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Dry needling is a technique used to treat myofascial pain syndromes by trained physical therapists.  As far back as the 16th Century, myofascial pain syndromes have been recognized by medical practitioners for causing sensory, motor, and autonomic symptoms and dysfunctions.  Myofascial pain syndromes are associated with palpable nodules or taut bands known as myofascial trigger points.  It was discovered an injection of analgesic medication into trigger points caused a decrease in symptoms, pain, and sensitivity to touch in the trigger points.  Today we know the actual insertion, and stimulation of the muscle trigger point, with a dry needle alone, provides pain relief without the need for additional medication. 

trigger points

Trigger points may exist for many reasons. With regards to the spine, they may be caused by mechanical dysfunctions such as forward head postures, joint hypermobilities, ergonomic stressors, poor body mechanics, and muscular imbalance such as scoliosis.  Active myofascial trigger points typically refer pain to a particular location on the body. These locations or sites are not restricted to a single segmental or peripheral nerve distribution. Clinically, trigger points can cause motor dysfunction or muscle weakness as a result of motor inhibition, restricted joint motion, and muscular stiffness. The trigger point may have sensory dysfunctions felt as localized tenderness, referred pain to specific areas, extreme pain to a painful or even non-painful stimulus. 

TECHNIQUE

Dry needling uses a thin solid needle to treat hyperirritable spots of skeletal muscle. These hyperirritable spots are called trigger points and are typically associated with palpable nodules in the muscle tissue.  Physical therapists insert a dry needle, without medication or injection, in the trigger points to treat myofascial pain. The needles are often very similar or the same as those used in acupuncture practices. Dry needling has no similarities with traditional acupuncture except for the tool being used during the process.

Acupuncture is based upon Chinese Medicine that seeks to regulate flow and stability of energy through the body by subcutaneous placement of needles in corresponding body parts. Acupuncture points are mainly along the pathways of energy flow, called meridians. In contrast, trigger point dry needles are inserted directly into specifically targeted muscles which have been found to be dysfunctionally tight or inhibited. Trigger point dry needling is based on neuromuscular and biomechanical principles.

Dry needling allows access to deep musculature that usually cannot be reached without use of a needle. It allows a deeper tissue release than a manual deep tissue massage. By releasing muscular restrictions, a physical therapist is able to further enhance the treatment and return to function. The goal of dry needling is to produce a twitch response, or short contraction, of the muscle being needled. The muscle twitch can interrupt the pathogenic process and produce mechanical changes in tissue. The insertion of a needle into the trigger point can temporarily produce a deep ache, cramping pressure, reproduce radiating (radicular) symptoms, and cause soreness that may last up to 24-48 hours. Usually treatment results in improvements in functional range of motion, decrease in complaints of pain, and ease of mobility. 

CERTIFICATION

Dry needling is a novel and new technique in physical therapy with rapidly growing acceptance. In the United States, each state independently determines the appropriateness of dry needling within the state's scope of practice through the state's licensure board. As of 2012, approximately 30 states have approved dry needling as an acceptable procedure within the scope of the physical therapy practice. The physical therapists at Virginia Therapy & Fitness Center are all trained and skilled in dry needling.