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A relatively new treatment called “Dry Needling” is now being employed by physical therapists, and it’s becoming increasingly popular with athletes.  Though some consider it to be painful and invasive, other swear by it as the miracle treatment that resolved their chronic pain issues and allowed them to keep competing at a high level after a severe muscular injury.  Studies have shown that dry needling is both safe and effective for treating myofascial injuries, many of which are chronic and debilitating for serious athletes.  

What is dry needling?

“Dry Needling” is also called “Trigger Point Needling” or “Intramuscular Manual Therapy” and with those three names, you might begin to get some idea what it’s all about.  It involves sticking a small needle, the same type used by acupuncturists, into an active and often painful trigger point.  The needle works within the muscle, thus the name “intramuscular manual therapy” and attempts to resolve the trigger point by overstimulating the nerve connection at that spot.

In the 1940’s, some of the initial investigations into treating myofascial trigger points involved identifying the points, and then treating them with an injection of some type of solution (saline, etc) to try to stimulate and disperse the trigger point and resolve the myofascial pain issue.

Later on, in the late 1970’s, further studies determined that the solution injected during the “wet needling” was not causing the relief, and that the needle alone, inserted into a trigger point, was all that was needed to stimulate the tissue to release.    

Trigger points are often located at the muscle to nerve junction, and occur when some other imbalance in the body, be it repeated stress or overuse, has caused the nerve to misfire and create a chronically tight spot that can radiate pain both locally around the area and because of the nerve connection, also has the potential to send pain to other places within the body.  

Dry needling hopes to use physical intervention to disrupt and reset that nerve signal, ideally releasing the trigger point and resolving the pain it causes.

How is dry needling different from acupuncture?

Dry needling and acupuncture both involve the same type of small needle, but acupuncture relies on an eastern theory of medicine, where disease originates from stagnation or excess of energy (Chi), while dry needling is based in western medicine that sees disease and dysfunction as more of a physical phenomena.  That said, a study comparing traditional acupuncture points to myofascial trigger points found that both their location and the area they affect with referred pain or dysfunction lined up 71% of the time.  That implies that much of the time, the same issue treated with an acupuncture session or dry needling session might have a similar treatment and outcome, regardless of the theory behind each of the treatments.      

Who can preform a dry needling treatment?

Dry needling in most states can only be preformed by a specially trained physical therapist, or doctor of physical therapy.  Other types of manual therapists that also work with trigger points, such as massage therapists, are legally prohibited from treating with dry needling because the treatment is intramuscular, and involves penetration below the skin level.  It become a bit murky in states where acupuncture is not thoroughly regulated, as often the distinction between acupuncture and try needling is in theory and intent, rather than practice.

What should I expect in a session?

Initially, a physical therapist will talk with you to discuss your issues and treatment goals.  They’ll then create a treatment plan, and with your consent and attempting to work within your comfort level, they’ll begin treating trigger points directly with needles, placed and left within the point for a period of time.

Depending on your treatment plan, the session may be mild and only slightly uncomfortable, or it may be excruciating for a short period of time while the nerves are stimulated toward release.  Regardless, it’s important to communicate with your therapist to work within your comfort level, because reflexive tightening of muscles to try to “grin and bear it” might actually cause more dysfunction than the treatment solves.  

After a dry needling session, you may be sore or bruised around the areas of treatment, potentially for several days.  Be sure to adjust your activity plan to accommodate until you’re back to normal.

Is it effective?

In short, yes. Myofascial trigger point related pain issues account for somewhere between 30 and 85% of chronic pain, depending on the study reviewed, meaning that a safe and effective way to treat them is in high demand.  Peer reviewed scientific papers have found that dry needling is “minimally invasive, cheap, easy to learn and carries low risk [and] its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews.”