Dry Needling

Dry Needling is a cost effective and efficient technique for the treatment of
myofascial pain and dysfunction. The approach is based on Western anatomical and neurophysiological principles.

Dry needling should not be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture.

Physicians Dr Travell and Simons defined a myofascial trigger point as a “Hyperirritable spot in a skeletal muscle.” The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena.

Myofascial trigger points (MTrPs) are commonly seen in both acute and chronic pain conditions. Hendler and Kozikowski cite Myofascial trigger points as the most commonly missed diagnosis in chronic pain patients.

Over the years it has been shown that it is possible to deactivate TrPs by injecting them with a large number of disparate substances (Lu & Needham 1980) The only reasonable inference drawn from this is that the pain relief obtained is not dependent on the specific properties that the substance may contain but rather on the stimulation of the needle used for the injection itself.

One of the first physicians to employ Dry Needling extensively for this purpose was Dr Karel Lewit of Czechoslovakia . Lewit (1979) reported favourably on the use of this technique in a series of 241 patients with musculoskeletal pain. The work of Hong and Jennifer Chu support Lewitt’s work and emphasize the therapeutic importance of eliciting a LTR (local twitch response).

Dry Needling may mechanically disrupt the integrity of the dysfunctional endplates within the trigger area – resulting in mechanical and physiological resolution of theMTrPs. A fascinating new study by Jay Shah shows biochemical changes in the MTrPs following twitch elicitation. This was done by real time blood micro- sampling of the MTrPs as it was needled.

Many years of work by Drs David Bowsher and Peter Baldry amongst other show a strong pain inhibitory role played by Opioids released by needling stimulation of A delta receptors.

Dr Chan Gunn in his I.M.S. approach and Dr Fischer in his segmental approach to Dry Needlingstrongly advocate the importance of clearing MTrPs area in both peripheral and spinal areas.

Today many Medical doctors, Physiotherapists, Chiropractors and Acupuncturists are using Dry Needling effectively and extensively within their practices for the treatment of Myofascial Pain & Dysfunction.

Treatment

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. Deep dry needling for treating trigger points was first introduced by Czech physician Karel Lewit in 1979. Lewit had noticed that the success of injections into trigger points in relieving pain was apparently unconnected to the analgesic used.

Proper dry needling of a myofascial trigger point will elicit a local twitch response (LTR), which is an involuntary spinal cord reflex in which the muscle fibers in the taut band of muscle contract. The LTR indicates the proper placement of the needle in a trigger point. Dry needling that elicits LTRs improves treatment outcomes, and may work by activating endogenous opioids.

Why do I need it?

Dry needling can be used to treat many musculoskeletal conditions.  It is very important to realise that using the technique outside of a balanced, professionally designed treatment regime that includes therapeutic exercise, manual therapy and patient education is not desirable.  That said, the technique is effective in treating back and neck pain, muscle strains, tight and painful scars, headaches, shoulder pain, and a myriad of other problems related to the muscles, pain and how the body copes with these.