Dry Needling

The differences between dry needling and acupuncture are many, so I’ll start with the similarities, it’s a much shorter list:

Both treatments use the same acupuncture needles…that’s pretty much it.

Is dry needling the westernised version of acupuncture?

Surprisingly no, it’s not.

It was used by physicians as early as the 1920’s. In the 1940’s (Travell and Simons) authored the ‘trigger point manual’ and dry needling became more widespread in the late 1970’s. It initially began as ‘wet needling’ where substances such as saline, steroids and pain killers were injected into muscular trigger points but later on it was discovered that it was the needling, rather than any substance, that was effective in treating musculoskeletal pain.

It is a minimally invasive treatment, but one that carries with it a low risk. I first had dry needling for my tennis elbow (lateral epicondylitis) last year and I was surprised at its effectiveness.

What can it do?

Muscles: Reduce musculoskeletal pain by targeting the trigger points (knots)  in the muscle; these are small palpable hypersensitive area within the bands of the muscle. It aids the removal of (noxious) substances that aggravate the local peripheral nerves and can increase local pain thresholds. Trigger points in muscles account for a high proportion of musculoskeletal pain, some studies have found up to 85%.

Tendons: By creating small holes in the tendon (fenestrations) the degeneration of that tendon is disrupted, and a healing response is promoted (fibroblast proliferation) which leads to improved collogen formation and healing of the tendon.

Fascia: Facia runs under our skin, around, and inside our muscles and stretches from our toes to the tops of our heads. It’s not just muscles which transmit force through the body, the fascia takes about 40% of the load. The thoracolumbar fascia, which is found in the lower lumbar area (see picture, it looks like a white diamond) has three times as many nociceptors (nerves that solely relay pain to the dorsal horn in the spine) as muscles in the back. Dry needling has a substantial effect on myofascial pain modulation.

What happens when the needles go in?

Apart from a small prick, it’s quite painless, but what I’m trying to elicit is something called a ‘twitch response’ and leads a decrease in local chemicals and a ‘reflex relaxation’ in the muscle. The local muscle fibres become depolarised. This decreases electrical activity in the muscle which is a good thing. Muscles can be afflicted with ‘spontaneous electrical activity’ which dry needling studies have demonstrated they can supress.

Blood flow is increased, which is good news for the trigger point which has been a but starved of decent blood supply and therefore oxygenation. By increasing the blood flow, substances that open up and relax blood vessels (vasodilators) are released relaxing the surrounding tissue

Science has not yet confirmed the underlying method by which dry needling provides pain relief but there are sound theories.  Researchers widely believe that dry needling activates something called the Endogenous Opioid System (also known as descending inhibition). Yes, the body CAN produce its own opioids such as enkephalin and β-endorphin pain and stress reducing chemicals) which modulate pain signals going up (from the spinal cord to the brain) and it can modulate the response to those signals on the way back down as well, hence the descending bit. Acupuncture literature also strongly suggests this to be involved.

Other theories include an increased tolerance to pain thresholds and increases in neurotransmitters such as noradrenaline and serotonin. There is also the possibility of a placebo effect. Science cannot rule this out entirely. Whatever the reason for its success, science can at least agree its complex.

Possible side effects

  • Fainting is a possible side effect so, just as a precaution, you’re always lying down.
  • Soreness afterwards and perhaps even delayed onset muscle soreness (DOMS).
  • Its possible that a little bleeding happens on the surface or below the skin, so you may notice a subsequent small bruise.
  • Fatigue and dizziness.
  • Pneumothorax – a puncture of the pleura, the sac around the lungs. Caution is used when dry needling in the area around the thorax.

Multiple studies and systematic reviews have concluded that it is an effective treatment compared to no treatment at all, is good in conjunction with other therapies and carries a low risk.

Dry needling isn’t a magical cure-all, it won’t make a weak muscle suddenly strong again, but in combination with physical therapy and rehabilitation it can be a very useful adjunct.

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