Dry NeedlingCarly Holthausen

Clemson University HLTH 4200

December 2015

Introduction.

Dry needling is an invasive, therapeutic treatment for pain in which a trained physical therapists inserts a very thin filament needle into your muscle directly at your myofascial trigger point(s)

Persistent pain causes your nerves to become “sensitized” in your extremities, spinal cord and brain. Dry needling works to deactivate these “sensitized” nerves

The needle is inserted into a trigger point, (potentially) causing a muscle spasm in that location. This type of muscle spasm is called a local twitch response

The twitch response helps break the cycle of pain by stimulating the body’s own healing capabilities (i.e. the anti-inflammatory effect)

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Myofascial Trigger Points (MTP).

Defined as “hyperirritable nodules of tenderness in a palpable taut band of skeletal muscle that can refer pain to a distant point and also causes distant motor and autonomic effects” 

Caused by some muscle fibers shortening and forming taut bands in response to the release of calcium ions from damaged fibers or excessive amounts of acetylcholine from the motor end plate

Persistence of MTrPs in neck and shoulder muscles for long periods will result in

headache neck and shoulder pain dizziness or vertigo limited neck and shoulder range of motion abnormal sensation, autonomic dysfunction, and disability

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MTP Prevalence.

Epidemiological surveys have shown that 30% to 85% of the population in the United States has MTP pain

Often goes undiagnosed Common and significant clinical problem, resulting in 15% of general

medical visits

Types of MTP.

Active – spontaneous and produce local or referred pain to remote structures

Latent - would not produce any symptoms unless evoked by an external stimulant

A recent survey of 72 patients with shoulder pain showed that active MTrPs were prevalent in the infraspinatus (77%) and the upper trapezius muscles (58%), whereas latent MTrPs were prevalent in the teres major (49%) and anterior deltoid muscles (38%)

Treatments for MTP.

Treatment Methods Dry Needling (DN)

Widely used due to simple operation and good efficacy Wet Needling (i.e. lidocaine/local anesthetic injection) Ischemic Compression Physiotherapy Laser Oral medication

Dry Needling Defined.

minimally invasive procedure in which an acupuncture needle is inserted directly into an myofascial trigger point (MTP), with the goal of deactivating the trigger point 32-gauge acupuncture needle inserted into the palpably painful nodule

using a superficial (10-20 mm) or deep (25-40 mm) needling technique

Benefits Immediate reduction in local, referred and widespread pain Restored range of motion and muscle activation patterns Effective in cases where localized treatment may only produce temporary

relief

How DN Works. The exact mechanisms of dry needling are unknown, but there is

scientific evidence that supports the idea that inserting a needle has a positive effect on the electrical and chemical communications that take place in our nervous system

There are mechanical and biochemical effects Biomechanical studies at the National Institutes of Health have shown

that inserting a needle into trigger points can cause biochemical changes that assist in pain reduction

Mechanical this treatment (ideally) elicits a “local twitch response”, a spinal cord reflex, that breaks the pain cycle

Essentially, inserting needles into trigger points in the body stimulates the body’s natural healing response, inhibiting the transmission of pain signals in our spinal cord and increasing the release of our own pain relieving chemicals within our brains

Acupuncture Defined.

“the use of needles inserted into and removed from the human body and the use of other devices, modalities, and procedures at specific locations for the prevention, cure, or correction of any disease, illness, injury, pain, or other condition by controlling and regulating the flow and balance of energy and functioning of the person to restore and maintain health”

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Dry Needling vs. Acupuncture

71% correspondence between MTrPs and acupuncture points HOWEVER trigger points are firmly anchored in the anatomy of the

neural and muscular systems, while acupuncture points are associated with an anatomically non-existent system of meridians, which carry Yin (spirits) and Yang (blood)

DN Effectiveness

Pain reduction, measured using various assessments, is significantly correlated with manipulated MTP status (from active to latent) through dry needling

Treatment has been connected with a significant, clinically relevant reduction in pain compared with baseline values, as well as improvements in mood, function, and ROM

Sources

http://www.sciencedirect.com/science/article/pii/S1356689X15001526 http://www.sciencedirect.com/science/article/pii/S0003999315000039 http://www.sciencedirect.com/science/article/pii/S1556370714000078 http://www.sciencedirect.com/science/article/pii/S1934148215000520 http://www.sw.org/physical-medicine-rehabilitation/dry-needling http://www.lindept.com/dryneedling.pdf