Dry Needling is a technique physical therapists use (where allowed by state law) for the treatment of pain and movement impairments. The technique uses a “dry”needle, one without medication or injection, inserted through the skin into areas of the muscle.

Other terms commonly used to describe dry needling, include trigger point dry needling, and intramuscular manual therapy.

Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles, and supported by research 1.

What is a Trigger Point?
A trigger point is a taut band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch, and touching a trigger point may cause pain to other parts of the body.

What Kind of Needles Are Used?
Dry needling involves a thin filiform needle that penetrates the skin and stimulates underlying myofascial trigger points and muscular and connective tissues. The needle allows a physical therapist to target tissues that are not manually palpable.

Physical therapists wear gloves and appropriate personal protective equipment (PPE) when dry needling, consistent with Standard Precautions, Guide to Infection Prevention for Outpatient Settings, and OSHA standards. The sterile needles are disposed of in a medical sharps collector.
Why Dry Needling?
In cases when dry needling is used by physical therapists, it is typically 1 technique that’s part of a larger treatment plan that could include stretching, exercise, and massage.

Physical therapists use dry needling with the goal of releasing or inactivating trigger points to relieve pain or improve range of motion. Preliminary research 2 supports that dry needling improves pain control, reduces muscle tension, and normalizes dysfunctions of the motor end plates, the sites at which nerve impulses are transmitted to muscles. This can help speed up the patient’s return to active rehabilitation.

How does Dry Needling Work?

An overused muscle undergoes “energy crisis” when it has been contracted for prolonged periods or with inappropriate contraction (as in whiplash where it occurs quickly and as a reaction). When in this crisis, the muscle fibers are no longer getting adequate blood supply, including oxygen and nutrients. If a muscle does not receive the oxygen and nutrients it needs, it will not allow the muscle to go back to its normal resting state thus staying in its contracted state.  This then creates a reaction to the nerves around the muscle becoming more sensitized and painful.

By using a needle to stimulate a trigger point within the contracted muscle, it helps to draw normal blood supply back to release the tension by flushing out the area. In addition, the prick sensation of the needle helps stimulate nerve fibers that send signals to the brain to release endorphins, which are the body’s own pain medication.

As part of their entry level education, physical therapists are well educated in anatomy and therapeutic treatment of the body. A physical therapist will use palpation skills to find the areas of trigger points, required for the most effective treatments. After inserting the needle, they may palpate around with the needle to find the most tightness in the trigger point or even get a muscle twitch indicating the muscle is responding. Physical therapists who perform dry needling supplement that knowledge by obtaining specific postgraduate education and training. When contacting a physical therapist for dry needling treatment, be sure to ask about their specific experience and education.

References
Cummings MT, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82(7):986–992. Free Article.
Kalichman L, Vulfsons S. Dry needling in the management musculoskeletal pain. J Am Board Fam Med. 2010;23(5):640–646. Free Article.

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