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I graduated from PT school in Boston, MA in 2010 and entered the workforce feeling like I knew everything a PT needed to know. After about 30 seconds of working I realized I knew next to nothing 🙂

PT school is fantastic for getting you ready for the BOARDS and to understand the basics, but I knew I was going to have to invest much of my own time and money in order to become the physical therapist I knew I wanted to be. I have taken countless courses in manual therapy, sports and orthopedic management, running and crossfit related courses and after working in physical therapy for almost 10 years I finally had the ability to get educated in and certified in dry-needling. My whole professional world changed at that moment.

What Is Dry Needling?

Dry needling is a treatment that involves inserting a thin mono-filament needle, without the use of injecting medications, into muscles, ligaments, tendons, subcutaneous fascia and scar tissue. The needles can also be inserted into peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromuscular pain syndromes. Physical Therapy uses the dry-needling to target intra-myofascial trigger Points MTrPs to alleviate myofascial pain. Needles are typically left in for 10-30 minutes and typically connected with electrical stimulation, electroacupuncture.

Several studies have demonstrated the ability of dry needling to cause immediate improvements in musculoskeletal pain by targeting these trigger points and eliciting a local twitch response. The proposed mechanisms of pain relief supported by research include:

• Normalization of local chemical environments surrounding active trigger points.

• Activation of our body’s natural opioid pain controlling pathways.

• A local increase in blood flow to create a “washout” effect and reduce inflammation.

• This treatment results in an anti-inflammatory immune reaction, decreases muscle tension, and leads to self-healing and internal balance

• Promote tendon healing by increasing collagen proliferation.

These effects of dry needling have been demonstrated across orthopedic, neurologic, sports, and post-surgical populations to improve range of motion, pain, performance, and increase local blood flow and oxygenation to surrounding tissues.

I often get asked if it is the same as acupuncture…

Both dry needling and acupuncture use a similar instrument (a needle) to perform a treatment. Acupuncture is literally translated into “needle penetration”. There are many techniques that are shared procedures among a variety of healthcare professions. The use of dry needles by a physical therapist does not make them an acupuncturist just as the use of corrective exercise work by a chiropractor does not make them a physical therapist.

BUT the philosophies and reasoning behind why the treatment is being performed are vastly different.

• Acupuncture is based in Eastern medicine and uses needles to balance “chi”, which is defined by acupuncturists as “life’s energy”.

• Acupuncturists believe chi travels through channels, or meridians, and that this flow can become stagnant or disrupted resulting in illness and disease.

• Acupuncturists insert needles into very specific points along the patient’s meridians to re-establish the flow of chi and these points do not change from person to person or based on how/where the patient’s symptoms are presenting.

• Acupuncture points are associated with an ancient conceptual but anatomically non-exist system of meridians which carry Yin (spirits) and Yang (blood).

• Dry needling is based in Western medicine and uses needles to stimulate trigger points within the muscle.  It is very anatomically specific and closely associated with the location of patient symptoms. TrP are firmly anchored in the anatomy of neural and muscular systems.

Click to watch a sped up video that demonstrates one method to perform dry needling for neck pain

What Exactly Is A Trigger Point?

Commonly described as a taut band of skeletal muscle located within a larger muscle group, trigger points fall into 2 categories, active or latent. An active trigger point is described as a palpable nodule that can cause local or referred pain without being touched or pressed on, and a latent trigger point is essentially the same thing only it does not cause any symptoms except when pushed on.

Several theories exist in the scientific community regarding how trigger points form and what exactly their role is in the development of pain. Some of these theories include:

• Sustained low level muscle contractions associated with stress and postural strain can lead to the formation of trigger points due to increased low level muscle contractions which can be a leading source of pain.

• Another theory as to why trigger points form that I commonly experience in the clinic is direct trauma. Whether this is calf pain from trying to hit a PR on your 5K, shoulder pain from performing MURPH, or hip pain while training for your first 70.3, this trauma can lead to the formation of trigger points causing significant pain to continue after normal soreness subsides.

When inserted into a TrP the needle elicits a local twitch response that subsequently provides a very strong neural impulse to the TrP circuit to break the vicious cycle so that the pain is relieved.

Who can benefit from Dry-needling?

Really anyone as long as there are no contra-indications. There are a variety of different pain cycles and tissue diagnoses that can greatly benefit from TrP DN. These include but are not limited to the following:

Knee OA

Lateral Hip Pain

Plantar Fasciitis

Achilles Tendinopathy

Hamstring Tendinopathy

Runner’s knee

Low back pain

Neck pain

Cervicogenic headaches

Shoulder pain

Golfer’s elbow

Tennis Elbow

Carpal Tunnel

Dry-needling may sound incredible but it is not a magic pill. While it can give you quick relief, it is only a small part of the puzzle. It is a great tool in the hands of a skilled physical therapist to alleviate pain that would otherwise keep you from sleeping, moving or performing an exercise and help propel you forward on the road to healing.

BUT, the biggest benefit will come from education on where the injury originated from, mobility, strength, and overall health to keep your injury from returning.

If you live in Orlando and are curious on how you might benefit from dry-needling and physical therapy please give us a call today at 407-476-6613

Rebecca Smith, PT, DPT, Cert-DN, TPI M2

References: Dunning et al. Dry Needling: A literature review with implications for clinical practice guidelines. Physical Therapy Reviews 2014 Vol. 19 (No. 4) 252-260