Dry Needling

It is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate

underlying myofascial trigger points, muscular, and connective tissues for the management of

neuromusculoskeletal pain and movement impairments. 

Dry needling (DN) is a technique used to treat dysfunctions in skeletal muscle, fascia, and connective tissue, and, diminish persistent peripheral nociceptive input, and reduce or restore impairments of body structure and function leading to improved activity and participation.

DN can be divided into deep and superficial DN. Deep DN has been shown to inactivate TrPs by eliciting local twitch responses (LTR), which are modulated by the central nervous system. A LTR is a spinal cord reflex that is characterized by an involuntary contraction of the contractured taut band, which can be elicited by a snapping palpation or penetration with a needle.

Deep DN of TrPs is associated with reduced local and referred pain, improved range of motion, and decreased TrP irritability both locally and more remotely. Superficial DN is thought to activate mechanoreceptors coupled to slow conducting unmyelinated C fiber afferents, and indirectly, stimulate the anterior cingular cortex. Superficial DN may also be mediated through stimulation of A-δ fibers, or via stretching of fibroblasts in connective tissue. Superficial DN is associated with reduced local and referred pain and improved range of motion.

Indications for Use:

DN may be incorporated into a treatment plan when myofascial TrPs are present, which may lead to impairments in body structure, pain, and functional limitations. TrPs are sources of persistent peripheral nociceptive input and their inactivation is consistent with current pain management insights. DN also is indicated with restrictions in range of motion due to contractured muscle fibers or taut bands, or other soft tissue restrictions, such as fascial adhesions or scar tissue.

Precautions:

There are certain precautions to be considered with the use of DN:

1. Patients with a needle aversion or phobia may object to the physical therapy treatment with DN. With appropriate education, however, these patients may still consider DN.

2. Patients with significant cognitive impairment may have difficulty understanding the treatment parameters and DN intervention.

3. Patients who are unable to communicate directly or via an interpreter may not be appropriate for DN treatments.

4. Patients may not be willing to be treated with DN.

5. Patients need to be able to give consent for the treatment with DN.

6. Local skin lesions must be avoided with DN.

7. Local or systemic infections are generally considered to be contraindicated.

8. Local lymphedema (note: there is no evidence that DN would cause or contribute to increased lymphedema, ie, postmastectomy, and as such is not a contraindication).

9. Severe hyperalgesia or allodynia may interfere with the application of DN, but should not be considered an absolute contraindication.

10. Some patients may be allergic to certain metals in the needle, such as nickel or chromium. This situation can easily be remedied by using silver or gold plated needles.

11. Patients with an abnormal bleeding tendency, ie, patients on anticoagulant therapy or with thrombocytopenia, must be needled with caution. DN of deep muscles, such as the lateral pterygoid or psoas major muscle, that cannot be approached with direct pressure to create hemostasis may need to be avoided to prevent excessive bleeding.

12. Patients with a compromised immune system may be more susceptible to local or systemic infections from DN, even though there is no documented increased risk of infection with DN.

13. DN during the first trimester of pregnancy, during which miscarriage is fairly common, must be approached with caution, even though there is no evidence that DN has any potential abortifacient effects.

14. DN should not be used in the presence of vascular disease, including varicose veins.

15. Caution is warranted with DN following surgical procedures where the joint capsule has been opened. Although septic arthritis is a concern, DN can still be performed as long as the needle is not directed toward the joint or implant.