Dry. Needling.
Wait, come back!
I lost you at the word ‘needle’ didn’t I?
It’s not what you think, I promise.
If you’ve ever given blood, had a flu shot or a cortisone injection it is NOT like that.
Those use hypodermic needles which slice (ouch) tissue as they go in. Hypodermic needles are also hollow, for the intent of drawing out liquids or injecting them into your body.
There’s got to be a tunnel for those fluids to pass through, so hollow.
Dry Needling on the other hand does not employ the use of an injection hence the name ‘Dry’ and, well, the needling part is…self-explanatory.
Dry Needling is not Acupuncture and Acupuncture is not Dry Needling.
While solid, monofilament needles are used in both professions the education and basis in which the two techniques are applied is different. Acupuncture is based in Eastern Medicine teachings while Dry Needling is based in Western Medicine teachings. Dry Needling is performed solely by Physical Therapists and Physicians and is based on different principles and clinical reasoning.
So, what is Dry Needling?
It is a technique used by Physical Therapists and Physicians to treat musculoskeletal pain and weakness. Typically inserted into painful areas of muscle (those pesky knots) that reveal themselves as tight and/or tender to pressure. If you’ve ever gotten a massage or foam rolled, the knots are those areas that feel like hot little landmines hidden in the muscle.
The massage or foam rolling may feel great but occasionally you may find areas that make you sweat or warm when they’re pressed on; those are knots, officially referred to as myofascial trigger points. These trigger points are the target when dry needling.
Once a trigger point is identified and confirmed, there are typically three (3) styles of technique you’ll experience.
PISTONING
Most PTs are trained in this method and many use it to great effect. Pistoning involves gently changing the depth and angle of the needle within the muscle to get at as much of the knot as possible. The end goal of the pistoning is the twitch. When the twitch occurs, the muscle will quickly but forcefully spasm. Multiple twitches may occur.
NEEDLE MARINATION
The initial moments of this style is similar to the pistoning but after getting a few twitches, the needle will be left in the muscle belly to “marinate” in the tissue. The concept behind this is that the needle is a foreign object and by leaving it in the tissue, the body will work to eliminate it by bringing all sorts of beneficial “goodness” into the area. This technique is often used to stimulate an inflammatory response in an area that has been chronically injured/irritated and that needs a “kickstart” back into the healing process.
PISTONING & ELECTRICAL STIMULATION
Ever increasing in its popularity, this style involves some light pistoning followed by leads being attached to one or more needles. The electrical current creates repeated muscle contractions which, in time, result in a relaxation effect within the muscle. This style of needling tends to be the most comfortable for clients.
What does it do?
At the local level, it temporarily increases blood flow, decreases acidity and inflammatory substances and can act as a “reset” button to allow for more comfortable movement.
At the system level, I personally feel that it has a grand effect on your nervous system.
Similar to foam rolling or lacrosse ball smashing of tissue, it changes your brain’s perception of, and input to, the muscles being treated. All of which can create a short term but beneficial nervous system adaptation.
Short term is key though, dry needling doesn’t typically offer a permanent fix to pain and dysfunction. Like most manual therapy techniques, the intent of dry needling is to normalize the system enough to create a window of opportunity in which tissue can be loaded appropriately to reinforce a long-term adaptation.
Short Hand: The needling allows your muscles to function more normally so that you can use exercise(s) to teach your brain how to properly recruit those muscles, positions and patterns safely.
Dry Needling is a powerful tool that has the ability to optimize recovery time and decrease pain more significantly than just doing exercises alone.
When is this treatment beneficial?
This technique is almost always beneficial for someone experiencing musculoskeletal pain.
To be clear is does not decrease injury healing time and will not shave weeks off of a post-op recovery, however, if a muscle is injured it can make using that muscle less painful while healing. It can have a very beneficial effect on arthritis, not by treating the boney changes directly, but by restoring normal muscle tone around an affected joint. It will not cure the cause(s) of chronic pain disorders like fibromyalgia but it can help reduce pain and restore function so that the chronic pain can be combatted with exercise. It can also help reduce the intensity of symptoms of tension headaches & chronic migraines, to name a few.
While an extremely useful tool, dry needling is not the musculoskeletal silver bullet to end all pain and suffering. It is, however, a very useful tool that allows your Physical Therapist to create short term but immediate changes in your pain that many other tools, including medications, may not be able to match. This change in pain creates the window of opportunity that, if coupled with movement and exercise, can create permanent change.
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