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As medical professionals, we are always searching for treatment techniques to improve our patient outcomes. Whether it is a new taping technique, an instrument assisted device, or soft tissue mobilization. Dry needling has been a technique that is much more up and coming throughout the United States but has been used in other countries for years. It is a procedure that uses a filament needle that is inserted into a trigger point which is a tender or painful, taut muscle that limits movement. They can be found in any muscle in the body but most notable to the patient population in the neck or upper trapezius region that are typically considered “knots”. We can treat these “knots” with soft tissue mobilization, myofascial release, spinal manipulation or mobilization, and postural retraining to name a few. I have found in my practice that dry needling has had a drastic improvement in treating impairments from muscular strains, spasms, or general muscular imbalances. It is used to elicit an involuntary twitch which causes a release of the contracted muscle or trigger point. This twitch essentially decreases the tone of the muscle and improves the movement that was limited by the restriction.
Trigger points can occur due to many different reasons; postural impairments, trauma, obesity, stress, generalized fatigue, muscular imbalances. They also are very noticeable and generate referral patterns to other areas of the body. For instance, headaches are a very common symptom in people that have poor posture. Forward head posture extends the head so you are able to gaze upward and see the world. This position shortens the suboccipital muscles that are attached to the bottom of your head and increases the tension of the upper trapezius muscles and can refer pain to the temporal region of the head and feeling of pressure or pain behind the eyes. If these postures can be corrected and the muscular tension can be released then headache symptoms can be alleviated. This exact complaint can occur within any extremity. If the bicep becomes to tight, pain in the shoulder can occur. If the gluteals become restricted due to weakness or compensatory movement patterns, pain will increase and can be the contributing factor to that big term “trochanteric bursitis”. If runners are experiencing Achilles pain while training for the Boston Marathon, the gastrocnemius or calves are too tight causing too much force through the heel. These muscles can be released with just a few needles which in turn will decrease pain levels and improve an individual's daily life.
We also have to look at the big picture. A muscle does not act upon itself. There is communication from higher levels. Kind of like in a business. Employees of a company that make a product have a manager. The manager also has a boss which is then supervised by the owner or the CEO of the company. The human body acts very similarly. The brain sends signals through the spinal cord that communicates to each individual muscle throughout the body which then makes the action. For instance, your quadriceps muscle is innervated by the femoral nerve which is made up of nerve roots from L2-4. If there is any sort of communication that is lost from any of the three nerve roots, there will be weakness in the quadriceps muscle action or any of the muscles that have input from those levels. So let’s put this in perspective. A large tree that has many branches waving in the air. The tree trunk is solid and rooted to the ground. On a bright sunny day the tree is flourishing and stable. Now here comes blizzard-like conditions. If the trunk has no impairments, the wind and snow might break off a few branches but the tree continues to stand. If there is even the smallest crack in the trunk, a strong enough wind will bring the entire tree down and will lay there in pieces. To make the tree function better and not be taken down by the blizzard, we need to fix the crack in the trunk. We can use dry needling to reach the specific muscles that are near the segments that are compromised near the “crack” and deeper than what we as physical therapists can reach with our thumbs. By allowing these segments to function properly, the communication throughout the limbs becomes clear.
It is definitely not this simple. There is much more to the assessment of how the individual presents and how to distinguish which type of manual procedure to use. Dry needling is not the only type of treatment to be performed, it always depends on the diagnosis and the most evidenced-based way to treat it. Can I guarantee that one treatment with dry needling will improve the mobility 100%? Never in 1000 years. It might require a couple, a few, or many treatment sessions to get an impairment normalized depending on if the condition is acute or chronic. However, dry needling has demonstrated throughout my professional career to be one of the most effective and efficient treatment techniques in my manual therapy toolbox.
