Dry Needling is a hot topic in the Physical Therapy world right now and has been for several years. It has also been growing in popularity among athletes, both as an intervention to aid in rehabilitation and as a potential tool for recovery and performance enhancement. So, what is this Dry Needling? How does it work? What can it do? Who can it help? What can I expect? Keep reading to find out…
According to the “Analysis of Competencies for Dry Needling by Physical Therapists” which was just released by the Federation of State Boards of Physical Therapy, dry needling is a procedural intervention used by physical therapists (PT) to treat pain, functional impairments, and disabilities. It is a skilled technique involving the use of solid filament needles to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability. In other words, thin needles are inserted into the body, most often into a muscle, in order to improve function and decrease pain.
Janet Travell, M.D. and David Simons, M.D. are often credited with the creation of dry needling in the 1970’s. Since then, other practitioners, such as Dr.’s C.C. Gunn and Y.T. Ma have helped to advance the practice of dry needling. It initially started purely as a method to address “trigger points” in muscles, but has expanded to include the nervous system. As research into dry needling has expanded, so has our understanding of how it works.
While there are still different theories about the mechanism through which dry needling improves healing and performance, there is a growing collection of research that indicates it’s potential. Studies that have shown physiologic changes associated with dry needling; along with studies highlighting it’s effectiveness in treating a variety of conditions.
Most of the controversy surrounding dry needling by Physical Therapists comes from oriental medicine and acupuncture practitioners. While the needle used is the same, the treatment philosophy and applications are different. Acupuncture is based on traditional Chinese medicine while dry needling is rooted in modern science.
What we do know…
Muscles can be relaxed or activated with dry needling. Tight muscles can be “released”, while lengthened or weak muscles can be “turned on”. There are also chemical changes that occur as a result of dry needling. Circulation is increased, cellular acidity is decreased, pain markers are decreased and chemicals that promote healing are increased. Because the needles are so thin, they are capable of creating a lesion that initiates a healing response without the risk of scar tissue formation.
Who can it help?
There are many people that benefit from dry needling. It is being used in the rehab setting for headaches, chronic pain and acute injuries. The injuries treated can range from common overuse injuries such as Achilles or rotator cuff tendinopathy, to acute sprains and strains. Competitive athletes are also using dry needling as a way to recover from intense training and minor nagging injuries. Dry needling can help improve flexibility and motor control, or decrease swelling and soreness. Follow these links for some specific examples of dry needling for sport performance (http://www.swimmingscience.net/2013/11/dry-needling-and-swimming.html, http://www.redskins.com/news-and-events/article-1/Redskins’-Dry-Needles-Speed-Recovery-Time/744d3f1e-b8c2-4f5d-8735-c4f8c8a2c468?campaign=was%3Afanshare%3Atwitter, http://suefalsone.com/ ).
What can I expect?
Hopefully, if you decide dry needling might be right for you, you can find a local Physical Therapist that specializes in the technique. Currently, the use of dry needling is governed by individual state practice acts. As of this publication there are 33 states that formally allow dry needling, 6 that prohibit it, and 11 that have not taken an official stance. Pennsylvania is one of the states without specific language in its practice act regarding the use of dry needling by Physical Therapists.
When you find a certified dry needling practitioner, you should expect them to perform a thorough evaluation prior to any treatment. They should review the procedure and expectations with you, and give you an opportunity to clarify any uncertainty. There is often additional written consent required for dry needling due to its invasive nature.
Treatment with dry needling is not usually a pleasant experience but it is often less uncomfortable than a deep tissue massage. Clients typically describe a deep ache sensation if the needle is in a good location, and an involuntary muscle twitch is often experienced. Adverse side effects are variable but can include muscle soreness, which is similar to the soreness after an intense workout, and the possibility of a bruise.
When done well, you should experience immediate changes in strength, flexibility and pain. It may require several sessions to make these changes long lasting, but there should be a noticeable difference after the procedure. Good Physical Therapists will include other interventions with the dry needling in order to maximize improvement and carry-over. These interventions may include, but are not limited to, stretching, joint mobilization, taping, corrective exercises and neuromuscular re-education. Electrical stimulation may also be applied to the needles during the procedure in order to enhance the response.
As techniques are refined, and more research is completed, dry needling will likely continue to grow in popularity. I look forward to learning more about more advanced techniques and improving my effectiveness as a dry needling Physical Therapist. Feel free to contact me at firstname.lastname@example.org with any follow-up questions.
John Salva, MPT
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