In our experience, we’ve found Dry Needling to be a powerful treatment for musculoskeletal and referred pain.
Dry Needling is often confused with Acupuncture- the Traditional Chinese Medicine therapy based on the philosophy of Meridians. In Acupuncture philosophy, “qi” or life-force flows through seven vertical channels in the body, and interruption of this flow is responsible for ill-health. By inserting needles into acupuncture points, the normal flow of qi is restored, and this returns the body to health. While acupuncture as a discipline has been proven effective at relieving pain from certain conditions, the philosophy itself departs from normal scientific Western medicine, in that it is not described in terms of anatomy, physiology and pathological basis of disease.
In response to this, Western medicine has developed a practice known as Dry Needling, in which needles are inserted into palpable tender points, connective tissue spasm or just in to the skin to stimulate nociceptors (danger sensing nerves). Interestingly, there is a high degree of correlation (71% as reported by Melzack et al.) between locations of known tender spots, and classical Acupuncture points for the relief of pain.
The term “trigger point” was coined in 1942 by Dr Janet Travell to describe a clinical finding with the following characteristics:
- Pain related to a discrete, irritable point in skeletal muscle or fascia not caused by acute local trauma, inflammation, degeneration neoplasm or infection.
- The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
- Palpation of the trigger point reproduces the patient’s complaint of pain, and the pain radiates in a distribution typical of the specific muscle harbouring the trigger point.
- The pain cannot be explained by findings on neurological examination. Definition from Wikipedia
- While this physiological construct (the trigger point) has never been demonstrated by high quality research, it’s inception as an idea has created a framework by which practitioners have worked to relieve their patients pain.
Dr Travell and a colleague, Dr David Simons were researching the role of myofascial trigger points in unexplained pain, and found that by injecting these trigger points with anaesthetic, they could effectively relieve a patients pain, local and referred. To further analyse the effect, Drs Travell and Simons investigated the effect of using needle insertion without the injection of anaesthetic, and found the results to be comparable. This suggests that the needle itself is the agent of change, rather than the pain relief provided by the anaesthetic. Thus the treatment can be effectively conducted with a “Dry Needle” as opposed to an injection. In recent times we’ve adopted the use of the acupuncture needle instead of the hypodermic needle, as they are thinner and cause less discomfort to the patient, and less tissue damage or bruising.
***Update*** since this time further studies have been done to show that non-specific needling (without attempting to locate specific points, just randomly placing needles) is on average as effective as skilled needling is. Other studies showed that even poking patients with tooth-picks and pretending to pierce their skin was basically as effective. This suggests that the initial explanation of releasing local muscle spasm by direct needle penetration can’t be the real mechanism by which this technique reduces a patients pain.
Dry needling practice varies depending on the intent, and the cause of the pain.
Structural needling involves insertion of a needle into the tender spot, with the intent of causing a fasciculation (twitch), or stimulating the brain to send inhibitory signals down the spinal cord. Though evidence is still inconclusive about the physiological basis of the treatment effect, it is thought that it is most likely the descending inhibition from the brain due to the stimulation of nociceptors in the skin, combined with psychosocial effects of the “clinical interaction”.
Superficial needling (transverse) is the method used to treat referred pain from primary nerve impingement/pathology. These are things like sciatica, headache, and arm pain from disc bulge in the neck. In this scenario, a patient experiences pain in a limb with out any actual injury to the painful area, due to compression of the nerve (centrally) supplying the skin in that region. By inserting the needle transversely into the skin, and applying several needles throughout the region of referred pain, we maximise the number of nociceptors being stimulated. After some time (this treatment often takes 15-20mins, as opposed to 3-5min for structural), the continuous noxious stimulus is inhibited by the brain (descending pain inhibition) by modulating the activity in the dorsal horn of the spinal cord. This results in relief of the referred pain.
Generally, we find Dry Needling to be a safe and effective treatment for musculoskeletal and referred pain, though we still don’t really have a great understanding of the physiology behind it. While it is not every patient’s cup of tea (due to needle phobia), for those who endure it there is often significant relief of pain, which last much longer than simply using other manual techniques such as massage or other manual therapies.