Dry needling - Voodoo medicine or a legitimate treatment option?

Dry needling is a Westernised form of traditional acupuncture. It's become a common treatment modality for many Sports Physiotherapists for sports and musculoskeletal injuries.

 

The questions I get asked most often are, 1. "What is the difference between Dry Needling and acupuncture?", and 2. "How does dry needling work?"


So, to go into some detail now. 

"What is the difference between Dry Needling and Acupuncture?"

Here is the explanation I normally give around this: Acupuncture is the traditional form of using needles, based around Chinese Medicine techniques and treating internal problems with external techniques.  It has been around for ~2200 years and treats along meridians, and is focused around restoring energy imbalances. It often aims to restore 'Yin and Yang' (balance, for lack of a better explanation), and 'Qi' ('Vital Energy' is probably the closest Western analogy).

I certainly don't claim to have a thorough understanding of Chinese Medicine concepts! I suspect to learn it it may actually be easier to NOT come from a Western medicine background. 

It's worth noting that to call yourself an acupuncturist there are quite strict regulations around this (at least in Australia). You have to have formal qualifications in acupuncture (several years of training really) and be registered with the Chinese Medicine Registration Board. There are very few Sports Physios in Victoria that have formal acupuncture qualifications as well (although there are a few!)

Dry Needling is a Western concept originating in the 1970s in the USA. It generally treats on a more anatomical model, and in a nutshell, treats things that are tight or painful, including 'motor points' or 'trigger points'. Perhaps putting it that briefly makes the concept sound more basic than it is, but it's a good single line summary.


The needles used for both Traditional Chinese Medicine and Dry Needling are the same. The needles are VERY thin - 0.20 to 0.30mm wide and anywhere from 3 to 70mm long (30-50mm most commonly). Yes the treatment can hurt - and leave you feeling a bit bruised for a few days, but the risks of side effects with this with appropriate training are very very low.


"How does Dry needling work?"

There are two main methods that I think dry needling works. Part of my Post Graduate studies in Sports Physiotherapy required writing an assignment on the research surrounding this and I have reproduced some of this below.

1. Principles of Trigger Point therapy

Muscle Trigger Points (effectively 'tight' areas within a muscle)  activate muscle nociceptive fibres that can initiate motor and sensory changes in the peripheral and central nervous system (Shah & Gillams, 2008).  This can manifest as characteristic referred pain or tenderness, autonomic phenomena (Simons, Travell & Simons, 1999), weakness and ROM restriction (Dommerholt et al., 2006).

Dry needling may treat the Trigger Points by:

  • Assisting to restoring the normal chemical environment within the previously abnormal area (Shah & Gillams, 2008).
  • Mechanical disruption of TP “contraction knots” (Simons et al., 1999).
  • Needling may damage or destroy motor endplates and cause distal axon denervation (Dommerholt et al., 2006).

Effectively dry needling can be used to regain the normal 'tone' and function of muscles or connective tissue (fascia). Conditions that I commonly use this for (with some anecdotal success) include

  • ITB syndrome and patellofemoral (kneecap) pain
  • symptoms similar to exertional compartment syndrome (e.g. calf)
  • gluteal pain (especially if unresponsive to massage etc).

2. Pain modulation

Dry needling can change pain experience or perception, so it can be used for issues where pain is the main problem and other treatment options are limited. I've used this with conditions such as acute tennis elbow, or a flare up of an arthritic knee.

We think this works by introducing a second painful stimulus (that's the needles!) and this stimulates a certain type of nerve fibre (A-delta) which can stimulate the release of natural pain suppressors. The effects of this last for up to 72 hours (Baldry, 2001).


So, I hope that gives some explanation about the myths and truths about dry needling. It's a good treatment option in my opinion, but always in adjunct with other treatments and appropriate advice.


(cover image thanks to physiologic.com.au)