By Elizabeth Akincilar, MSPT, Cofounder, PHRC Merrimack
Let’s Talk Dry Needling
What is dry needling? If you’ve ever found yourself asking this question, then this is the blog for you! This week we’re diving into dry needling to give you everything you need to know! From definitions, to variations, to the differences between dry needling and acupuncture- We’re covering it all!
Attention: With training, physical therapists in most states are licensed to practice dry needling (except CA+ a few others). Check APTA to see if dry needling is within PTs’ scope of practice in your state.
What is Dry Needling?
When performed, it can decrease muscle tightness, increase blood flow, and reduce local and referred pain. Providers use solid needles that don’t contain any kind of medication.
This is why the technique is called “dry.” Nothing is injected into your body. Trigger point injections are different. They contain medicine and are performed by a physician or nurse practitioner.
How Does Dry Needling Work?
When muscles are overused, the muscle fibers aren’t getting adequate blood supply. When they don’t receive sufficient blood supply, they don’t get enough oxygen and nutrients to allow muscles to return to their normal resting state. When this happens, the tissue near the trigger point becomes more acidic.
The surrounding nerves can become sensitized, which makes the area sore and painful. Stimulating a trigger point with a needle helps draw normal blood supply back to flush out the area and release tension.
Once the therapist locates a trigger point, they insert a needle through the skin directly into it. It is the mechanical disruption of the needle that facilitates the trigger point to release. The therapist may move the needle to elicit a local twitch response, which is a quick contraction of the muscle.
This reaction can be a good sign that the muscle is responding to the treatment. Some people feel improvement in their pain and mobility almost immediately after a dry needling session.
For others, it takes more than one session.
Dry Needling: Treating Pelvic Pain
Dry Needling is an effective adjunct treatment intervention that compliments manual therapy treatment techniques. Both the muscles of the pelvic girdle, i.e. the gluteals, piriformis and abdominal muscles, can be treated with dry needling as well as the muscles of the pelvic floor.
Physical therapists that treat the pelvic floor muscles with dry needling require specialized training. Additionally, dry needling can also be used to improve scar mobility and decrease pain associated with scars, such as C-section scars and other abdominal scars.
What To Expect From Dry Needling
If your physical therapist utilizes dry needling during a treatment there are a few things you can expect:
- First, the therapist needs to accurately identify the trigger point manually.
- Then they clean the area with alcohol before inserting the needle. There are various techniques that can be utilized once the needle is inserted which will depend on the goals of treatment. The patient may feel a twitch response when the needle is inserted.
- After treatment some patients will report immediate decrease in pain and/or improvement in mobility and/or function and others will report some soreness.
- Your therapist may prescribe specific exercises to help maintain the benefits of the treatment.
Dry Needling Series: Different Variations
Direct Dry Needling
Involves inserting the needle, often perpendicular to a single muscle belly, to directly target one muscle.
Threading
Threading is when the needle is inserted on an angle to the muscle belly so that it spans a wider breadth of a larger muscle.
Threading can also be used to target more than one muscle with one needle.
Static Needling
Static needling is when the needle(s) are placed and left alone for a determined amount of time, depending on the therapist’s goals. The needles can be placed superficially or more deeply into muscle tissue.
This gentle approach stimulates a healing response and is better suited for those with muscular pain.
Pistoning
Pistoning is a more aggressive form of needling in which the therapist moves the needle up and down multiple times within a muscle belly at a fast pace to elicit a twitch response and microtrauma to the local tissue to initiate a stronger healing response.
This strategy is better suited for less painful muscles that are strong and tight, with tolerable trigger points. This technique is more likely to cause soreness or bruising.
Dry Needling with Neuromodulation
Dry needling with neuromodulation is when the therapist places the needle in the targeted muscles and attaches small alligator clips to the needles. Through an electrical stimulation unit, rhythmic vibrations are delivered to the muscle tissue for three to ten minutes.
This helps to relieve pain and restore normal tissue function by directly communicating with the nervous system. This is an excellent method for reducing post needling soreness and providing a reset to muscles.
Dry Needling vs Acupuncture
Traditional Chinese medicine explains acupuncture as a technique for balancing the flow of energy or life force — known as chi. By inserting needles into specific points along these meridians, acupuncture practitioners believe that your energy flow will re-balance.
Dry needling is a treatment that healthcare providers use for pain and movement impairments associated with myofascial trigger points. A trained provider inserts thin needles into or near trigger points. The needles stimulate the muscles, which causes them to contract or twitch. This helps relieve pain and improve range of motion.
Dry needling is almost always used as part of a larger pain management plan that could include exercise, stretching, massage and other techniques.
Attention: With training, physical therapists in most states are licensed to practice dry needling (except CA+ a few others). Check APTA to see if dry needling is within PTs’ scope of practice in your state.
Frequently Asked Questions
Q: Do you have some links to any strong research that demonstrate efficacy and/or the mechanisms you state for dry needling?
A: We suggest looking into Jan Dommerholt, PT’s work on dry needling
Q: Can this be done in old scar tissue from a 7+ year old episiotomy?
A: Yes!
Q: Does it help relieve numbness from cesarean?
A: Dry Needling can improve blood flow to the tissues around the cesarean scar which may help improve sensation.
Q: Is this done by a doctor?
A: A physical therapist or acupuncturist!
Q: Which muscles do you dry needling for pelvic floor dysfunction? Only deep glutes?
A: We assess all of the muscles that may be contributing to the pelvic floor dysfunction including all layers of the glutes, pelvic floor, hip flexors, adductors and more. Some providers have training to needle the pelvic floor directly, in a side lying position, entering on the sides of the perineum (no needles inside the vagina). We can needle muscles that are tight and painful, such as the pelvic floor, and we can also needle muscles that are weak and need to be recruited to take load off of the pelvic floor, such as the glute max. The addition of e-stim to the needles can make a big difference in both reducing pain and increasing appropriate muscle recruitment.
Q: Any other side effects besides bruising and soreness?
A: There are other potential side effects, but bruising and soreness are the most common. If you are experiencing symptoms you believe could be a side effect of dry needling, it is best to talk to your provider.
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Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.
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