Dry needling is a therapeutic technique that uses small, sterile monofilament needles to relieve muscle tension and pain. The therapy uses a “dry” needle, free of substances or medications, to stimulate and release myofascial trigger points (MTPs), or “knots” in the tendons and muscles. These knots are characterized by tenderness, referred pain and muscle dysfunction.
Dry needling is also sometimes referred to as intramuscular stimulation (IMS) or myofascial trigger point therapy (“myo” = muscle, “fascial” = connective tissue). Trigger points develop from overuse or direct trauma to our muscles, and along with causing pain can also weaken muscles and decrease our range of motion.
The incidence of trigger point pain appears to be very high, with studies in the US. indicating it as the main source of pain in 30-85% of subjects in primary care or pain clinics.
The exact mechanism of how dry needling works isn’t completely clear, but it appears to inhibit pain signals to the brain, along with stimulating the release of our body’s own pain relieving chemicals. Releasing trigger points allows the muscle to return to its normal resting length and helps restore proper strength and function.
Dry Needling vs. Acupuncture
While dry needling is usually performed with acupuncture needles, the theory and technique differ. Acupuncture is an ancient technique that originated thousands of years ago in China. It’s based on the theory that our body contains channels or “meridians” in which energy or “Qi” flows through, and blockages in these channels can result in pain or other health disorders. Acupuncture needles are placed at specific locations to help relieve these blockages and restore the normal flow of Qi.
Dry needling is based on Western Medicine and our current understanding of anatomy and neurophysiology. Rather than inserting needles into acupuncture points, the needles are directed into trigger points in muscles that are known to be associated with specific pain patterns.
Dry Needling For Hip Pain
Hip pain, known medically as greater trochanteric pain syndrome, is a condition resulting in chronic pain and tenderness at the outside of the hip. It’s commonly thought to be due to bursitis, or inflammation of the bursa (a fluid filled sac) on the side of the hip.
Conventional treatment for bursitis consists of injections of corticosteroids into the area to relieve inflammation. However, recent research points to the role of trigger points in the muscles around the hip as the underlying cause.
A recent study published in Journal of Orthopaedic & Sports Physical Therapy compared the effects of dry needling and corticosteroid injections for greater trochanteric pain syndrome, and found that dry needling was just as effective. Another small study showed that 4-8, 60-minute-long dry needling sessions was effective at reducing pain and disability in those with chronic hip and thigh pain. The subjects also reported improvements in sleep and functional mobility.
Dry Needling For Plantar Fasciitis
One of the most common foot-related problems, especially among older adults, is plantar fasciitis. The plantar fascia is a ligament that connects your heel bone to your toes and supports your foot’s arch. Symptoms of plantar fasciitis include irritated or inflamed ligaments which result in pain near the heel. Although plantar fasciitis is a relatively common condition, there’s no clear consensus on the best form of treatment, though exercises to strengthen the feet can help.
A small randomized controlled trial recently examined the effectiveness of dry needling for plantar fasciitis, finding that trigger point dry needling “can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis.” For the trial, 20 participants were divided into two groups. One group received dry needling once a week for 4 weeks; the other group (the control group) received no treatment. Those who had the dry needling treatment experienced significant reductions in pain severity. Although there was no change in range of motion for the treatment group, they did note significantly improved foot function compared to the control group.
Dry Needling For Low Back Pain
Most people will experience lower back pain at some point in their lives. In fact, lower back pain is one of the most common chronic pain conditions in older adults.
Treatments range from passive bed rest to invasive surgery, and many suffer chronic pain with heavy reliance on painkiller medications. New guidelines from the American College of Physicians recommend first treating low back pain with non-drug therapies such as acupuncture, spinal manipulation, massage and exercise, and only using opiods as a last resort.
Dry needling can be an effective strategy for both short- and long-term pain relief, especially when the pain is associated with myofascial trigger points. One study found that when dry needling was combined with standard physical therapy, there were more significant improvements in pain and disability compared to physical therapy alone.
A systematic review of evidence also suggests that dry needling appears to be a “useful adjunct” to other therapies for chronic low back pain.
There’s also some evidence that dry needling may be effective for ‘failed’ low back syndrome — that is, chronic back pain that persists after conventional treatment or surgery. In a small trial, six individuals with ‘failed’ low back syndrome underwent dry needling of the iliopsoas muscle (the muscle that flexes the hip joint) and experienced a significant reduction in pain and were able to return to normal activity.
Another study looked at adults with chronic low back pain who had not improved with standard physical therapy, and randomized them to receive either dry needling or continued physical therapy. The results found that the dry needling group were “clearly and significantly better” than the control group. They also reported that 18 out of the 29 participants in the dry needling group were able to return to their normal work, whereas only 4 of the 27 in the control group returned to normal work.
Dry Needling Risks
Dry needling is generally considered a safe procedure when performed by a properly trained practitioner. It uses sterile, single use needles that are very thin so minimal bleeding or bruising takes place. There may be soreness and slight bruising at the area of needle placement, but that usually subsides within a few days.
A very rare but serious potential risk of dry needling and acupuncture is pneumothorax — puncturing the lung. The risk for this is estimated to be about 1-2 in 100,000 and is mostly due to improper technique by the practitioner.
Although more larger scale clinical trials are needed, based on the available research and clinical experience, dry needling is a safe and effective treatment for pain and both acute and chronic injuries. It’s essential that the practitioner is well trained in needling techniques and has a thorough understanding of human anatomy to ensure a safe and effective procedure.
