Dry needling
Encyclopedia
Dry needling is the use of solid filiform needles for therapy
of muscle pain, sometimes also known as intramuscular stimulation. The needles are similar to acupuncture needles. Dry needling contrasts with the use of a hollow hypodermic needle
to inject substances such as saline solution, botox or corticosteroids to the same point. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue
. Analgesia produced by needling a pain spot has been called the needle effect. Acupuncture
and dry needling techniques are similar, but their rationale and use in treatment are different.
s 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 contraction knots, which are related to the production and maintenance of the pain cycle. Deep dry needling for treating trigger points was first introduced by Czech physician Karel Lewit in 1979. Lewit had noticed that the success of injections into trigger points in relieving pain was apparently unconnected to the analgesic used. Proper dry needling of a myofascial trigger point will elicit 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, and may work by activating endogenous opioids. Inserting the needle can itself cause considerable pain, although when done by well-trained practitioners that is not a common occurrence. No study to date has reported the reliability of trigger point diagnosis and physical diagnosis cannot be recommended as a reliable test for the diagnosis of trigger points. Chan Gunn
introduced a type of dry needling called intramuscular stimulation in the 1980s that moved away from using trigger points. Baldry developed a version called superficial dry needling in 2005, in which the needle is inserted about 5-10mm into the tissue above the trigger point.
concluded that dry needling for the treatment of myofascial pain syndrome in the lower back appeared to be a useful addition to standard therapies, but that clear recommendations could not be made because the published studies are small and of low quality. A 2007 meta-analysis examining dry needling of myofascial trigger points concluded that the effect of needling was not significantly different to that of placebo controls, though the trend in the results could be compatible with a treatment effect. One study (Lorenzo et al. 2004) did show a short-term reduction in shoulder pain in stroke patients who received needling with standard rehabilitation compared to those who received standard care alone, but the study was open-label and measurement timings differed, limiting the use of the study. Again the small sample size and poor quality of studies was highlighted.
In July 2011 the Court of Appeals of the State of Oregon issued an order asserting that dry needling is "substantially the same" as acupuncture. In September 2011,the Oregon Board of Chiropractic Examiners And Oregon Attorney General appealled said order on the grounds that they feel the commissioner who issued the order was mistaken in his assertion.
Therapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...
of muscle pain, sometimes also known as intramuscular stimulation. The needles are similar to acupuncture needles. Dry needling contrasts with the use of a hollow hypodermic needle
Hypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...
to inject substances such as saline solution, botox or corticosteroids to the same point. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
. Analgesia produced by needling a pain spot has been called the needle effect. Acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
and dry needling techniques are similar, but their rationale and use in treatment are different.
Technique
In the treatment of trigger pointTrigger point
Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point practitioners believe that palpable nodules are small contraction knots and a common cause of...
s for persons with myofascial pain syndrome
Myofascial pain syndrome
Myofascial pain syndrome , also known as chronic myofascial pain , is a syndrome characterized by chronic pain caused by multiple trigger points and fascial constrictions...
, 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 contraction knots, which are related to the production and maintenance of the pain cycle. Deep dry needling for treating trigger points was first introduced by Czech physician Karel Lewit in 1979. Lewit had noticed that the success of injections into trigger points in relieving pain was apparently unconnected to the analgesic used. Proper dry needling of a myofascial trigger point will elicit 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, and may work by activating endogenous opioids. Inserting the needle can itself cause considerable pain, although when done by well-trained practitioners that is not a common occurrence. No study to date has reported the reliability of trigger point diagnosis and physical diagnosis cannot be recommended as a reliable test for the diagnosis of trigger points. Chan Gunn
Chan Gunn
Chit Chan Gunn, CM, OBC is the founder and president of the Institute for the Study and Treatment of Pain in Vancouver, British Columbia, Canada. Dr. Gunn developed a process called Intramuscular Stimulation to treat neuropathic pain...
introduced a type of dry needling called intramuscular stimulation in the 1980s that moved away from using trigger points. Baldry developed a version called superficial dry needling in 2005, in which the needle is inserted about 5-10mm into the tissue above the trigger point.
Efficacy
A systematic reviewSystematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...
concluded that dry needling for the treatment of myofascial pain syndrome in the lower back appeared to be a useful addition to standard therapies, but that clear recommendations could not be made because the published studies are small and of low quality. A 2007 meta-analysis examining dry needling of myofascial trigger points concluded that the effect of needling was not significantly different to that of placebo controls, though the trend in the results could be compatible with a treatment effect. One study (Lorenzo et al. 2004) did show a short-term reduction in shoulder pain in stroke patients who received needling with standard rehabilitation compared to those who received standard care alone, but the study was open-label and measurement timings differed, limiting the use of the study. Again the small sample size and poor quality of studies was highlighted.
Practice
Dry needling is practiced by physical therapists in many countries, including South Africa, the Netherlands, Spain, Switzerland, Canada, Chile, Ireland, the United Kingdom and New Zealand. In the United States, physical therapists in several states including Virginia, Maryland, Ohio, Colorado, Georgia, New Mexico, and Kentucky perform the technique, and several other states, including Louisiana, Tennessee and North Carolina, have recently updated board positions allowing the practice. Physical therapists are prohibited from penetrating the skin or specifically from practicing dry needling in California, Hawaii, Nevada, New York, and Florida, though many states have no regulations on dry needling. Additionally, chiropractors are legally allowed to practice dry needling in many states including Alabama, Colorado, Connecticut, Delaware, Florida, Illinois, Maryland, New Hampshire, New Mexico, North Carolina, Rhode Island, South Carolina, Texas, Utah, Virginia, and West Virginia.Controversy
Many acupuncturists have argued that dry needling appears to be an acupuncture technique requiring minimal training that has been re-branded under a new name ("dry needling"). Whether dry needling is considered to be acupuncture depends on the definition of acupuncture, and opinions vary on whether trigger points correspond to acupuncture points or meridians. Many physical therapists and chiropractors have asserted that they are not practising acupuncture when dry needling. They assert that much of the basic physiological and biomechanical knowledge that dry needling utilizes is taught as part of their core physical therapy and chiropractic education and that the specific dry needling skills are supplemental to that knowledge and not exclusive to acupuncture.In July 2011 the Court of Appeals of the State of Oregon issued an order asserting that dry needling is "substantially the same" as acupuncture. In September 2011,the Oregon Board of Chiropractic Examiners And Oregon Attorney General appealled said order on the grounds that they feel the commissioner who issued the order was mistaken in his assertion.