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Dry Needling Therapy, Types, Techniques, Uses, Warning

Dry Needling Therapy (also known as intramuscular manual stimulation, or intramuscular needling) is a treatment technique that has been utilized by physiotherapists. Dry needling, also known as myofascial trigger point dry needling^[rx]^[rx] is an alternative medicine technique similar to acupuncture. Dry needling is sometimes also known as intramuscular stimulation (IMS).^[rx] It involves the use of either solid filiform needles^[rx] or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. Dry needling is mainly used to treat myofascial trigger points, but it is also used to target connective tissue, neural ailments, and muscular ailments. The American Physical Therapy Association defines dry needling as a technique used to treat dysfunction of skeletal muscle and connective tissue, minimize peripheral nociception (pain), and improve or regulate structural or functional damage.^[rx]

Types of Dry Needling Therapy

The in and out technique, during which a practitioner inserts a filiform needle into a trigger point and removes it right away. Results of a 2014 review suggest that this form of dry needling provides no benefits.
The non-trigger points technique, during which a practitioner inserts needles into surrounding muscle, instead of a knot or pressure point.
With ‘deep dry needling – the needle penetrates the mTrP directly. This mechanically destroys the trigger point region. Typically, there is a brief twitch of the muscle fibers where the mTrP lies (local twitch response). This deep form of needling is described as ‘intramuscular stimulation’ (or IMS).
By contrast – during ‘superficial dry needling’ the needle is just placed superficially, 1–2 mm below the skin, in the area over the mTrP. This form of dry needling is described as ‘superficial afference stimulation’ (or SAS) and is intended to detention the deep-seated mTrP in a reflex reaction.
Direct wet needling (14 RCTs) – 8 of the 10 trials comparing different substances found that the effect was independent of the injected substance.
Direct dry needling (5 RCTs) – 3 trials comparing dry and wet needling found no differences between the groups. One trial found that dry needling had a similar effect to oral metoprolol. One trial compared dry needling at correct and incorrect sites, the results of which were unclear.
Indirect wet needling (3 studies) – sub-or intracutaneous injection of water or saline over the trigger points appeared to be ineffective.
Indirect dry needling (3 studies) – needling alone did not appear to be superior to various interventions.

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The Technique of Dry Needling Therapy

Technique for dry needling depends on which tissue is being targeted and what the overall objective of the treatment is. For example, one of the most common treatment objectives for dry needling, myofascial trigger points (TrPs), differs physiologically from treatments for scar tissue, connective tissue issues, and other medical issues.^[rx]

In the treatment of trigger points for persons with myofascial pain syndrome, dry needling is an invasive procedure in which a filiform needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple, hyperirritable contraction knots related to the production and maintenance of the pain cycle; essentially, myofascial trigger points will generate much local pain upon stimulation or irritation.^[rx]^[rx]

Dry needling can be divided into categories in terms of depth of penetration: deep and superficial dry needling.^[rx] Deep dry needling will inactivate myofascial triggers points by provoking a local twitch response (LTR), which is an involuntary spinal cord reflex in which the muscle fibers in the taut band of muscle contract. The LTR indicates the proper placement of the needle in a trigger point. Dry needling that elicits LTRs improves treatment outcomes,^[rx] and may work by activating endogenous opioids.^[rx] The activation of the endogenous opioids is for an analgesic effect using the Gate Control Theory of Pain.^[rx] In addition to relieving myofascial trigger points, deep dry needling is also identified to decreases pain, increase the range of motion, and minimize myofascial trigger point irritability.^[rx] In regards to the factor of pain reduction, relief occurs at four central levels: local pain, spinal pain through nerves, brain stem pain, and higher brain center pain.

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The relief of myofascial trigger points has been more highly researched than relief of connective tissues, muscle fascia, muscle tension, and scar tissue; however, the American Physical Therapy Association claims that there potentially may be some benefits of dry needling on these ailments according to some available evidence.^[rx] The APTA also disclaims that dry needling should not be used as a standalone procedure, but should be used in conjunction with other treatment methods, including manual soft tissue mobilization, neuromuscular re-education, functional retraining, and therapeutic exercises.^[rx] Once the needle is inserted, one can manually or electrically stimulate the filiform needle depending for the desired effect of treatment.

Indications of Dry Needling Therapy

Dry needling is almost always used as a part of an overall plan that will likely include some type of exercise, manual therapy, heat therapy, and education. Dry needling is used to increase the range of motion that may be limited due to muscle tightness or scar tissue. Dry needling may also treat:

Joint problems
Disk problems
Tendinitis
Migraine and tension-type headaches
Jaw and mouth problems (such as temporomandibular joint disorders or TMD)
Whiplash injury
Temporomandibular pain syndrome,
Lateral and medial epicondylitis,
Periarthropathy (shoulder, hips),
Tendinosis,
Insertion tendinopathy,
Arthritis,
Degenerative cervical, thoracic or lumbar spine syndrome,
Spinal syndrome with the segmental functional disorder,
Visceral pain syndrome.
Repetitive motion disorders (like carpal tunnel syndrome)
Spinal problems
Pelvic pain
Night cramps
Phantom pain
Post-herpetic neuralgia (pain left behind by shingles)
Neck/Back Pain
Shoulder Pain
Tennis/Golfers Elbow
Headaches
Hip and Gluteal Pain
Knee Pain
Achilles Tendonitis/Tendonosis
Plantar Fasciitis
Sciatica
Muscular Strains/Ligament Sprains
Chronic Pain
Athletic Performance
FDM

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Contraindications of Dry Needling Therapy

DN therapy should be avoided in patients under the following circumstances

Pregnant women
People who are not able to understand the treatment
People who are very afraid of needles
In a patient with needle phobia.
Patient unwilling – fear, patient belief.
Unable to give consent – communication, cognitive, age-related factors.
Medical emergency or acute medical condition.
Over an area or limb with lymphedema as this may increase the risk of infection/cellulitis and the difficulty of fighting the infection if one should occur.
Inappropriate for any other reason.
Abnormal bleeding tendency
Compromised immune system
Vascular disease
Diabetes
Pregnancy
Children
Frail patients
Patients with epilepsy
Psychological status
Patient allergies
Patient Medication
Unsuitable patient for any reason