Why Dry Needling?

images5What is Dry Needling and why does it work?

Dry Needling is an invasive procedure in which an acupuncture needle is inserted into a specific target soft tissue in order to improve or restore function and/or control pain.

The term ‘Dry Needling’ is used to differentiate this technique from injections  performed with a variety of injectables, such as procaine, lidocaine, serotonin antagonists, etc etc.

Single Needle Needling

Dry Needling is based on the western anatomical and physiological paradigm and uses as its tool the fine solid filiform acupuncture needle but is in all other aspects different from traditional acupuncture.

Dr Travell first described the use of Myofascial Trigger Point (MTP) injections for myofascial pain in1942. In 1979, Lewitt spoke of the ‘needle effect’, the effective use of the dry needle as opposed to the wet needle when using injection techniques, hence the term Dry Needling developed.

[1] Prior to the development of Dry Needling,  MTP’s were treated primarily with injections. Several recent studies have confirmed that TP  Dry Needling (DN) is equally as effective as injection therapy [2]. The reason for the pain relief is now believed to be due to the stimulation of the needle used for the injection as opposed to the properties of the substance being injected. There are biochemical changes shown in the TP following twitch elicitation. This was done by real time blood micro-sampling of the TP as it was needled.

Other terminologies used in literature describing similar techniques including amongst others: IMS (intramuscular stimulation) – this was specifically developed by Dr Chan Gunn in Canada; PENS (percutaneous electrical stimulation); Superficial Dry Needling – developed by Dr Peter Baldry and Dr Andrew Fischer’s spinal segmentation sensitization model.

Trigger point dry needling (TP DN)  is a technique used for ‘releasing’ MTP’s. This release is hypothesized to occur as a result of the elicitation of local twitch responses (LTR’s) with subsequent inactivation of the myofascial trigger point. Here we must credit the years of research work by Dr David Simons and Dr Janet Travell.

It is often wrongly assumed that needling techniques fall under the exclusive scope of medical practitioners and oriental medicine / traditional acupuncturists. Increasingly Dry Needling is being used by Physiotherapists, Chiropractors, Osteopaths, Nurses, Doctors, Anaesthetists, athletic trainers and some sports and massage therapists as part of their treatment and rehabilitative programs.

Interest in Dry Needling as a treatment technique has gained phenomenal popularity worldwide as clinical outcome studies and research trials increase, we become more evidence-informed and evidence-based in our use of this inexpensive yet very efficient modality.

Dry_Needling250Why does Dry Needling work?

First there must be a cause of the pain. Pain which lingers or severe pain sends signals to the brain via the spinal cord. These signals may return through the Sympathetic Ganglion and activate Primany Afferent Nocioceptors (H) which will feedback to the spinal cord  causing the pain to continue instead of disappating. This is called the painful Reflex Arc.

The onset of a painful reflex arc can lead to the development of muscle spasm which can lead to the onset of trigger points and the associated muscle  spasm can last for weeks, months or even years.

The introduction of a physical stimulus in the form of an acupuncture needle has the effect of breaking the reflex arc and relaxing the muscle spasm / trigger point and thus resulting in a healing response.

A few common questions and answers

Q.  What are the prerequisites for attending a Dry Needling course?

A. You must hold a current qualification and registration with your professional board. Dry needling must fall within your scope of practice and you need to hold professional indemnity insurance to cover the training and practicing of an  invasive procedures such as DN.

Q. What HCP disciplines are best suited to use Dry Needling?

A. Undoubtedly Physiotherapy, Osteopathy, Chiropractic, Sports Physicians, Neurologists, Anaesthetists, Sports Physios, Manual Therapists  and other clinicians involved with the treatment of pain, myofascial dysfunction and rehabilitation.

Q. I am a nursing sister, can I use Dry Needling?

A. If you are working in a pain clinic or a rural clinic Dry Needling could be a great tool for you. You would have to complete the Myofascial trigger point therapy course before taking the 3 day Module 1-3 DN course.

Q I have a 3 year sports massage BSc, can I take the Dry Needling course?

A. This will depend on the scope of practice of your professional board and whether you hold the necessary indemnity insurance for invasive procedures. with the above being in place you may join the Dry Needling modules after completion of the Myofascial Trigger point intro course. You should also have been in practice for a minimum of 3 years.

Q. Is Dry Needling the same as Acupuncture?

A. No! DN and Acupuncture are not the same but do have similarities. The same needle types are used and the insertion of the needle will cause similar responses but essentially acupuncture follows the traditional chinese medicine theories of energy fields and flows whereas DN follows a more western philosophy of treating myofascial pain and dysfunction. This being so the choice of needle site placement and method of needling will differ. Read our commentary article on acupuncture vs Dry needling by Claire Waumsley here.

Q. I have done an 80 hour Acupuncture Foundation course. At what level can I slot into the Dry Needling training?

A. Depending on your level of experience, we provide a special one day bridging course covering dry needling and myofascial physiology for those who we deem require the briding course. On completion of this you may take any levels of the course that are of specific interest to yourself. If however you have been working as a HCP for a number of years and your experience is deemed to be sufficient you will be allowed to progress into the module 1-3 DN course.

Q. Do I have to take the modules in order?

A. Yes! You must complete modules 1-3 before you can take modules 4 & 5 in that order. It is a course requisite that you complete all 5 modules and the Anatomy module and pass the exam in order to be recognised as a DN practitioner by the DN Institute. Participants are also not advised / permitted to needle areas / regions that are covered in modules that they have not completed (from both a safety and indemnity insurance point of view)  The Anatomy Update module can be taken at any stage to optimise the building of your skills and theoretical base and forms part of the DN practitioner certification.

Q. Does Dry Needling hurt?

A. Pain is subjective but the sensation when the needle is inserted is often described as a tingling or dull ache or can elicit the twitch /spasm response which is not painful but can sometimes be uncomfortable. With Dry Needling, thin filament needles are used compared to the hollow needles which are used when giving an injection. Patients can also describe a  heaviness in the limbs or a pleasant feeling or a feeling of relaxation during the treatment.

Q. Where is DN mainly practiced?

Dry needling is practiced by physios, chiropractors, osteopaths, doctors, sports trainers and manual therapists in many countries, including South Africa, the Netherlands, Spain, Switzerland, Canada, Chile, Ireland, Portugal, the United Kingdom, Australia and New Zealand. In the United States, physical therapists in several states including Virginia, Maryland, Ohio, Colorado, Georgia, New Mexico, and Kentucky perform the technique, and several other states, including Louisiana, Tennessee and North Carolina, have recently updated board positions allowing the practice.

 

[1] Huijbregts .P Myoscial Trigger points, Pathophysiology & evidence-informed diagnosis and management .p219 227. 2011.

[2] Hong C Z . Lidocaine injections versus dry needling to myofascial trigger point: the importance of the local twitch response. Am  J  Phys Med Rehabil 1994 : 73:256-263