Dry needling: a review with impact on clinical practice
Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin, and encompasses stimulation of underlying neural, muscular and connective tissues. The proposed working mechanism is as follows: "The inserted and manipulated needle elicits a local twitch response (LTR) that subsequently provides a very strong neural impulse to break the vicious cycle so that pain is relieved".
Mechanical, chemical, endocrinological, microvascular, neural and central effects of dry needling have been extensively described.
Dry needling is different from traditional Chinese acupuncture; it neither attempts to move qi along meridians, nor does it rely on diagnoses from traditional Chinese acupuncture or Oriental medicine, like bi syndrome or blood stagnation. However, the procedures, locations and techniques are very similar, and 93,3% of common MTrPs corresponds with classical acupoints, just as myofascial referred-pain patterns correspond with acupuncture meridians.
Recently, in the US the definition of dry needling has been narrowed to an intramuscular procedure, the insertion of needles into MTrPs.
This review aims to evaluate the extensive body of evidence on the technique, and to argue for a wider definition and indicaton of dry needling, to benefit from the many treatment effects.
Local injection therapies, often referred to as ‘wet needling’, use hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, ‘dry needling’ refers to the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate. Dry needling is typically and historically used to treat muscles, ligaments, tendons, subcutaneous fascia, scar tissue, peripheral nerves, and neurovascular bundles for the management of a variety of neuromusculoskeletal pain syndromes.
The APTA defined dry needling in 2013 as "intramuscular manual therapy (IMT) or "triggerpoint dry needling (TDN)": "insertion into areas of the muscle known as trigger points", thereby limiting physiotherapists' scope of practice. However, there is very limited evidence that TDN has an effect when compared to standard care. Inter-examiner reliability of manual palpation of trigger points is very poor, as are the clinical diagnostic criteria for trigger MTrPs identification.
Moreover, an extensive body of evidence exists to support the use of dry needling beyond MTrPs; targeting muscular, neural and connective tissues. The wider dry needling technique is effective for the reduction of pain and disability in knee OA, hip OA, piriformis syndrome, CTS, migraine, tension-type headache, temporomandibular disorder, shoulder pain, neck pain, low back pain en plantar fasciitis.
Just as the Maitland, Kaltenborn, and McKenzie approaches are unique brands of manual therapy, so is ‘TDN’ and ‘IMT’ to dry needling. They provide a single framework or paradigm within the much broader field of dry needling. By limiting the scope of practice, APTA is limiting effect of treatment.
What is your experience and training with dry needling and for what indications do you use the technique?
> From: Dunning et al., Phys Ther Rev 19 (2015) 252-265. All rights reserved to W. S. Maney & Son Ltd.. Click here for the Pubmed summary.