC are very active in various sports and different workouts at all ages, so as a result injuries and tightness are bound to occur.
If maintenance treatment is done and even preventative treatment, we can prevent injuries from occurring or getting worse. One of the most important principles in DN is identifying the basic foundation of a patient’s pain. This includes the following: history of the injury, pain story, and the location and behavior of the symptoms. All of these variables draw upon the pain patterns and allow us to get a sense of what tissues need to be examined.
Once the source of pain is identified, trigger point referral patterns come into play. The muscle is one potential source of pain, so trigger point referral maps give us an idea of a potential painful area. There are also referral pain patterns for joints, discs, nerves, bones, ligaments, viscera and blood vessels.
Anything with a nerve supply can cause pain. So, a trigger point, an area that is causing pain, can be treated with dry needling. We deactivate a hyerirritable (i.e. knot or tight area) spot in the skeletal muscle by inserting a needle into it, which elicits the local twitch response. By combining the needle with electrical stimulation, this will relax the muscle allow for a sense of relief.
Our doctors at MVPC are very attentive with each patient during the DN process. Often times, patients are unaware why they are having pain in certain areas of the body. We look to determine exactly why a muscle has developed a neuromuscular dysfunction or a trigger point, why a disc has become painful, or why a nerve is generating pain.
At this point in time, DN becomes the tool that is effective in not only taking the pain away but also restoring function of the body. When the body is moving and functioning properly, the pain level should remain very low. By alleviating overall body aches and pains, we can prevent a misfiring neuromuscular system and help specific system towards functioning properly.
An inefficient muscle will not function correctly and as a result will cause pain. When DN is performed, the needle is used to diminish the dysfunction. The muscle itself is restored to its optimal length by decreasing banding, or by alleviating undue strain on adjacent pain generating structures. DN serves as a way to restore and reset the system to allow for optimal movement to occur.
Since DN is still a foreign concept to some, many of our patients are curious as to what type of pain, problems, and/or conditions it helps with. Some of the main conditions we specifically target are:
- Sciatic Pain
- Muscle Spasms
- Carpal tunnel syndrome
- Tennis/Golfer’s elbow
- Frozen Shoulder
- Glute pain
- Hamstring (And other repetitive) strains
- Shin splints
- Hip/ Knee pain
By introducing a new stimulus (i.e. the needle) this impedes or slows down the reflex arc and this is where the relaxation of the muscle occurs. When a muscle is in spasm it becomes damaged and the spasm reduces blood flow in the muscle. What does this mean? It means less oxygen and nutrients are being supplied to the muscle. Muscle fibers then die off and are replaced with scar tissue. This keeps the muscle very tight and tense keeping it in spasm and in pain. By inserting a needle into a muscle spasm it causes the muscle to relax and allows the patient to experience significantly less pain.
Dry needling is not a treatment to shy away from. The treatment as a whole has so many great benefits in pain reduction. Reducing pain, while also reducing the intake of pain relieving medication, and bringing down swelling as whole are reasons enough to undergo this specific type of treatment. The MVPC doctors want our patient’s pain to stay at a minimum, and this treatment itself has the ability to do this.