Before you start reading this article, do me a favor: reach up into the side of your neck and poke around a bit in the muscle (this is your upper trapezius muscle). Do you have neck tightness or tenderness from your desk job or from last weekend’s activity? Can you find a nodule in the muscles that is tender and painful when you touch it?
If so, this is called an active myofascial trigger point. Active trigger points are associated with pain and may contribute to stiffness that restricts the range of motion in joints.
What’s all the hype about Dry Needling??
First off, it’s very different from acupuncture. The only similarity between dry needling and acupuncture is the use of a small monofilament needle. The goals of acupuncture are to realign the patient’s chi and meridians and the needle depth is only to the level of the skin.
In contrast, the goals of dry needling are to increase blood flow, flush out harmful substances gathered in an area, and most importantly, provide a “neurophysiological reset” to increase muscle activation ability. The needle goes directly into a tight muscle belly, below the level of the skin, to achieve these goals.
The science behind Dry Needling
Scientific evidence has shown that active trigger points (such as those that hang out in the upper trap next to your neck) have elevated levels of biochemicals associated with pain and inflammation, such as protons (higher acidity), bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukins, and norepinephrine.
Research has also shown that after dry needling is performed, there are measurable decreases in some of these substances, which correlates with a decrease in pain and local tenderness.
The goal of Dry Needling
When physical therapists dry needle, they are trying to get a twitch response out of the muscle. This means that the muscle will contract and relax with insertion of the dry needle into an active trigger point. This twitch response allows for an increase in blood flow to the muscle which flushes out harmful substances.
Once the muscle has an increase in blood flow and these substances have decreased, the ability of this muscle to fire and activate improves drastically. For me, the improvement of muscle activation is the biggest goal of dry needling.
How Dry Needling resets muscles after injury
Oftentimes during injury, our stabilizing musculature gets shut down and inhibited which contributes to the continued pain cycle. Dry needling allows us to give an internal stimulus to these muscles to wake them up and get them firing again. Dry needling should always be followed up with the prescription of corrective exercises to promote continued activation of the targeted muscle.
What can Dry Needling treat and what to expect?
Dry needling is a great technique because it allows us to treat a variety of different structures, including: muscles, ligaments, tendons, joints, and nerves. Some of the most common injuries that respond well to dry needling are tennis/golfers elbow, low back pain, achilles tendinopathy, neck pain and headaches, and generalized joint pain such as shoulder or knee pain.
When being dry needled, it’s normal to have a deep ache feeling in the muscle being treated. You may also feel this muscle twitch in response to the needle. Everyone is different, and some patients get off the treatment table immediately feeling better. For others, it’s harder to gauge the response immediately following treatment and they notice relief over the next 24-48 hours. Muscle soreness after dry needling is normal for 24-48 hours and you can resume your normal daily activities after treatment.
Dry Needling and low back pain
Since low back pain is one of the most common diagnoses seen in physical therapy, let’s discuss the implications of dry needling in this area in more detail. Dry needling can be very successful in decreasing pain in the low back because it allows the therapist to target several different structures. The paraspinal and multifidus muscles are penetrated by the needle initiating the neurophysiological effects mentioned earlier in the “Science” section of this article.
This is why back pain related to muscle strain or tightness responds well to the dry needling technique. Another structure that can generate pain in the spine is facet or zygapophyseal joints. These are the joints formed as vertebrae stack on top of one another and allow for flexion, extension, and rotational range of motion in the spine.
Facet joints receive sensory innervation from the nerve root that exits through that joint. If this joint becomes inflamed, this sensory nerve can become hyperirritable and contribute to lasting pain. Dry needling increases blood flow to flush out inflammatory mediators and allows a “reset” to the sensory nerve at this joint. In cases of sciatica or radiculopathy, dry needling at the level of the involved spinal nerve root causes these same effects to calm nerve irritation. This leads to a decrease in pain levels and inflammation in the spine as well as activation of deep spinal stabilizer muscles.
Can Dry Needling help me?
While dry needling is not an appropriate treatment option for everyone, it is effective in treating a variety of different orthopedic conditions. While other treatment options such as massage, joint manipulation, and myofascial release focus on an external treatment of anatomic structures, dry needling allows us to give an internal stimulus to this system.
Dry needling can be used for acute and chronic pain alike. So whether you have a new injury that has popped up or chronic pain that has been bothering you for years, ask your physical therapist about dry needling!