Physical Therapy

8 Popular Questions About Dry Needling

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I am so thrilled to officially be certified in dry needling! Last weekend, I absorbed practice changing information from Myopain Seminars.  My physical therapy knowledge was enhanced with current evidence-informed information on myofascial pain and I learned how to effectively treat it. 

I practiced dry needling 26 different muscles on my lab partner and she did the same to me.  I experienced how dry needling felt on various parts of my body.  Yes, I was sore, but it was remarkable how much more freedom of movement I felt in my neck, shoulders and low back.  My diffuse chronic low back pain reduced tremendously and I had the best night sleep in a long time.  I was so impressed with the knowledge of the instructors, their clinical pearls and the amazing success stories they shared in their own practices.  I left that course rejuvenated in my PT practice and excited to not only bring out the needles but to also take a new viewpoint when I listen to each of my patient’s stories regarding their pain.

Last week at work my mind was filled with a new perspective, a new possibility.  I listened to each patient with a new tool in my pocket.  Many of my existing patient’s were on their road to recovery but continued to describe a diffuse pain.  I tested out my dry needling skills on several of them.  I felt more than prepared to do so and couldn’t wait to hear the results.  

My first dry needling patient returned for his second appointment that week.  This session was with the PT assistant and I was nearby talking to another patient about dry needling.  I was absolutely amazed at what I saw.  He was standing tall and was participating in some strength training exercises. Just two days prior, he was unable to stand up straight, moved slowly and was in no shape to exercise.  I asked him how he felt after the dry needling.  He remarked that he has no back pain and can move a lot better.  I couldn’t believe it! This is a man with a 10 year history of chronic low back pain.  This was perfect timing for my current patient her to hear his experience. She became intrigued but had some questions.  

Her inquiries about dry needling were the theme last week.  I was excited about something new I could offer my patients and they all had tons of questions. Almost every person had never heard of it but wanted to know more.  I found myself describing everything that I learned and thought it would be very helpful to extend this Q&A to my readers.  I’ve listed below the most common questions I received this week and I did my best to not only answer but also include a few extras from the experts on the topic. 

What is Dry Needling?

Dry Needling is a treatment used by a broad spectrum of health care professionals, including physical therapists, to directly diminish painful muscular knots called trigger points.  These trigger points create tenderness directly over them and in areas further away. This distal pain is known as referred pain. Every muscle in our body has a specific referral pattern.  Typically, the pain in these referred areas is more diffuse and difficult to pinpoint.  This area isn’t necessarily tender to the touch and you may not remember even doing anything to cause this soreness.  It is often chronic and came on without any specific explanation.  The following video does an amazing job explaining what a trigger point is and the phenomenon of referred pain.

How does it work?

A very thin filiform dry needle (without medication) is inserted into the trigger point of a muscle. This creates a local twitch response that causes the trigger point to dissipate.  The exact mechanism of what actually happens at the cellular level is still being studied.  What we do know about the effects of Dry Needling on trigger points is summarized in Jan Dommerholt’s (founder of Myopain Seminars) textbook, “Trigger Point Dry Needling. An Evidenced and Clinical-Based Approach”.

DN (Dry Needling) does alter the chemical environment of active TrPs (Trigger Points), reduce or eliminate endplate noise and decrease the sensitivity of TrPs, but little is known about what the needle actually does to cause these effects. -Jan Dommerholt

What does it feel like?

You may experience a slight prick as the needle penetrates. However, most of the time, you will not feel anything as it enters your skin. Once the needle contacts your muscle tissue and the trigger point, you will typically feel a deep ache or cramp. This sensation may build in intensity and then twitch or spasm. If your trigger point is large, you may experience several twitches. Within seconds to a few short minutes, the deep ache will subside and the treatment will be over.

What will I feel afterwards?

Most of the time, you will experience a dull ache for about 1–2 hours. This ache feels like a sore muscle that’s been worked. Some muscles are more sensitive then others and if you had a large trigger point with multiple twitches, this soreness may last up to 48 hours. If the trigger point was the true source of your pain or loss of motion, you may notice an immediate reduction in this pain and/or greater freedom of movement.

How is this different from acupuncture?

This topic has raised significant controversy with opposition from many acupuncturists.  The needles used in dry needling are the same needles used in acupuncture and the methodology of treatment is similar to an approach that some acupuncturists use.  The extent of their scope of practice is beyond my understanding just as the scope of a physical therapists practice is not well understood by the majority of acupuncturists.  When dry needling is done by a physical therapist, the underlying rationale is based on the resolution of trigger point.  It is an intervention that is well defined by Myopain Seminars.

Dry Needling is a technique use to treat dysfunctions in skeletal muscle, fascia, and connective tissue, and, diminish persistent peripheral nociceptive input, and reduce or restore impairments of body structure and function leading to improved activity and participation. – Workbook Myopain Seminars, page 1

Are Physical Therapists the only clinicians that do Dry Needling?

No.  Dry needling is being done all over the world by several different healthcare practitioners. These include allopathic, osteopathic, naturopathic, podiatric, veterinary and chiropractic medicine.  In addition, acupuncturists, dentists and massage therapists perform this treatment. However, this is dependent upon the country and the local regulations (Dommerholt).  The following video does an excellent job explaining the benefits and why dry needling is successfully done by a physical therapist.

How long has Dry Needling been around?

The concept of injecting a trigger point with a needle has been around since the early 1940’s. Well respected medical doctors Janet Travell and David Simons were the first physicians to inject a variety of substances into muscular trigger points.  In 1979, a Czech physician, Karl Lewit, discovered that the effect of the needle on the trigger point was the same whether or not a substance was injected.  Since then several other studies supported his claim and the treatment technique of “Dry Needling” was born.  

How do I find a Physical Therapist who is certified in Dry Needling?

There are several different companies that certify physical therapists in dry needling. The company I was certified through, Myopain Seminars, has a “Find a Clinician” section on their website.  You simply type in your zip code and a map with a list of clinicians will populate.  (I haven’t made the list yet but I can assure you that I’m fully certified.)  Other companies that certify for dry needling include Kinetacore, Integrative Dry Needling, Spinal Manipulation Institute and many more.  The majority of these organizations have a “Find a Therapist” section.

I hope you feel your questions were answered.  Please make a comment below if you have any additional questions.  If I don’t know the answer, I will do my best to find it for you!

Sources

Dommerholt, J., Fernandez-de-las-Penas, C. 2013. Trigger Point Dry Needling. An Evidenced and Clinical-Based Approach. Churchill Livingtone, Edinburgh

Dommerholt J, Gerwin R, Layton M. Workbook Myopain Seminars. 2013.

www.moveforwardpt.com

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