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Physical Therapy

What is Dry Needling?

September 14, 2020
By Health Loft

What is Dry Needling?

Dry needling has been gaining popularity causing many people to wonder “What is dry needling?”. Dry needling, as described by the American Physical Therapy Association (APTA), is “a technique used to treat dysfunctions in skeletal muscle, fascia, and connective tissue, diminish persistent peripheral nociceptive input, and reduce or restore impairments of body structure and function leading to improved activity and participation.” When performed by physical therapists, dry needling is able to reduce pain generated by multiple sources and improve range of motion.

 

How does dry needling work?

Dry needling uses a thin, solid needle that is inserted into the skin and muscle tissue directed toward an active trigger point or latent trigger point. A trigger point is commonly known as a muscle knot, or “tight spot” within muscle tissue. An active trigger point is one that spontaneously causes pain, whereas a latent trigger point causes pain only when compressed. Both active and latent trigger points can limit a muscle’s ability to function and activate properly.

When a dry needle is inserted into a trigger point it can cause a “twitch response” within the muscle, leading it to relax. However, a twitch response isn’t mandatory to reduce the trigger point. Researchers have shown there is a change in the pH level and the biochemical levels of a muscle around a trigger point. When a dry needle is inserted around the trigger point there is another change in the biochemical and pH levels, likely causing the reduction in pain. 

 

Is Dry Needling Safe?

Yes! Dry needling is considered very safe in the physical therapy community. A recent study found the most common adverse events to dry needling were bleeding (normally less than or similar to a pin prick), bruising, and pain during treatment. The same study reported <0.1% of patients experienced a major adverse event including pneumothorax (collapsed lung), excessive bleeding, or prolonged aggravation.

The physical therapists that perform dry needling are certified and have completed ample post-graduate training. Not to mention, to become a licensed physical therapist, one must complete a doctorate in physical therapy, pass the National Physical Therapy Exam, and have extensive knowledge of the human body.

 

Different Dry Needling Techniques

  • Deep Dry Needling: In this technique, the needle is inserted directly into the trigger point. The needle is manipulated to cause a muscle twitch and frequently this is repeated as long as the muscle keeps having twitch responses or until the muscle tension decreases. Of course, the patient may request to stop before a change in muscle tension is felt. This technique can be used in the same muscle with multiple trigger points and on multiple muscles during one treatment session. 
  • Superficial Dry Needling: The opposite of deep dry needling, a twitch response is not sought in superficial dry needling. Instead, the needle is inserted into the muscle near but not into the trigger point. The needle is then left in the muscle until the muscle tension is lessened, frequently 30 seconds to 2 minutes. Similarly to deep dry needling, this technique can be used on multiple muscles during the same treatment session. Oftentimes, superficial dry needling is used when deep dry needling causes significant muscle soreness or the patient does not like feeling a twitch response. This technique is also commonly used when dry needling to reduce scar tissue adhesions experienced after a surgery or injury. 
  • Electro Dry Needling: Two needles are inserted into a trigger point or on each side of a trigger point. Then, electrodes are hooked up to each needle. The frequency is adjusted to prompt different responses, such as the release of endorphins and other chemical responses. Like the other techniques, electro dry needling can be performed multiple times during one session and over multiple different sessions.

 

Are there any risks or side effects of dry needling?

As with any treatment, there are risks with dry needling. However, these risks are small compared to those of medicated injections or other invasive procedures. The most common side effects of dry needling are bleeding, bruising, and pain during treatment. If a patient bleeds, it is normally very little and is able to be wiped away with alcohol swab. More serious risks include pneumothorax (collapsed lung), excessive bleeding, and allergic reaction to the needle. As stated above, the rate of these serious events are <0.1%, as they are easy to avoid. A dry needling certified physical therapist is well aware of the anatomy surrounding the lungs and is able to perform techniques to prevent the needle being aimed at the lung, even when dry needling neighboring muscles. In addition, before performing dry needling a patient is screened for bleeding disorders, current medications, and metal allergies to ensure the safety of the patient.

Is Dry Needling painful?

To some extent yes; But not always. The dry needling technique performed, as well as the person’s preexisting pain level, effects the pain experienced during treatment. The insertion of the needle into the skin and muscle is rarely painful. Frequently, it is described as a “poke”. A muscle twitch response, as wanted in deep dry needling, can be painful. On the other hand, superficial dry needling is often relaxing, not painful. Muscle soreness after dry needling is expected, however it should not last more than 24 hours and can be reduced with exercise, heat, or over the counter pain medication if needed.

Most patients notice immediate improvement in pain or range of motion after the first session of dry needling. However, it is possible that a person will need more than session of dry needling. 

It is important to mention, that dry needling is not intended to be performed outside of a comprehensive physical therapy treatment plan. To gain the most benefit, a physical therapist will evaluate an individual person and develop a specific treatment program for that person’s needs and goals.

If you have further questions regarding dry needling, or are interested in scheduling a dry needling appointment with one of our physical therapists in Chicago, IL, you can start by calling us at (312) 374-5399 or by scheduling an appointment online. If you have further questions regarding dry needling, we would also be happy to answer them.  Remember to also check out our FacebookInstagram, and Twitter pages for more fun facts and articles on nutrition, physical therapy, and exercise!

 

Submitted by Kellie Stickler
Edited by Alexander Franz
Reviewed by James Caginalp PT, DPT, CSCS, CES, PES

REFERENCES

  1. American Physical Therapy Association. (2013). Description of dry needling in clinical practice: An educational resource paper. http://www.apta.org/StateIssues/DryNeedling/ClinicalPracticeResourcePaper/.
  2. Shah, J.P., Danoff, J.V., Desai, M.J., Parikh, S., Nakamura, L.Y., Phillips, T.M. & Gerber, L.H. (2008). Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archives of Physical Medicine and Rehabilitation, 89(1): 16-23. doi: 10.1016/j.apmr.2007.10.018.
  3.  Boyce, D., Wempe, H., Campbell, C., Fuehne, S., Zylstra, E., Smith, G., Wingard, C. & Jones, R. (2020). Adverse events associated with therapeutic dry needling. International Journal of Sports Physical Therapy, 15(1):103-113.
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