I recently became among the first physical therapists trained and certified in the State of Wisconsin to provide dry needling to our clients. Dry needling is an exciting new addition to our treatment services that has allowed me to facilitate some rapid and lasting positive changes with our patients as an extension of the manual treatment we have provided in the past.
In 2009, the Wisconsin Physical Therapy Examining Board approved dry needling as falling within the scope of practice of licensed physical therapists that have had organized training. I was trained by Jan Dommerholt, a Dutch-trained physical therapist who is a pioneer in the United States in the use of dry needling, as well as an expert in myofascial pain. Training consisted of over 150 hours of practical instruction followed by a comprehensive written and practical exam.
What is dry needling?
Dry needling technique (DNT), also known as intramuscular stimulation (IMS), uses very small diameter solid filament needles carefully inserted into trigger point areas of painful muscles and connective tissue fascia resulting in rapid and often long-lasting pain relief. Trigger points are taut bands palpated within muscles and surrounding fascia that cause local pain or refer pain to more distant locations. These taut bands restrict pain-free mobility and limit muscle function as well as smooth coordinated movement. As soon as I learned about it and started incorporating it into my manual therapy practice, I realized that it was a wonderful adjunct (by no means, a replacement) to the work I already do with more specificity, and quick results.
How does it work?
Stimulation of trigger points with the needle causes a brief twitch response in the muscle (a small, quick contraction) resulting in a softening of the taut band and an immediate decrease in the sensitivity of the trigger point. Research indicates that this happens from mechanisms that change the sensory message of pain from both a mechanical and biochemical standpoint at the trigger point as well as within the central nervous system. The motor response from the central nervous system is then inhibited and there is a relaxation of the muscle contraction or taut band. In using this method, I first feel, localize and start treating restrictions or knots within muscles and fascia with methods of soft tissue mobilization and myofascial release. As I find areas that are more tender and perhaps not changing quickly, I will apply the needling techniques specifically to these areas, and then continue with further manual tissue mobilization. After creating more mobility I follow up the manual work with stretching, movement training, and strengthening both with my hands on the patient, as well as training and instructing exercises that will enhance the improvement further.
Is this like acupuncture?
The only similarity to acupuncture is that both dry needling and acupuncture use the same tool, a small diameter, solid filament needle. Acupuncture can be a useful treatment modality for many conditions, however, it is a discipline (applied by a trained, licensed acupuncturist) that is part of an entirely different paradigm of Oriental or Eastern medicine. Dry needling is more aligned with Western medicine and extends from models of functional anatomy and soft tissue mobilization, myofascial release, and trigger point therapy.
Why is it called “dry” needling?
Some pain specialists use a larger diameter hypodermic needle to inject substances such as anesthetic, corticosteroids, saline, or Botox into similar trigger points within muscles. This can be helpful, but the needles are larger diameter as they house a hollow tube for passage of the medication, and at their tip they are more of a cutting tool which can cause some local tissue trauma. In searching for the best material to have a positive effect on trigger points, researchers have found that it is not so much the substance, but the needle itself that causes the change. Therefore, it has been well tested and shown that a smaller diameter acupuncture-type needle that is “dry” (ie, no substance injected) is most effective.
What type of conditions can be treated?
Any pain of orthopedic or musculoskeletal origin can benefit from having needling as part of the treatment. Diagnosis examples are listed below. Some of these problems are more from joint issues than muscle, but surrounding muscles will be loaded with trigger points that are often causing or a result of the problem and contributing to pain and movement inefficiency:
- Back and Neck Pain
- Temporomandibular Joint (TMJ) Dysfunction
- Pinched Nerves
- Herniated Discs
- Sacroiliac Dysfunction
- Rotator Cuff Tendinitis and Tears
- Shoulder Impingement Syndrome
- Adhesive Capsulitis (Frozen Shoulder)
- Lateral Epicondylitis (Tennis Elbow)
- Medial Epicondylitis (Golfer’s or Pitchers Elbow)
- Carpal Tunnel Syndrome
- General arm or leg pain, tingling, and numbness
- Chronic or Acute Muscle Strains
- Many types of knee or shin pain in runners and other athletes
- Achilles Tendonitis
- Plantar Fasciitis (Heel Pain)
Don’t hesitate to call, email, or schedule an appointment to see if this modality can help you and relieve pain suffered from any of the above conditions.