Why has dry needling become so popular recently?

What exactly is dry needling? Isn’t it just acupuncture with a new name? Can it actually help with anything?

Our chiropractor Dr Grant Colombo has prepared this helpful article for your benefit.

Dry Needling | Chiro Health & Rehab Centre, Concord West, SydneyWhat is dry needling?

Musculo-skeletal accupunture/dry needling in essence involves needle penetration at specific sites, resulting in stimulation of surrounding tissues. This in turn evokes several physiological and psychological responses which ideally result in a reduction in musculo-skeletal pain.

Specific sites are generally targeted during needling that are associated with the presence of Myofascial trigger points (MTrp’s). The physician aims to reduce and ideally resolve the presence and effects of these trigger points and return the tissue to its normal function.

Dry Needling | Chiro Health & Rehab Centre, Concord West, SydneyWhat are Trigger points?

There are generally four markers that are considered to classify and/or identify a trigger point:

  • – Taut band within a muscle that is tender to touch
  • – A tender spot in the band found on palpation
  • – The tender spot that may reproduce familiar pain (local or referred pain)
  • – A localised twitch response may appear when needled (doesn’t always occur)

These trigger points can be classified as either active or latent:

Active: Localised or referred pain which is present during rest and mechanical stimulation. Manual stimulation of these points will reproduce familiar symptoms and pain.

Latent: These trigger points are commonly referred to being clinically silent. Symptoms often manifest during strong manual stimulation or needling. Stimulation of these areas may also produce symptoms that are not familiar to the patient.

Musculoskeletal pain is often associated with an area of exquisite tenderness (hyperalgesia) at a trigger point site. These sites present with tenderness due to sensitised nerve endings. The trigger point sites are often accompanied by muscle shortening which can present with pain and increased dysfunction. Spasm and pain inhibition are also commonly associated with the presence trigger points and have the potential to irritate surrounding structures and cause further pain in surrounding and remote areas.

What Causes trigger points?

It has been claimed that trigger points are a major source of pain in approximately 30-85% of patients. Trigger points have been identified in nearly every painful musculoskeletal condition. The precise cause of the formation of trigger points remains poorly understood however evidence suggests that the initial stages consist of the development of tight or contracted muscle fibres. It is believed excessive release of chemicals responsible for muscle contracture then develop as a result of these sustained increases in muscular tension. These taut bands of muscle then seem to remain tight even without the conscious stimulation required to normally initiate a muscular contraction. It is these areas that are actively and passively conveying pain signals felt in a wide variety of musculoskeletal conditions.

Dry Needling | Chiro Health & Rehab Centre, Concord West, SydneyEffects of Needling

One of the effects of inserting a needle into an area of an active trigger point is to produce a local twitch response. When produced what usually follows is a consequent change in in length and tension of affected muscle fibres. Research has shown that as a result of this arousal of mechano-receptive activity there is a bombardment of large sensory input into the pain transmission areas of the spinal cord. It is believed that this influx in sensory input has the gate like effect of blocking passage of pain producing information generated by receptors in trigger point sites. This results in a consequent alleviation of pain.

Further research explained that even superficial skin needling was also able to evoke a pain reduction. It is hypothesized the insertion of the needle into these areas surrounding a trigger point site stimulates pain transmitting nerve fibres, with the consequent release of pain reducing chemicals from inhibitory nerves in the spinal cord. These chemicals (opioid peptides) inhibit the transmission of pain signals conveyed to the spinal cord by sensory nerves from the trigger point site also resulting in a reduction of pain.

Biochemical: Needle penetration causes micro-trauma to tissue cells → triggers the inflammatory process → stimulates the release and influx of Histamine and inflammatory mediators → creates vasodilation, increasing blood flow to area → leukocyte influx to area → promoting phagocytosis and removal or cellular debris → promotion of cellular and tissue repair following removal of needle.

Mechanical: Sensory signals from tissue micro-trauma stimulate the release of endogenous ligands especially Enkaphalins → stimulation and increased secretion of Endorphins and Serotonin from pituitary → activation of descending inhibitory pain mechanism → reduction of symptomatic pain.

What will I feel during needling?

The needle insertion should be relatively painless. In some cases a small prick may be felt. Resistence to the needle will be felt as it enters the tissue layers.  While some people will feel very little depending on sensitivity levels some may feel a muscle ache like pain at the site of insertion or surrounding areas. When a nerve, artery or vein is contacted by the needle filament, a sharp burning, stinging and/or ache may be felt. These may be localised or travel down a specific area innervated by the specific structure in question. This pain should dissipate within treatment and is of no serious concern. Following the removal of the needles the area stimulated may ache and feel as if the area is “corked”. This is a normal response and should only last several hours or up to 24 hours depending on sensitivity levels. Stretching and relaxation techniques should be employed to minimise these effects.

Dry Needling | Chiro Health & Rehab Centre, Concord West, SydneyWhat do we want to happen?

So basically what we as practitioners want to occur is to evoke the localised twitch response. This will not always occur but is a general indication of stimulation of a specific trigger point site. Some people are more sensitive than others and this response may be heightened and easier to elicit while others may never get this response but will still generally receive the benefits of breaking down this taut muscle band.

Just the insertion of the fine needle filament into an affected area will initiated the inflammatory and healing response. This is generally referred to as the tissue micro-damage/repair cycle and will result in an overall reduction of muscular dysfunction and consequent pain.

Both these procedures will work on and initiate the eventual desensitisation of the symptomatic tissues. Reductions in pain and increases in functionality are very commonly elicited after the needling procedures. This is the goal the practitioner will try to achieve and will generally result in a happier and less symptomatic patient.

What’s the difference between acupuncture & dry needling?

Dry needling and acupuncture are often confused. Acupuncture is needling based on the principles of Chinese Medicine where meridian lines and Chi points are involved in the assessment and treatment to enhance energy flow in affected parts of the body. Dry needling has a western medicine basis where principles of neurophysiology and neurochemistry provide the scientific reasoning for the release of trigger points.

By Dr Grant Colombo (chiropractor), October 2016

needling-cartoon

References:

  1. Baldry 2011, Management of Myofascial Trigger Point Pain- ACUPUNCTURE IN MEDICINE 2002;20(1):2-10.
  2. Jan Dommerholt, Bethesda MD Physiocare/Myopain seminars – Dry needling — peripheral and central considerations. Journal of Manual and Manipulative Therapy 2011 VOL. 19 NO 4. p 223-237.
  3. J Dunning, R Butts, F Mourad, I Young, S Flannagan, T Perreault – Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews 2014 VOL. 19 NO. 4 p 252-265.