PHYSICAL THERAPY
Dry needling is a treatment technique emerging into mainstream physical therapy. I attended a course through Kineticore: Functional Dry Needling Level 1 on October 21-23. Patients have lots of questions like, “how does it work?”, “Is that like acupuncture?”, “will it hurt?”. Prior to taking this course I had some similar questions .
This is a technique that requires special training of the physical therapist in addition to his or her education in school. Not all therapists are certified to become dry needlers. However if the physical therapist chooses to practice this technique he or she may become certified through continuing education. They may perform this technique provided this is mandated in the state in which they practice. Fortunately dry needling is incorporated into the Rhode Island physical therapy state practice act.
Definition:
Kineticore’s definition of dry needling is “…a skilled technique performed by a physical therapist using filiform needles the 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 disabililty.”
The “dry” needle is a solid needle with a rounded tip. There is no medication/substance contained within the needle. The needle is a filiform which is much smaller in gauge than a hypodermic needle. Different lengths can be used to affect different depths of the structures we are trying to target.
How does it work?
First the therapist will conduct a thorough examination of your neuromuscular system, which can include strength, palpation, range of motion and movement patterns to identify your source of dysfunction. This source of dysfunction is termed a “trigger point”. This does not always coincide with exactly where you feel your pain.
The clinician will insert the dry needle into the tissue to obtain a twitch response of the muscle. This can be visualized by the therapist and likely felt by the patient. The therapist may choose to piston the needle a couple of times in this area and /or hook the needle up to electrical stimulation to gain more of a contraction over a period of five or more minutes.
What are the benefits?
Several studies in this course identified the body’s physiological response to dry needling:
Increased blood flow: Increased blood flow to a dysfunctional area increases potential for healing.
Decreased banding: A taut band of tissue cannot contract or relax properly. By gaining a twitch of this muscle, normal length may be restored. Additionally a muscle that cannot contract properly is reset.
Biochemical changes: Elevated levels of chemicals in the body that are involved in inflammation and immune regulation can be seen in a region of an active trigger point. One study cited during this course found significant decreases in some of these substances following a local twitch response with a dry needle in patients with neck pain.
Improvement in pain threshold: Certain areas of the brain that are involved in inhibition of pain are activated with dry needling
Is that like acupuncture?
No. The only similarity is the type of needle used. Acupuncturists have a completely different system for identifying source of dysfunction. Traditional Chinese medicine explains acupuncture as a technique for balancing the flow of energy known as Qi or Chi which flows through pathways in your body known as meridians. By inserting needles into specific points along these meridians acupuncturists attempt to re-balance energy flow in the body.
Will it hurt?
This is a tough question to answer because everyone has different pain threshold. My experience during this course was an aching sensation once the muscle twitched. This sensation is momentary and potential benefits would far outweigh a short time of discomfort.
Will it help me?
For the clinical benefits listed, yes this can help. Numerous neuromuscular conditions can be treated such as low back pain, neck pain, and tendonitis. There are contraindications to treatment with this technique such as compromised immune system, pregnancy , local infection or tumor, history of lymph node removal, cardiac pacemaker, uncontrolled anticoagulant usage, and immediately post surgical. Your clinician will review these with you to ensure you are a good candidate for dry needling.
Kineticore Physical Therapy Education: Functional Dry Needling Level 1 (2016, October. Plainville, MA.
