What is Dry Needling?

The more we utilise dry needling with our clients, the more we understand its benefits and expand its use in the treatment of musculoskeletal injuries. Addressing everything from low back pain, migraines, and sports injuries; dry needling proves beneficial in the most common muscle, tendon, ligament, and joint issues seen in a therapists practice
. 
As we utilise this technique with our clients, it is important for them to know the basics about dry needling, what to expect from treatment, and what conditions can benefit from this therapy. Below are seven important items to understand when seeking treatment.

1. WHAT IS DRY NEEDLING?
Dry needling is a skilled technique performed by trained Physical Therapists aimed at managing neuromusculoskeletal injuries and pain while addressing movement dysfunction. Dry Needling utilises a thin filiform needle to penetrate the skin, fascia, and muscles to address adhesions, trigger points, and connective tissue. This speeds healing and relieves pain by decreasing muscle hypertonicity, increasing joint range of motion, and correcting movement dysfunction through releasing a trigger point adhesion.

2. DRY NEEDLING IS NOT ACUPUNCTURE. 
Acupuncture is an ancient traditional Chinese technique that utilises the knowledge of meridians. This focus allows an acupuncturist to work on a person's inner balance, energy, qi, and one's life-force. Work up and exam includes physical, tongue, and pulse examination. Traditional acupuncture has been widely studied and practiced for thousands of years.

Dry needling relies on the practitioners expanded knowledge of skeletal and neuroanatomy. This knowledge allows one to identify damaged and sensitive tissues, taut bands, and trigger points as well as injured and overused tissues. Dry needle practitioners utilise an extensive examination that includes movement analysis and special orthopaedic evaluations.

3. WHAT IS A TRIGGER POINT?
A trigger point is a spot of muscle/fascia that is hypersensitive, painful when compressed, composed of a taut muscular/fascial bands that restrict oxygenated blood flow, and can refer pain and tenderness while causing motor dysfunction. Muscle overtraining or direct trauma to the muscle can lead to the development of trigger points. Trigger points may also develop during occupational, recreational or sports activities when muscle use exceeds the muscles capacity to handle stress, disturbing normal recovery. Dry needling differs from other types of therapy because it focuses on stimulating these trigger points and releasing the tension in order to alleviate pain.

4. WHAT IS A TWITCH RESPONSE
The twitch response is a localised, reflexive response of a dysfunctional area of muscle to palpation, or in our case, a dry needle. When needling a trigger point, this is one of our goals as it leads to a rapid release of a taut muscle band, decreasing tightness and sensitivity of the surrounding area. A tight muscle or one with a trigger point will feel an achy discomfort with an occasional twitching or cramping sensation. This twitch response returns the muscle to a normal state by releasing inflammatory chemicals from the trigger point and restoring blood flow to the area. According to a recent study in the Journal of Orthopaedic & Sports Physical Therapy, The twitch may be a sign that the treatment will be successful. A local twitch response is a spinal cord reflex that creates an involuntary contraction that can be triggered by a snapping palpitation or penetration with a needle. When the patient has an involuntary twitch response, that suggests that the needle has hit the right spot.

5. IS DRY NEEDLING THERAPY PAINFUL? 
Dry Needling utilises a thin filiform needle to penetrate skin, fascia and muscles to address adhesions, trigger points and connective tissue to speed healing and relieve pain. Often, patients will experience a mild, dull ache during treatment and up to 24 hours post treatment. Some discomfort is experienced during the rapid ‘twitch response’ but this discomfort is minimal and last only a few seconds. It is normal to have mild to moderate muscle soreness after dry needling treatment. Drinking lots of water, stretching, moving your body and heating the sore muscles can reduce the duration of the soreness. Side effects include mild muscle soreness and occasional bruising in some patients.

6. CONDITIONS COMMON TREATED WITH DRY NEEDLING.

* Headaches
* Neck Pain
* Low Back Pain
* Knee Pain (Osteoarthritis)
* Shoulder Dysfunction (adhesive capsulitis, impingement, rotator cuff strain)
* Tennis & Thrower's Elbow
* Carpal Tunnel Syndrome
* Hip Pain
* IT Band Syndrome
* Patellofemoral Pain Syndrome (Runner's Knee)
* Medial Tibial Stress Syndrome (Shin Splints)
* Achilles Tendinopathy
* Plantar Fasciitis
* Ankle Sprains
* Muscle Strains

7. WHAT DOES CURRENT LITERATURE SAY & WHO CAN BENEFIT?
Dry Needling is an extremely effective treatment for acute and chronic pain, decreased flexibility, joint dysfunction, and recovery from physical activity and competition. Patients who undergo dry needling therapy experience less pain quickly, with most finding relief after their first treatment. According to reports published by the Journal of Orthopaedic & Sports Physical Therapy, patient function is restored much more quickly when dry needling is incorporated as part of the care plan.

Chronic upper-quarter (neck/upper back/shoulder) headaches and spinal movement dysfunction have all been associated with myofascial pain syndrome (trigger points). Kietrys et. al. published a meta-analysis on the effectiveness of dry needling on this syndrome. Based on their research and findings, they recommend dry needling as an effective option for treatment of upper quarter myofascial pain syndrome. They found that pain measures decreased for most patients immediately after treatment and at the four week follow-up meeting. - Effectiveness of Dry Needling for Upper-Quadrant Myofascial Pain: A Systematic Review and Meta-analysis. http://www.jospt.org/doi/pdf/10.2519/jospt.2013.4668.

A 2015 study looking at ankle sprain rehabilitation found that adding trigger point dry needling, of the lateral lower leg peroneus muscle, to a rehabilitation plan of proprioceptive/strength exercise the four weeks following an acute lateral ankle sprain, had greater improvements in function and pain than the controlled group of just exercise. - Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomised Clinical Trial.http://dx.doi.org/10.1155/2015/790209

It is normal to take several dry needling therapy sessions before the muscle is fully functional again. This is because trigger points are located under deep layers of muscles, so it could typically takes several sessions for the changes to take full effect. But clients will usually notice the difference right after each treatment.