History
Dry needling is the use of solid filiform needles for therapy of muscle pain, sometimes also known as intramuscular stimulation. The term dry needling used to differentiate the use of needling in a western physiological paradigm from the use of needling in an oriental paradigm which is referred to as acupuncture. Deep dry needling for treating trigger points was first introduced by Czech physician Karel Lewit in 1979.
What is dry needling?
Dry needling is the use of solid filiform needles for therapy of muscle pain, sometimes also known as intramuscular stimulation. Acupuncture and dry needling techniques are similar. Although the needles used have been called “acupuncture needles” and were described as such in the Huang Di Nei Jing in the Han dynasty and at one time were manufactured for use by acupuncturists they are now more properly referred to as solid filiform needles and are used in both procedures. Dry needling contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or corticosteroids to the same point. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue. Analgesia produced by needling a pain spot has been called the needle effect.
Dry needling for the treatment of myofascial (muscular) trigger points is based on theories similar, but not exclusive, to traditional acupuncture; however, dry needling targets the trigger points, which is the direct and palpable source of patient pain, rather than the traditional “meridians”, accessed via acupuncture. The distinction between trigger points and acupuncture points for the relief of pain is blurred. As reported by Melzack, et al., there is a high degree of correspondence (71% based on their analysis) between published locations of trigger points and classical acupuncture points for the relief of pain. What distinguishes dry needling from traditional acupuncture is that it does not use the full range of traditional theories of Chinese Medicine. Dry needling would be most directly comparable to the use of so-called ‘a-shi’ points in acupuncture. The debated distinction between dry needling and acupuncture has become a controversy because it relates to an issue of scope of practice of various professions.
Técnica
In the treatment of trigger points for persons with myofascial pain syndrome, dry needling is an invasive procedure in which a filiform needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle.
Chan Gunn introduced a type of dry needling called intramuscular stimulation in the 1980s that moved away from using trigger points. Gunn believed that the peripheral muscle spasm was not the origin of pain, but instead a tight multifidi was causing spinal nerve compression, radiculopathy, and nerve damage running peripherally. This spinal nerve damage eventually reached the associated muscle, causing spasm and transformation to a trigger point. Therefore, Gunn recommended a needle be placed in the paraspinal muscles in addition to the distally affected muscle. Peter Baldry developed a version called superficial dry needling in 2005, in which the needle is inserted about 5–10 mm into the tissue above the trigger point. Baldry practiced deep dry needling until he had a patient in the early 1980s with a trigger point in his anterior scalene muscle. Baldry decided to only penetrate the skin for fear of puncturing a lung. Baldry has such success with this technique that he applied it throughout the body by simply puncturing the skin superficially over a trigger point without actually reaching it.
Indications
There is a growing number of studies using dry needling alone for the treatment of various conditions, confirming the good results. For example, dry needling is used successfully in the treatment of:
- Shoulder myofascial pain
- Hemiparesis shoulder pain
- Chronic impingement syndrome (impingement)
- Brachialgia caused by PGM in the infraspinatus muscle
- Alterations in motor activation patterns of the shoulder
- Low back pain
- Radiculopatias cervical and lumbar
- Chronic neck pain caused by whiplash
- Neck pain sensation concomitant with respiratory distress
- Chronic postsurgical thoracic myofascial pain
- Chronic knee pain myofascial
- Idiopathic anterior knee pain
- Chronic pain in patients with foot arthrodesis
- Pain and dysfunction of the temporomandibular joint
- Chronic myofascial pain in different locations
- postherpetic pain
- migraines
- tension headaches
- chronic headaches
- Incomplete quadriplegia spasticity in cerebral palsy