Dry Needling and Physical Therapy

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There has been a lot of buzz surrounding dry needling in the physical therapy world for the past few years. Have you heard of it?  If you haven’t, you’re in luck; I’m going to cover this topic on the blog today. And, even if you have heard about dry needling, chances are you may have received some misinformation about how it works, who is an appropriate candidate, and what the research supports. Let’s jump in.

What is dry needling?

Dry needling is a treatment tool performed by a licensed physical therapist (or a licensed physician, chiropractor, nurse practitioner, or physician assistant) for the treatment of pain and movement impairments. The technique uses a "dry" (as opposed to a wet needle used to inject substances) solid filament needle. The needle is inserted through the skin into areas of the muscle.

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How is dry needling used in physical therapy?

Like most physical therapy interventions, dry needling is simply a tool to help increase range of motion, improve muscle activation, and decrease pain. It is not a cure-all. The primary goal of physical therapy is always to restore proper movement and function for our clients and dry needling can sometimes help us achieve that.

Is dry needling the same thing as acupuncture?

No. The only similarity between dry needling and acupuncture is the solid filament needles that are used. Acupuncture is a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles, it utilizes a functional movement assessment and knowledge of neuroanatomy, and it is supported by medical research.

How does dry needling work?

Dry needling works by inserting the solid filament needle directly into the muscle and applying electrical stimulation to that needle to contract and “reset” the muscle. With normal electrical stimulation, the electrode pad is placed on the skin. However, the skin provides significant resistance for that current and results in a weaker stimulation. Intramusuclar electrical stimulation provides a more significant treatment effect.

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Does dry needling hurt?

The number one question people ask before trying dry needling is, “does it hurt?” Thankfully, the answer is no. When people hear the word “needle”, they often think of getting blood drawn or receiving a flu shot; but the width of solid filament needles used for dry needling is less than a millimeter. People are often pleasantly surprised at the absence of pain. The most common unpleasant sensations that sometimes occur are mild tingling or burning.

Is dry needling safe?

Dry needling is considered a very safe treatment when performed by a certified practitioner. The most common side effects include: mild bruising, fatigue, and soreness. Other less common side effects are headache and dizziness; and very rare side effects (occurring in less than 0.1% of individuals) are pneumothorax when needling over the rib cage or infection.

There are some populations of people who are not candidates for dry needling. These include: those with uncontrolled anticoagulant usage, history of lymph node removal, compromised immune system, or those with an active infection or tumor. Individuals with an acute injury or those recovering from an orthopedic surgery that occurred within the past 12 weeks are also not appropriate for dry needling around the area of injury (for example: wanting to needle lower leg muscles on a newly-sprained ankle or wanting to needle thigh muscles on a recently-replaced knee joint) because the needling could increase the inflammatory response and/or risk of infection.

Does medical research support the use of dry needling?

It’s one thing to share our firsthand experience with dry needling and how it has helped patients in our clinic, but we strive to make sure what we are doing is supported by medical research.

The technique of dry needling as a physical therapy intervention is relatively new in the grand scheme of things. A lot of the studies available have been published within the past decade. There have been several case reports and case series that have shown positive results for dry needling in the treatment of chronic headaches, neck pain, back pain, hip pain, and elbow pain.

There is also some new, exciting research coming out this year on the use of dry needling and electrical stimulation for the treatment of post-stroke spasticity and hemiparesis.

With that being said, there is still quite a bit of research that needs to be done to better examine the best protocol for dry needling in physical therapy. It’s human nature to want to find a “cure-all” and dry needling is not that. The foundation of physical therapy is always going to be to improve physical function with active movement: strengthening, stretching, proper body mechanics. However, dry needling can be a very useful tool in treating certain conditions when used in combination with these basic, yet powerful principles of physical therapy.  

How much does this cost?

At Peak Physical Therapy & Wellness, we charge a flat fee of $45 for a 30 minute dry needling session. This session includes a brief assessment of functional strength and range of motion to make sure the client is a good candidate followed by needling and electrical stimulation to the appropriate area(s). We then recheck the strength and range of motion and provide the client with at least one exercise to reinforce the improvements that were made with the dry needling.

How do I know if dry needling is right for me?

If you are curious as to whether dry needling is right for you, give us a call at 877-791-PEAK or send us an email at laurel@peakptwellness.com and we will gladly answer any questions you may have.  

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References

1.     Gildir S., Tüzün E.H., Eroğlu G., Eker L. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache.  Medicine (Baltimore). 2019 98(8):e14520 doi: 10.1097/MD.0000000000014520.

2.     Mejuto-Vázquez M.J., Salom-Moreno J., Ortega-Santiago R., Truyols-Domínguez S., Fernández-de-Las-Peñas C. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014 Apr;44(4):252-60. doi: 10.2519/jospt.2014.5108. Epub 2014 Feb 25.

3.     Hosseini L., Shariat A., Ghaffari M.S., Honarpishe R., Cleland J.A. The effect of exercise therapy, dry needling, and nonfunctional electrical stimulation on radicular pain: a case report. J Exerc Rehabil. 2018 Oct 31;14(5):864-869. doi: 10.12965/jer.1836356.178. eCollection 2018 Oct.

4.     Rainey C.E. The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report. Int J Sports Phys Ther. 2013 Apr;8(2):145-61.

5.     Mahmoudzadeh A., Rezaeian Z.S., Karimi A., Dommerholt J. The effect of dry needling on the radiating pain in subjects with discogenic low-back pain: A randomized control trial. J Res Med Sci. 2016 Oct 18;21:86. doi: 10.4103/1735-1995.192502. eCollection 2016.

6.     Pavkovich R. EFFECTIVENESS OF DRY NEEDLING, STRETCHING, AND STRENGTHENING TO REDUCE PAIN AND IMPROVE FUNCTION IN SUBJECTS WITH CHRONIC LATERAL HIP AND THIGH PAIN: A RETROSPECTIVE CASE SERIES. Int J Sports Phys Ther. 2015 Aug;10(4):540-51.

7.     Shariat A., Noormohammadpour P., Memari A.H., Ansari N.N., Cleland J.A., Kordi R. Acute effects of one session dry needling on a chronic golfer's elbow disability. J Exerc Rehabil. 2018 Feb 26;14(1):138-142. doi: 10.12965/jer.1836008.004. eCollection 2018 Feb.

8.     Ghaffari M.S., Shariat A., Honarpishe R., Hakakzadeh A., Cleland J.A., Haghighi S., Seif-Barghi T. Concurrent Effects of Dry Needling and Electrical Stimulation in the Management of Upper Extremity Hemiparesis. J Acupunct Meridian Stud. 2019 Apr 23. pii: S2005-2901(18)30147-X. doi: 10.1016/j.jams.2019.04.004.

9.     Ansari N.N., Naghdi S., Fakhari Z., Radinmehr H., Hasson S. Dry needling for the treatment of poststroke muscle spasticity: a prospective case report. NeuroRehabilitation. 2015;36(1):61-5. doi: 10.3233/NRE-141192.

10.  Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Mar;47(3):133-149. doi: 10.2519/jospt.2017.7096. Epub 2017 Feb 3.

11.  Dunning J., Butts R., Mourad F., Young I., Flannagan S., Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014 Aug;19(4):252-265.

 

alexandra miller