Dry Needling: What it is and What it isn’t – An Overview

If you have had the unfortunate pleasure of experiencing Rehab at Ortho Rhode Island, then you know we utilize a wide variety of manual therapy techniques and modalities in addition to exercise with the main objectives of improving functional mobility and achieving individualized goals. One of those modalities is Dry Needling. Dry Needling, sometimes referred to as Functional Dry Needling (FDN), is just one of the many specialty certifications that can be obtained by both Physical and Occupational Therapists. While not all our therapists are certified, our staff works together to ensure that any potential candidate, as determined by their Provider, is able to receive treatment.

While many people have heard of Dry Needling through friends, family, medical providers, etc., just as many are shocked by the suggestion that we want to poke you with needles to make you feel better! This brief outline is meant to be an introduction to Dry Needling and answer a few questions as to how it may be beneficial. Dry Needling is not for everyone and is not meant to be used as a sole treatment. You should ask your Therapist (PT/OT) if you have questions on whether this treatment may be beneficial for you.

Functional Dry Needling (FDN) is a skilled intervention performed by Physical and Occupational Therapists that involves the insertion of thin monofilament needles penetrating the skin to stimulate areas of neuromuscular pain and functional movement impairments. The primary goal of Dry Needling is to improve function and should be part of a comprehensive treatment plan to improve both mobility and pain.

Indications for use:

FDN may be indicated for the following neuromuscular impairments or connective tissue dysfunction: myofascial trigger points/muscle spasm, scar tissue formation, tendinitis/tendinopathy, joint dysfunction, muscle strains, and radiculopathies.

FDN is not meant as a stand-alone modality, but rather as a complement to a comprehensive treatment plan created by your PT/OT.

Physiological Benefits

FDN may elicit a local twitch response of the muscles. This has been shown to alleviate spontaneous electrical activity of the muscle, reduce the concentration of inflammatory and nociceptive related chemicals, and relax taut bands of muscle.

Activation of fibroblasts and pro-inflammatory mediators creates a natural inflammatory response that increases blood flow via vasodilation and collagen proliferation. This has been shown to positively influence neuromuscular healing, remodeling, and fiber recruitment.

Natural opioid-based pain response is facilitated through endogenous cannabinoids and the sympathetic nervous system. Non-opioid pain relief is facilitated via release of serotonin and norepinephrine from the brain stem. (The needles are not medicated!)

Contraindications:

Children younger than 12

Patients with needle aversion

Patients with cognitive impairments

Local skin lesions

Patients on anticoagulant therapy

Compromised immune systems

First trimester of pregnancy

Vascular disease (i.e. varicose veins)

Following a surgical procedure where the joint capsule has been opened (requires MD approval if <3months)

Procedure:

FDN is performed following a complete PT/OT Evaluation when clear therapeutic goals and objectives have been established.

Needle placement is based on well researched and established acupuncture points throughout the body.

The PT/OT may then choose to utilize electrical stimulation attached to the needles to achieve local twitch response and release of endorphins for greater pain mediation.

Active movement and/or additional manual treatment are recommended following FDN session in order to promote normal movement patterns and muscle firing.

Although variable, most patients should experience pain relief and improved function within 1-4 FDN sessions and should be discontinued if no improvement occurs >4 sessions.

As part of procedural guidelines, written patient consent and OSHA Blood Borne Pathogen standards are used with all FDN sessions.

References:

APTA, Description of Dry Needling in Clinical Practice: An educational resource paper. 2013

Dry Needling Institute of American Academy of Manipulative Therapy. 2018