Indications and Treatment

Dry Needling

Teresa Bristol, PT, Cert. DN, DPT

How it Works

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Dry needling has been defined in narrow and incomplete perspectives to broad and comprehensive terms by varying sources.1 Dry needling in a broader view is defined as the insertion of monofilament needles without injectate into muscles, tendons, trigger points, fascia as well are around neurovascular tissue.  Acupuncture on the other hand is a derivative of Chinese medicine that dates back over 3,000 years.   Acupuncture is based on the theory that health is determined by the balance flow of chi, which is present in all living organisms. According to acupuncture theory, chi circulates through the body along twelve major pathways called Meridians.2 These pathways are used to target specific internal organs.  Acupuncture is performed through the insertion of needles along Meridians to bring about desired effects.3 In some literature you will see acupuncture and dry needling used interchangeable as some principles from both Chinese medicine and modern approaches are combined.4

The insertion of dry needles into connective tissue and neurovascular bundles have been proven to be effective in relieving pain and disability in a variety of conditions including low back pain, knee osteoarthritis, carpal tunnel syndrome, shoulder and cervical pain as well as plantar fasciitis to name a few.1, 5 There are chemical and vascular effects that cause increase in circulation and aid improving pain and disability.1

Theories

There are different theories explaining how this works including Melzacks6, 7 gait theory that proposes that the insertion of needles causes increased input to the central mechanism and thus causes the gait to pain to close. Hong8 later proposed that dry needling into trigger points with a local twitch response causes a break in the pain cycle. A randomized clinical trial (RCT) was performed by Itoh et al.5 comparing treatment with acupuncture between three groups: 1) standard acupuncture 2) superficial dry needling 3) deep dry needling. The three groups received treatment over the course of twelve weeks. The standard acupuncture group received treatment that included the insertion of needles into standard points in the lumbar region and lower extremity with sparrow pecking (inserting and partial retraction the needles numerous times) to elicit a dull pain (de qi). Then the needles were retained in the skin for ten additional minutes. The superficial and deep needling groups received similar treatment, but the needles were inserted in trigger points (instead of standard method) and a local twitch response (involuntary muscle contraction) was elicited. Superficial needle penetration was three millimeters and deep needling was twenty-three millimeters (mm). A de qi response was also elicited followed by ten additional minutes of needle retention.

Research

The visual analogue scale and the Roland Morris Questionnaire were used as primary outcome measures.  Twenty-seven subjects completed the specified treatment.  The deep needling group showed significant improvements in pain and disability at three weeks of treatment.  This group also displayed progressive reduction in pain over the remaining course of treatment, although not a statistically significant difference.  No significant difference was found in any of the outcome measures in the standard acupuncture group and the superficial dry needling group.

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This article published by Itoh5 provides some information that may be beneficial in selecting the type of dry needling noted with the improvements in short-term relief in pain and improved disability with trigger point deep needling.

 PT Works - Pediatric Therapist - Pediatric Physical Therapy - Pediatrician

Another systematic review exploring the efficacy of dry needling in short-term pain relief in subjects with knee osteoarthritis revealed a statistically significant improvement.1 This was substantiated in a study published by Witt et.9 Al in 2006. A RCT was performed on a control group of 355, and acupuncture group consisting of 357 subjects. The purpose of this study was to determine whether acupuncture was effective in treating patients with knee osteoarthritis in comparison to control group. The subjects in the acupuncture group receive up to 15 treatment sessions within the first 3 months of initiation of care. The control group did not receive any acupuncture with this period. Only manual needle insertions were allowed and no other approaches were utilized. The outcomes of this study revealed a significant improvement in pain as well as functional outcomes in the treatment group who received acupuncture.

Believer

Initially I was very skeptical about this treatment approach.  However after research, trial and completing some amazing courses, I am amazed at how great it works as an adjunct to traditional physical therapy.  Have you received similar treatment?  What were your outcomes?  If not are you willing to try it?  If not why?

References

  1. Dunning J, Butts R, Mourad F, et al. Dry needling: a literatur review with implications for clinical practice guidelines. Physical Therapy Reviews. 2013;000(000):1-13.
  2. All About Acupunture. 2015.
  3. Acupunture, A Brief Introduction. 1996-2014.
  4. Itoh K KY, Kitakoji H. Trigger point acupunture treatment of chronic low back pain in elderly patients-a blinded RCT. Acupuncture in Medicine. 2004;22(4):17-177.
  5. Itoh K, Katsumi Y, Kitakoji H. Trigger point acupunture treatment of chronic low back pain in elderly patients-a blinded RCT. Acupuncture in Medicine. 2004;22(4):17-177.
  6. Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain. 1977;3(1):3-23.
  7. O’Sullivan S, Schmitz T, Cohen L. Chronic Pain. Physical Rehabilitation. Philadelphia: F.A. Davis Company 2007:1117-1139.
  8. Hong CZ. Treatment of myofascial pain syndrome. Current pain and headache reports. 2006;10(5):345-349.
  9. Witt Claudia JS, Brinkhaus Benno, Liecker Bodo, Wegscheider Karl, Willich Stefan. Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm. Arthritis & Rheumatism. 2006;54(11):3485-3493.

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