Dry Needling, What’s the point?

MDC Physiotherapy

Let’s start with a little bit of the history of dry needling. In the 1970s, China initiated the first glimpse of a new method of treatment (1). There was a surge of interest in acupuncture, specifically its use for anaesthesia and in the treatment of painful conditions. The term dry needling arose from the need to provide a contrast to the injection of a fluid through a hypodermic syringe. This technique is known as wet needling. Dry needling does not contain the injection of substance, only the insertion of the needle into the soft tissue itself (1).

Dry needling is highly amalgamated within the domain of effective treatments for painful musculoskeletal disorders. It was the research into the use of injections, to both cause and relieve pain in muscular tissue, that led to the development of trigger point theory and then to the use of dry needling as a treatment.

So, what’s a trigger point then?

Put simply, a trigger point is a stiff localised spot of intense tenderness in a taut band of skeletal muscle reproducing the experience of pain. Trigger points can be classified as active and latent with also primary, secondary or satellite trigger points. Let’s focus on active and latent. Active trigger points can cause pain unexpectedly, even without stress being place through the muscle. Active trigger points can cause pain through a distinctive referral pattern of the muscle through a twitch response on palpation or by reduced flexibility and range of motion. Latent trigger points are also tender on palpation which can refer some pain through ischaemic compression but do not cause a distinct referral pain.

Latent trigger points can develop within soft tissue structures for extended periods of time following an injury, when recruited the latent trigger point become active stimulating a healing response, with the goal of permanently reducing pain. As mentioned previously, trigger points can develop within soft tissue resulting in painful areas, such myofascial pain spots, tension points, stiffened tissue, post injury scarring, ligaments. Meaning dry needling can be performed almost anywhere anatomically!

Research

Research (2,3) has grown in the past number of years, investigating dry needling for tendon issues. One paper (4) identified that taut bands created by active and latent trigger points placed additional strain on tendon insertions which stemmed the development of an enthesopathy or an attachment of a trigger point. More recent research (5) shows moderate evidence that suggests that dry needling can be effective for improving pain intensity and pain-related disability in individuals with neck pain symptoms associated with Trigger Points. Along with manual and exercise therapy patients can experience an immediate short-term reduction.

Additionally, dry needling can benefit those who experience tension type and cervicogenic headaches! A systematic review (6) reported that dry needling is an effective treatment in reducing the frequency and intensity of cervicogenic headaches. Outcome measurements were collected through a visual analogue scale from the patients. Two studies within the review showed significant improvements with dry needling over 4-5 weeks of treatments. So, what’s the point? Reading through the research we can recognise dry needling can stimulate recovery as a sole treatment or as an adjunct with exercise therapy.

Legge D. A history of dry needling. Journal of Musculoskeletal Pain. 2014 Sep 1;22(3):301-7.
Kubo K, Yajima H, Takayama M, Ikebukuro T, Mizoguchi H, Takakura N. Effects of acupuncture and heating on blood volume and oxygen saturation of human Achilles tendon in vivo. European journal of applied physiology. 2010 Jun;109(3):545-50.
Nagraba Ł, Tuchalska J, Mitek T, Stolarczyk A, Deszczyński J. Dry needling as a method of tendinopathy treatment. Ortopedia, traumatologia, rehabilitacja. 2013 Mar 1;15(2):109-16.