Written by: Jordan Coffey (Physiotherapist)
I am sure many of you have heard of the terms “dry needling” and “acupuncture”, but are unfamiliar with the intricacies of these treatment modalities.
Acupuncture is derived from ancient Chinese Medicine and was coined the term “Oriental Medicine” through oversight and licensure boards. This procedure is widely used in Asian medical practices even today and has been widely practiced for over 4,000 years. Traditionally, up to 20-30 needles were used!
While acupuncture and dry needling both incorporate usage of a “hair-line” thin needle to target different tissues, the location of insertion of the needle and desired treatment response differs. Acupuncture draws on principles to correct blood flow or “chi” and bring it back into balance. This is achieved by inserting needles into specific points throughout the body and redirecting blood flow along correct meridian lines. Acupuncture is used mainly to, although not limited to, treat systemic pathologies.
Image 1: 12 Acupuncture meridians based on internal organ.
Dry needling is a more recently evolving practice, rooted in the work of Janet Travell’s Mysofascial Trigger Point Release practices and Chan Gunn’s Intramuscular Stimulation (IMS) practices. Basic dry needling practices involves insertion of a thin needle to stimulate trigger points in the tissue, which include muscles, tendons, ligaments, or joints. The needle is inserted to illicit a therapeutic effect. The needles are inserted into trigger points, which are defined as “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is tender when pressed, can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomenon” (2) Travell et al. 1983. These trigger points can become focal areas of pain and tenderness and may impact the way we move our muscle as a whole. It is termed “dry” needling to differentiate from using a “wet” needle to inject fluid within the tissue, such as an analgesic or corticosteroid. Dry needling is a time-efficient, cost-effective, successful, and safe treatment modality widely utilized by physiotherapists worldwide and right here at 4Lane Physiotherapy!
Image 2: Trigger point complex – which you can see the taunt band within the muscle fibres.
In the (2) Lewit 1979 study, 312 patients treated chronic pain sites using dry needling found immediate hypoesthesia, or reduction of sensory stimuli and in this case painful stimuli, in 86.8% of the total study population. Relief duration was:
- Permanent in 32%
- Several months in 20%
- Several weeks in 22%
In total, several weeks or longer of pain relief was achieved by 74% of chronic clients with a single session of dry needling in this particular study. There is a pathophysiological triple tier effect for dry needling which is broken up into local, segmental, and extra segmental subcategories.
- Increased nutritive blood flow to deep tissues through vasodilation and modulation of immune responses
- Chemical milieu changes which result in elevated levels of neuropeptides and a “flushing” out response of pro-inflammatory chemicals and chemical substances contributing to pain
- Neutralizes the pH of the tissue penetrated
- Endogenous opioid peptide release and activation of larger mechanoreceptors (Aβ) which help to dampen pain signals
- Dampening effect of descending inhibitory pain systems
- Increase in serotonin re-uptake
- Anti-inflammatory effect
Simply put, dry needling can help to control inflammation, increase blood flow to local tissues, reduce pain input from local trigger points, reverse sensitivity to pain, activate opioids-based pain reduction, and inhibit painful neural pathways. It is a great adjunctive treatment to be used in conjunction with other treatment modalities, such as hands-on treatment for pain relief, reassurance, education, and catered exercise prescription.
Image 3: Insertion of the thin “hair-line” needle into muscle tissues to treat common musculoskeletal conditions.
Dry needling is used to treat musculoskeletal conditions such as:
- Shoulder impingement
- Neck pain
- Tennis Elbow
- Carpal Tunnel Syndrome
- Acute low back pain
- Knee pain
- Plantar Fasciitis
- Ligament pain or dysfunction
What are the risks involved in dry needling?
In a small percentage of patients (roughly 1-3%) post-treatment fatigue or drowsiness may occur. Minor bruising or bleeding may occur in certain patients’ post-treatment (roughly 15-20%) and this is considered normal.
If you are suffering from an acute of chronic musculoskeletal injury please call # 08 9756 7424 or visit us online at www.4lane.com.au to book in for an initial assessment, hands-on treatment for pain relief, reassurance, advice, a catered home exercise program, and if indicated – some dry needing! J
(1) Lewit K. The needle effect in the relief of myofascial pain. Pain 6: 83-90, 1979.
(2) Travell JG and Simon DG. Myofascial pain and dysfunction; the trigger point manual (vol 1). Baltimore: Williams & Wilkins, 1983.