Tell Me More About Dry Needling
Dry Needling is a trending topic right now, especially in light of the current opioid epidemic. It has become particularly popular due to it's immediate effects, low risk factors, and conservative nature.
Dry Needling is the insertion of a very thin needle into skin and myofascial tissue. The technique is considered "dry" because there is no exchange of fluids. In other words, no medication is injected into the body and no bodily fluids are removed. For this reason, the gauge or thickness of the needle can be much smaller than that of a standard injection needle.
The main goal of dry needling relates to trigger points or "knots." There are two types of trigger points: active and latent. Active trigger points are hyper-irritable taut bands of muscle tissue which have chemically different compositions than latent trigger points. Due to this difference, active trigger points have a lower threshold of activation meaning less activity or stimulus is required for the active trigger point to send signals to the brain alarming of threat. This can be one reason why doing something that was once pain-free such as reaching behind your back now induces pain. Your pain threshold has decreased locally. Latent trigger points, on the other hand, are present as palpable tightness but do not have that same over-excitability and thus pain-inducing component. (Shah & Gilliams, 2008)
Here's an analogy to describe this phenomenon. Children are great examples because they are predictably excitable (and cute!). You have two children, Ashley and Laurie. They are chasing each other around the playground at your local park. Laurie trips and falls, but because she just had her favorite snack and slept through the night, she jumps up and continues running, unscathed. Ashley also falls to the same extent while running. She missed her afternoon snack and was up all night with nightmares. Because Ashley's conditions already had her at a disadvantage, her threshold for being more sensitive to the fall is lower. She then cries and must be consoled.
Ashley in the scenario above represents the active trigger point. Although the same fall affected both girls, Ashley's temporary conditions encouraged her to be triggered more easily, exactly the same as an active trigger point which has more nerve-exciting conditions. Dry Needling has been shown to alter that chemical environment of active trigger points, making them more similar to the higher threshold (and lower activation) state of latent trigger points. (Dommerholt 2011)
Dry needling can be performed for several conditions, including, but not limited to, muscle spasm, muscle strains, tendinitis, tendinosis, overuse injuries, and headaches. St. Joseph's University Medical Center in Paterson, NJ frequently uses Dry Needling in the Emergency Department and reported a decrease in opioid prescriptions by 58% in one year, as reported on NPR's All Things Considered this past week.
The Journal of Orthopaedic & Sports Physical Therapy has a great one-page perspective on Dry Needling for further reading. The technique can be performed by physical therapists, physicians, and chiropractors who complete the required coursework and credentialing. Dry Needling is not a technique that is taught in generic graduate programs. For more information, please consider the references below or ask your practicing physical therapist.
Shah & Gilliams. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal Bodywork & Movement Therapies. 2008;12:371-384.
Dommerholt J. Dry needling — peripheral and central considerations. J Man Manip Ther. 2011;19(4):223-227.
Wang H. ER Reduces Opioid Use By More Than Half With Dry Needles, Laughing Gas. All Things Considered. 2018.
Teyhen et al. Painful and Tender Muscles Dry Needling Can Reduce Myofascial Pain Related to Trigger Points. J Orthop Sports Phys Ther. 2013;43(9):635.
