Dry Needling

Dry Needling is a hands-on approach to treat Myofascial Pain and Dysfunction. A variety of manual techniques are used during Chiropractic treatments to inactivate myofascial trigger points, and to restore normal muscle tones, muscle length, coordination, function, strength, as well as skeletal and spinal alignment. All skeletal muscles anywhere in the body can be treated this way.

What Is a Trigger Point?

A myofascial trigger point is a hyper-irritable spot in a muscle which is located in a taut (tight) band and is painful to touch. This hypersensitive spot or nodule (the “knot”) can give characteristic referred pain, referred tenderness and other referred symptoms in areas other than where the muscle is located. (Travel and Simons in Myofascial Pain and Dysfunction: The Trigger Point Manual). Janet Travell, MD first described the existence of trigger points in the 1940’s.

Treatment of Myofascial Trigger Points

There are several ways to treat myofascial trigger points. Travell and Simons note that trigger points can be treated by ischemic compression, with spray and stretch, injection with local anesthetic (trigger point injections) and with dry needling. Chiropractic manipulative therapy has also been shown to reduce myofascial trigger points.

What is Dry Needling?

Dry Needling is a valuable, effective and efficient adjunct treatment for myofascial trigger points. It is an invasive procedure in which a thin solid filament sterile needle is used. Dry Needling involves insertion and sometimes repetitive manipulation of the needle within the myofascial trigger point. The purpose of this technique is to reduce or resolve myofascial trigger points. No medication of any kind is injected.

Reduction of trigger points can bring immediate relief of symptoms but usually takes repetitive treatment.

The advantages of dry needling over other treatments are that we can treat parts of the muscle, and deeper layers of muscles, which our hands and fingers cannot reach. In addition, there are no drugs used so we can treat many trigger points during each treatment.

Thus, results are achieved with dry needling which cannot be obtained with any other treatment.

Dry Needling is an invasive procedure and should be performed only by those clinicians who have taken additional study and course work in this topic and who are qualified to perform this treatment. At this time, there are only a few Chiropractic Physicians certified in Dry Needling therapy.

Dry Needling must not be confused with any type of acupuncture. Whereas acupuncture is founded on traditional Chinese Medicine, Dry Needling is based on Western anatomical and physiological principles. It is founded by scientific concepts and it continues to evolve using the latest research.

Dry Needling, combined Chiropractic Adjustments and other manual or mechanical therapy treatment, can help the following conditions:

• Acute and chronic tendonitis
• Athletic and sports-related overuse injuries
• Post-surgical pain
• Post-traumatic injuries, motor vehicle accidents, and work related injuries
• Chronic pain conditions
• Headaches and whiplash
• Lower back pain
• Frozen Shoulder
• Tennis Elbow
• Muscle Spasms
• Fibromyalgia
• Sciatic Pain
• Hip Pain & Knee Pain
• Repetitive Strain Injuries
• TMJ
• Carpal Tunnel Syndrome
• Other neuromusculoskeletal conditions

Dry Needling Treatment Approach

Dry Needling is never a treatment by itself. It is always done in conjunction with other therapy such as Chiropractic Adjustments, exercises, postural training, therapeutic ultrasound, electrical muscle stimulation, therapeutic laser therapy, vaso pneumatic therapy, and kinesio taping. It is important that you are an active participant in your own treatments and well being. Therefore you must follow through with any home exercise or therapy regiments that are recommended.

Typically, we will use Dry Needling once a week to inactivate the trigger points and you will have one or two more treatments that week to work on other aspects of your condition. There is no specific, predetermined number of treatments for patients with myofascial pain. Chronic conditions will require more treatments than acute conditions. In addition, the amount of treatments will also depend on concurrent other medical conditions, your compliance with the exercises, your age and physical condition, and on the amount of visits ordered by your physician and approved by your insurance company. Insurance does not always cover this type of therapy.

How Does It Work?

One effect of Dry Needling is that it produces a local twitch response. This results in muscle relaxation due to the release of shortened bands of muscle fibers. Other effects of dry needling are localized bleeding/micro damage that results in inflammation and histamine release which is the first step in stimulating the body's healing process. Another byproduct of Dry Needling is the production of natural endorphins that are natural pain relievers produced by the body and platelet derived growth factors that aid in healing.

Side Effects

Dry Needling may cause a temporary increase in pain which can last from a couple of hours to several days, followed by an expected improvement in the condition being treated.

Complications

Like any medical procedure, there are possible complications. While these complications are uncommon, they do sometimes occur and must be considered prior to giving consent to the procedure.

1. Any time a needle is used there is a risk of infection. However with the use of disposable sterile needles infections are extremely rare.
2. A needle may be placed inadvertently in an artery or vein. If an artery or vein is punctured with the needle, a hematoma (or bruise) will develop.
3. If a nerve is touched, it may cause paresthesia (a prickling sensation) which is usually brief, but it may continue for a couple of days.
4. When a needle is placed close to the chest wall, there is a rare possibility of a pneumothorax (air in the chest cavity).

Before the Treatment

Prior to the treatment, a history will be taken and a thorough physical therapy examination will be performed. Patients need to inform us if they have conditions such as pregnancy, if they have implanted devices like a pacemaker, a bone stimulator or other electrical stimulators, and if they use medications like blood thinners or immunosuppressants.

During the Treatment

A gown is provided for female patients and shorts are available as well for any patient. However, for a proper and thorough examination and treatment the gown may be opened up from the back or it may be partially moved by the practitioner. Care will always be taken to respect your privacy.

You will be in a comfortable position; usually lying on your stomach or on your back. When the needle is inserted you may feel a little prick though the skin. Following this, you will not feel the needle at all when the muscle is relaxed. If the muscle is tight, there is some soreness. When the needle hits the trigger point, there will be a local twitch response. This twitch response is very brief and unexpected. It can be momentarily painful. During your visit, multiple trigger points in several areas will be treated.

After the Treatment the treated areas might be sore. This is a muscular soreness (see “Side Effects”). Therefore, modalities to decrease muscle pain will be helpful: heat and stretching.