Dry needling is an invasive procedure/ technique that physical therapists and other trained healthcare providers use to treat musculoskeletal pain and movement issues. It’s almost always used as part of a larger pain management plan that could include exercise, stretching, massage and other techniques.
Mainly it is used to treat underlying myofascial trigger points.
In the word “myofascial,” “myo” means muscle. Fascia is the thin, white connective tissue wrapped around your muscles; just like a slice of cheese between 2 pieces of breads, one being the muscle and another being the skin. Trigger points are knotted, tender areas that develop in your muscles. These trigger points are highly sensitive and can be painful when touched and associated with a hypersensitive palpable nodule in a taut band. Sometimes, a trigger point may be near the location of your pain. But they’re also often the cause of referred pain. Referred pain is pain that affects another part of your body.
How trigger points affect you? AKA pathophysiology :
- The formation of trigger points is caused by the creation of a taut band within the muscle. This band is caused by excessive acetylcholine release from the motor endplate combined with inhibition of acetylcholine esterase and upregulation of nicotinic acetylcholine receptors.
- Taut bands are produced as protective measure for muscle damage, usually cause in response to eccentric and concentric loading, sustained postures and repetitive low loads.
- Pain caused by trigger points is due to hypoxia and decreased blood flow within the trigger point. This leads to a decreased pH which activates the muscle nociceptors to restore homeostasis.
- They cause muscle weakness, restricted ROM and autonomic phenomena.
How dry needling actually works? AKA mechanism of action:
Dry needling has been shown to immediately increase pressure pain threshold and range of motion, decrease muscle tone, and decrease pain in patients with musculoskeletal conditions. Its suggested mechanisms of action include:
- Elicits local twitch response, helps in altering muscle length and tension in fibers, stimulate beta fibers.
- Dry needling causes vasodilation in the small blood vessels leading to increased muscle blood flow and oxygenation.
- produces local and central nervous responses to restore hemostasis at the site of the trigger point which results in reduction in both central and peripheral sensitization to pain.
- does analgesic effect on proximal MTrP.
Can be used in what cases? AKA indication:
- strains
- OA
- Tendinopathies
- Joints and disks issues
- Migraine
- Whiplash
- Phantom limb pain
- Postherpetic neuralgia
- RSI
Which cases to avoid? AKA Contraindication:
- Pregnant
- Psychological ds
- Who can’t understand
- Afraid of needle
- Compromised immune system
- Recent surgery
- Blood thinner
Potential side effects:
- Heaviness
- soreness
- Bruising at or near the insertion site
- Bleeding at the insertion site
- Fainting
- Fatigue
How it is different from wet needling?
Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue.
Basic principle or elements of clean needle procedure include washing hands between patients, keeping treatment area clean, using sterile needles, immediately isolating used needles.
How it is different from wet needling?
APPLICATION:
