Dry Needling Literature Review

By

Dr. Mark Rathjen PT, DPT, CSCS

Dr. Claire R. Lakatos-Rathjen PT, DPT, SCS, CSCS

C.O.R.E. Physical Therapy and Sports Performance, PC.

Dry needling is a fairly new modality aimed at diminishing muscle trigger points/pain using a “dry” needle inserted into the muscle trigger point. The purpose of this review is to inform the reader and separate the truth vs myth. At CORE, our treatment is based off the latest research based clinical findings. As a teaching/research facility, we find this attribute to be vital to providing the highest level of care.

This is the typical Trigger point dry needling process of Trigger point Needling.

1.Muscular pain can often refer to many referred pain patterns that can be either proximal or distal to the trigger point. The palpation by a trained professional is needed to find the taut bands and the trigger points.These tigger points can even be seen qualitatively with an MRI. (9)

2. The Therapist then pistons the needle in and out of the trigger point eliciting a twitch response. After any where from 1-5 twitches inside of the trigger point is often enough to release the band and eliminate any muscle knots and trigger points.

3. In more Complicated cases, It may be appropriate to needle distal to the site of the trigger point, still eliciting a decrease and pain and symptoms.(3)

4. After the site has been “cleared” of the twitch response and no palpable band is observed, the therapist is finished needling in that area.

Note : Its important to know that acupuncture and other forms of dry needing is performed in a COMPLETELY different manor and is not similar in any way. Some forms of dry needling do not piston the needle to elicit the twitch response.

At CORE, we exclusively the pistoning/twitch response technique, as it has been more effective and provides faster results in our clinical setting. It is not uncommon to have a decrease is muscular pain by 50% or more in one or two sessions.

This process is usually very quick, easy, minimally invasive and only minimal with discomfort.

Here is what YOU need to know about DRY NEEDLING as per our Literature review and a few of the quick synopsis from various research in the field. If you would choose to follow up and read the entire research articles, references are included.

  • In this study, the results showed a significant decrease in pain immediately after needling, even distal to the actual site of the trigger point. This shows that referred pain can often come from a trigger point above or below the site of a trigger point, and various techniques can be utilized in more complex cases.

“This study demonstrated the remote effectiveness of dry needling. Dry needling of a distal myofascial trigger point can provide a remote effect to reduce the irritability of a proximal myofascial trigger point.” (7.)

  • Dry needling can be more effective if utilizing a deeper needling procedure and protocol, when its appropriate clinically.

Its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews. Dry needling can be used as part of complex treatment for chronic musculoskeletal pain and can be applied by family physicians, rheumatologists, orthopedic surgeons, physiatrists, pain specialists, dentists, and physical therapists.

The deep method of dry needling has been shown to be more effective than the superficial one for the treatment of pain associated with MTrPs. (1) 

  • Another physician writes as a conclusion to his paper regarding dry needling:

“With the increase in research in this field over the past two decades, there are many high-quality studies that demonstrate dry needling to be an effective and safe method for the treatment of myofascial pain when diagnosed and treated by adequately-trained physicians or physical therapists.” (2)

  • A Recent Study from 2012 Concludes the following, showing various intervention approaches may be viable in more complicated cases;

“ …recent study demonstrated that distal muscle needling reduces proximal pain by means of the diffuse noxious inhibitory control. Therefore, in a patient too sensitive to be needled in the area of the primary pain source, the treatment can be initiated with distal needling.” (3.)

  • A recent meta analysis from 2013 concluded the following after a literature review on a significant amount of related dry needling research;

“Based on the best current available evidence (grade A), we recommend dry needling, compared to sham or placebo, for decreasing pain immediately after treatment and at 4 weeks in patients with upper-quarter MPS”.(4.)

  • Another physician led study concluded the following in the results analysis;

“This study provides evidence that dry needle–evoked inactivation of a primary (key) MTrP inhibits the activity in satellite MTrPs situated in its zone of pain referral. This supports the concept that activity in a primary MTrP leads to the development of activity in satellite MTrPs and the suggested spinal cord mechanism responsible for this phenomenon.” (5.)

  • In regards to chronic back pain, one such study concludes;

“TrP and paraspinal dry needling is suggested to be a better method than TrP dry needling only for treating myofascial pain syndrome in elderly patients”. (6.)

  • One final study regarding Chronic low back pain shows significant effect short and longer term:

“The group that had been treated with needling was found to be clearly and significantly better than the control group (P > 0.005, N = 53) with regard to status at discharge, status at 12 weeks’ follow-up, and status at final follow-up. At final followup, 18 of the 29 study subjects had returned to their original or equivalent jobs and 10 had returned to lighter employment. In the control group, only four had returned to their original work and 14 to lighter employment; nine were still disabled. The results seem to justify the procedure in chronic low-back patients in whom myofascial pain (the majority) rather than skeletal irritation is the dominant disabling feature. (8.)

In Summary, 

Dry needling is safe, effective, and provides fast results from trigger point pain. It can be very well tolerated in various areas and muscle groups around the body.  The literature on the topic is varied, and still in its infancy, so the evidence is still at a moderate level, but MOST of the research is promising and has shown good significant efficacy in the realm of research.

It is important to remember, needling does not solve all trigger point issues, as sometimes the trigger points are a result of an asymmetry, imbalance, postural deficits or rotational forces of the spine. A quality Doctor of Physical Therapy should use needling in CONJUNCTION with a treatment plan to insure long term relief of pain, and increased  physical function for years to come.

References

(1.) Dry Needling in the Management of Musculoskeletal Pain

Leonid Kalichman, PT, PhD and Simon Vulfsons, MD

(2.) J Back Musculoskelet Rehabil. 2015;28(1):173-9.

Efficacy of dry needling for treatment of myofascial pain syndrome.

Fogelman Y, Kent J.

(3.) Myofascial Pain (Rd Gerwin, Section Editor)

Current Pain and Headache Reports

October 2012, Volume 16, Issue 5, pp 407-412

Trigger Point Needling: Techniques and Outcome

Simon Vulfsons , Motti Ratmansky, Leonid Kalichman

(4.)Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis

Authors: David M. Kietrys, PT, PhD, OCS1, Kerstin M. Palombaro, PT, PhD, CAPS2, Erica Azzaretto, PT, DPT3, Richard Hubler, PT, DPT4, Bret Schaller, PT, DPT5, J. Mathew Schlussel, DPT, Mary Tucker, PT, DPT6

Published: Journal of Orthopaedic & Sports Physical Therapy, 2013 Volume:43 Issue:9 Pages:620–634 DOI: 10.2519/jospt.2013.4668

(5.) American Journal of Physical Medicine & Rehabilitation:

May 2007 – Volume 86 – Issue 5 – pp 397-403

Dry Needling to a Key Myofascial Trigger Point May Reduce the Irritability of Satellite MTrPs

Hsieh, Yueh-Ling PhD, PT; Kao, Mu-Jung MD; Kuan, Ta-Shen MD, MS; Chen, Shu-Min MD; Chen, Jo-Tong MD, PhD; Hong, Chang-Zern MD

(6.)The Journal of Alternative and Complementary Medicine

Dry Needling of Trigger Points with and Without Paraspinal Needling in Myofascial Pain Syndromes in Elderly Patients

Published in Volume: 13 Issue 6: August 25, 2007

(7.) American Journal of Physical Medicine & Rehabilitation:

February 2010 – Volume 89 – Issue 2 – pp 133-140

doi: 10.1097/PHM.0b013e3181a5b1bc

Remote Effects of Dry Needling on the Irritability of the Myofascial Trigger Point in the Upper Trapezius Muscle

(8.) Dry Needling of Muscle Motor Points for Chronic Low-Back Pain: A Randomized Clinical Trial With Long-Term Follow-Up.

GUNN, C C MA, MB, BChir; MILBRANDT, W E MD; LITTLE, A S MD; MASON, K E BSc, MSc

(9) Arch Phys Med Rehabil. 2016 Jan;97(1):67-73. doi: 10.1016/j.apmr.2015.09.019. Epub 2015 Oct 14.

Quantification of Myofascial Taut Bands.

Chen Q1, Wang HJ1, Gay RE2, Thompson JM2, Manduca A3, An KN1, Ehman RE3, Basford JR4.