You may have heard of people getting dry needled and wondered, “what the heck is dry needling?” It is a very useful tool that I use in my physical therapy treatments. I have been using this technique for over a decade now, and it has been a game changer with my patients and for myself personally!
Dry needling is using acupuncture-like needles, but is not trying to affect energy lines or meridians of the body like acupuncture or Traditional Chinese Medicine (TCM). Dry needling is a “Western” medical approach. Also, dry needling is called “dry” needling because we are not injecting any medication into the body, unlike trigger point injections, in which an anesthetic (numbing medication) or corticosteroid is injected.
Basically I could use a tool (like a Theracane or a scraping tool), my elbow, my hands, or my fingers to manually work through fibrotic soft-tissues. With dry needling, my tool is the needle. It can get into the deeper fibers that are causing the pain. It can mechanically break up trigger points and has many positive physiological effects.
Dry needling has central and peripheral nervous system responses to pain control, and has been shown to immediately decrease the pain response in patients by increasing the pain threshold (Gattie et al., 2017). The pain threshold is the point upon which you will feel pain; therefore, if you raise the threshold, then it will take more to feel the pain. Also, it has also been shown to immediately decrease muscle tone (decrease those pesky trigger points or “knots”) and increase range of motion (Gettie et al., 2017).
Dry needling has also been shown to decrease substance P (Hsieh et al., 2014). What the heck is substance P? It’s a neuropeptide that is involved in the signaling of pain in the brain and part of the inflammatory cascade (Mashaghi et al., 2016). This is part of the technical, and possible physiological explanations for how it decreases pain. So this technique is not just woo-woo or a placebo affect.
Is dry needling safe? YES! If done appropriately and by a trained professional. The biggest risk is infection because we are penetrating the skin. Just like there is risk of infection with any abrasion, paper cut or bug bite. However, the needle is so fine-filament (meaning it’s really skinny!) that the risk is VERY low. The other major risk is a pneumothorax (or punctured lung). Again, I am trained in anatomy and how to skillfully use this technique so done by a trained and skillful professional, the risk is low. Also, this risk is only when needling near the lungs. So absolutely no pneumothorax risk when needling hips, low back, elbow, knees, calves, etc…
How big is the needle? Like I mentioned above, it’s VERY skinny. The lengths vary depending upon the body part I am needling. If I’m needling an elbow or hand, it’s pretty short. If I’m needling a hip or glutes, the needle is longer. But still they are all very fine-filament.
Can I see an acupuncturist at the same time? Yes! They have different goals and effects on the body. Sometimes I have even referred a patient to an acupuncturist for a different reason than I am treating the patient for.
Does it hurt? Well, everyone is different. I think it feels like “good” pain or “productive” pain, as I like to call it. You may feel a poke with the initial needle going in, and possibly a deep ache. Sometimes you will feel a referred pain and often in the same region you have YOUR pain. Your muscle might involuntarily twitch, which is normal. We often think that is a good thing when we can get a twitch because then we are effectively reaching the trigger point or “knot.” I have many patients that see me specifically for dry needling because it helps them significantly with their pain relief. Also, I dry needle myself!
How often do I need to do it? This varies by injury and individual. I don’t think dry needling is the only thing that needs to be done in a physical therapy session. I believe it’s part of a whole plan. It allows us to retrain your movement patterns and activate muscle groups that may be inhibited. Sometimes it’s only one time but typically it will be more like once a week for 6 weeks. If you have a tendinopathy like Achilles or hamstrings, it may take a little longer. Also, if your injury is older, then it may take a little more time. As a patient gets dry needled, their bodies often adjust; I find people experience the most pain during their first session. Typically, the next day, people are amazed at how much they feel better! I dry needled a patient her first time this week. After we were done, she stood up and couldn’t believe how much better her neck and upper back felt. She was so excited and was turning her head back and forth in disbelief. My job is so much fun!!! :)
What ailments can dry needling help? So many things! Back pain, neck pain, tennis elbow/golfer's elbow (lateral/medial epicondylitis), Achilles tendinopathy/tendinitis, hamstring tendinopathy/tendinitis, knee pain, hip pain (FAI—femoroacetabular impingement/labral tears), piriformis syndrome, carpal tunnel syndrome, and MORE!
Have more questions? Email me at margiheie@gmail.com or leave me a message at 612.778.6240 and I’ll call you back:)
Cheers!
Margi
References:
Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(3), 133-149.
Hsieh, Y. L., Yang, C. C., Liu, S. Y., Chou, L. W., & Hong, C. Z. (2014). Remote dose-dependent effects of dry needling at distant myofascial trigger spots of rabbit skeletal muscles on reduction of substance P levels of proximal muscle and spinal cords. BioMed Research International. https://doi.org/10.1155/2014/982121
Mashaghi, A., Marmalidou, A., Tehrani, M., Grace, P. M., Pothoulakis, C., & Dana, R. (2016). Neuropeptide substance P and the immune response. Cellular and Molecular Life Sciences: CMLS, 73(22), 4249–4264. https://doi.org/10.1007/s00018-016-2293-z
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