Physiotherapists have used dry needling as a treatment modality for over 30 years. However, it is surprising that many patients we treat are still unfamiliar with this treatment. It could be that their prior experience with physiotherapy did not involve using needles. After all, only physiotherapists with special training using this technique and who are registered to do so with the College of Physiotherapy of Alberta can treat patients using needles. Therefore, not all physiotherapists are trained to do so.
And so this blog aims to answer some of the most common questions regarding dry needling.
What is Dry Needling?
Dry needling is the use of acupuncture needles inserted into tight muscles to reduce their tension and pain. These acupuncture needles are sterile monofilament needles that are so thin that they fit inside needles used to draw blood or to apply medications and vaccines.
Their use in physiotherapy practice is for the sole purpose of reducing tight muscles that are causing pain and movement restrictions. In addition to their therapeutic benefits, they are often used for diagnostic purposes to determine if deep muscles cause a patient’s pain or limitation. The reason for the name “dry” is because no medications are administered, and no bodily fluids are being removed with the needle.
What Are Some Common Conditions That Benefit From Dry Needling?
Any muscles that are painful, tight, or shortened can be treated with dry needling. So, conditions like chronic muscle strains, tendon problems like tendonitis or tendinopathies and painful trigger points can be be addressed. Trigger points are abnormal muscle tissue resistant to normal movement or release despite stretching or massage techniques. These could be scar tissue from an injury or areas of contracted tissue from a nerve problem or chronic weakness. Tension headaches caused by tight neck muscles are one example of a condition treated with dry needling.
What Are the Advantages of Dry Needling?
Dry needling has three advantages: speed of muscle relaxation, precision and depth. When a tight muscle is needled, it first produces a muscle contraction, and the tighter a muscle is, the greater the contraction. Following this contraction is a release and relaxation of the muscle. The muscle will then continue to relax for 1-3 days after treatment. This is why dry needling is so effective as a diagnostic tool – we can determine the results of our treatment and re-test our movements quickly to implicate the treated muscles’ role in the dysfunction.
The second advantage of dry needling is the depth of penetration. Needles come in different lengths, from very short ones to treat superficial muscles to long needles to treat bigger muscles. Massage therapy, foam rolling, and metal scrapers or vibration devices are helpful but are limited in that they can only address superficial tissues. A needle, on the other hand, can be placed safely into the deepest part of the muscle to the bones from which they attach. This sounds painful, but bones do not hurt when needled. Most of the time, the deepest portion of the muscles near joints is often at fault. Dry needling is the best and only way to treat these hard-to-reach areas.
The third advantage to dry needling is precision. Because the needles are so fine, their placement is extremely precise. This is one of the biggest reasons why dry needling is so safe. It can never penetrate bone, and it cannot cause harm to blood vessels or nerves.
Are There Risks To Dry Needling?
Yes, any medical procedure involving needle insertion carries some inherent risks, regardless of how delicate the needles are. By far, the biggest risk to this treatment modality is infection. To mitigate this risk, the needles themselves are sterile and placed in a Sharps container once used on each person. Also, the skin is always cleaned with an antiseptic solution called Stanhexidine, which is an effective antimicrobial agent that can be used against a wide range of bacteria, fungi, and viruses. This cleaning agent is often used in surgical procedures.
The needles can sometimes puncture a vein and cause bruising. This is a cosmetic issue and does not cause continuous bleeding. However, if a patient is on long-term blood thinners, this treatment technique is contraindicated.
Is Dry Needling Necessary If I Am Afraid of Needles? Will My Treatments Still Be Effective?
We do encounter quite a few patients for whom dry needling is not appropriate or recommended. Also, some patients are afraid of needles and choose not to be treated with this modality. Dry needling is simply one treatment modality among many. In fact, its success is greatly dependent on firstly, an accurate diagnosis. Secondly, it pairs very well with manual therapy, and thirdly, an individualized and personal home exercise program is vital if it is to be effective. Dry needling was never meant to be a stand-alone treatment. Success with physiotherapy depends on patients’ understanding of their condition and being compliant with self-management programs (like prescribed therapeutic exercises) at home and at work.
So, even though dry needling is an incredibly powerful tool to treat hard-to-reach muscles, many patients can still benefit from not being needled. The choice of whether to be needled or not is always the choice of the patient. This is why the more treatment tools and skills a physiotherapist has, the better a patient’s outcomes. For example, a carpenter is most effective when he has many tools in his toolbox and not just a hammer.
Is Dry Needling Painful?
Because the needles are so fine, the actual insertion of the needle through the skin is often painless.
What is painful is when the needle elicits a contraction from a tight muscle. Normal muscles do not contract from a needle placed into it. But tight muscles do. This sensation is often described as a deep ache. The patient will feel the muscle contraction as a “twitch.” You should feel discomfort from the treated muscle for 1-2 days. Thereafter, you should feel an improvement in that muscle. Some patients feel relief immediately after each treatment. Some patients describe the post-treatment discomfort as “a good pain” – a sensation that is far better than the pain from the tightness itself.
How Many Treatments Are Usually Needed?
This question is the most difficult to answer because not all injuries present and behave the same way. It also greatly depends on how many needles each person can tolerate. What we do know for certain in the research studies is that treatments with dry needling are far more cost-effective than treatments without dry needling. In other words, we can diagnose conditions faster and with greater accuracy and resolve problems faster if the affected muscles are too deep and out of reach of superficial techniques.
In summary, the best way to determine if dry needling should be a part of your physiotherapy care is to discuss this with your physiotherapist. Dry needling is an effective option for treating muscles that are difficult to reach. Its effectiveness will depend greatly on the practitioner’s skill and experience and the patient’s compliance with their entire management program. It is not a panacea. But the practice of physiotherapy would not be the same without it. And millions of patients around the world who have been safely treated with this technique can surely attest to that.
See also: Dry Needling vs. Acupuncture: How Are They Different?