Have you ever had a friend come from physiotherapy and tell you they were treated with ‘dry needling’? You might think to yourself ‘What is dry needling?’ or ‘How does dry needling work?’ or maybe ‘That sounds painful, why should I try dry needling?’ The truth is, dry needling can be somewhat painful (or not at all depending on your pain tolerance), but we wouldn’t be recommending this method of treatment if it weren’t effective.
This post covers where dry needling came from, how it works, why it works, and the recent research to support it.
The terms Functional Dry Needling (FDN), Trigger Point Dry Needling (TDN), and Intramuscular Stimulation (IMS) are all used interchangeably. Note that Acupuncture is not included on this list. Acupuncture has roots in eastern medicine philosophies, while FDN is a western medicine practice. Though both practices use the same needles, the training, application, and philosophies are quite different; therefore, not considered synonymous.
Dry Needling involves the insertion of a thin, filament-like needle past the skin and into muscle tissue. It is termed ‘dry’ because no substance is injected or fluids removed from your body. The needles are blunt-typed and very thin, meaning they are quite comfortable. There is little to no pain caused from the needle penetrating your skin. However, chances are if you have heard of dry needling you have heard it is painful. That’s because it is painful. Though the needles themselves are relatively painless, the practitioner is trying to elicit a ‘twitch response.’ This is a cramping, almost spasm-like, reaction of the dysfunctional muscle tissue. It is a very short but intense contraction, lasting less than a second. Multiple twitches may happen before the muscle is fully released. This is the response your therapist wants to produce, so in the example of dry needling, pain is a necessary evil. Pain tolerances vary widely person to person, so how much pain you experience is really something you would have to see for yourself. The whole experience is over in approximately 10 to 15 seconds per needle.
So what exactly is happening during this twitch response? Dry needling targets muscle trigger points. Trigger points are hyper-irritable muscle fibers that represent dysfunction or problems in the neuromuscular system (the neuromuscular system is basically the connections between your brain, nerves, and muscles to create movement). When you have trigger points in a muscle you may experience pain if you use that muscle to move, touch the painful spot, or sometimes even if you aren’t doing anything at all. Trigger points have been shown to make ‘noise’ on an EMG, be visible under ultrasound imaging, react stiffly to a vibration stimulation, and have a different pH balance and neurochemical makeup than normal resting muscle fibers. Trigger points also produce the characteristic ‘twitch response’ to stimulation – either by needle or by deep palpation. This twitch response resets the muscle fibers to their normal resting state. Think of it as rebooting a computer. FDN is an effective way to reach the exact fiber and depth required to induce a twitch response required to remove the trigger point completely.
FDN is a relatively new technique, so there is currently limited evidence to support its use. A systematic review was released in March 2017 looking at the effectiveness of FDN. (A systematic review is a comprehensive study that gathers all the best available evidence on a specific research question and statistically combines the results of each article. This is powerful research and the highest level of evidence you can achieve as it evaluates all the current studies to answer a question, not just a single study on its own). This systematic review started by gathering the 200+ articles published on FDN, and analyzed the results of 13 chosen for their superior quality. In short, the results of this study reported dry needling to have a positive effect on pain over control or ‘sham’ treatment as well as various other types of therapies for short time periods - up to 3 months. However, there is no evidence to say FDN is better than other physiotherapy interventions when considering long-term results (6 -12 months). FDN did still prove superior to ‘sham needling’ and control (wait and see if it improves with time) groups in the longer-term studies.The results of this study reflect my experiences in clinical practice. Personally, I have found that if dry needling is going to work for you the results will be apparent in 1 to 3 sessions. You can often notice a positive effect immediately after the treatment. A positive effect would mean decreased pain and increased range of movement within the first few hours or days after treatment. If you do not see a positive change within the first few sessions, then dry needling might not be the treatment technique for you. It is also not the only way to achieve a positive effect. There are other techniques a physiotherapist can use to release a muscle. Though in some cases dry needling can get a muscle released faster. When you consider goals or outcomes over the long term there are always several ways you can successfully get there. So don’t worry if you don’t like dry needling or aren’t comfortable trying it for any reason. If you are interested in trying it, I have found it to work well on acute muscle pain such as: strains from the gym, muscle imbalances, or muscle tension from poor posture just to name a few. I prefer to use this technique on athletic injuries in particular. Currently, I incorporate dry needling into treatment for about 50% of my patients, and I have had very good success overall with the technique. However, dry needling is not for everyone, and is just one tool a physiotherapist can use to obtain the overall goal of improving your movements and getting you back to your favorite activities. Talk to your physiotherapist to learn more about the benefits of dry needling, and see if it right for you.
Amy Fahlman, physiotherapist downtown Ottawa
BSc PT, MCl Sc (manip), FCAMPT
1. 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. J Orthop Sports Phys Ther. Mar;47(3):133-149. doi: 10.2519/jospt.2017.7096. Epub 2017 Feb 3.