By Carel Wildenboer PHYSIO’S
Dry needling uses the same needles as traditional acupuncture, but is backed by a different philosophy. I have seen some amazing outcomes with the use of dry needling. It is important to note, however, that dry needling is best used in conjunction with thorough education about the injury, and a rehabilitation plan that covers exercise based recovery as appropriate.
What is dry needling used for?
Dry needling targets muscle tissue, and its nerve connections, so any conditions where muscle pain or tightness is an issue could potentially benefit. This may include such things as neck tension, headaches, back pain, tennis elbow, ITB friction syndrome, shoulder conditions or shin pain.
Dry needling is very safe for most people (it should not be used during pregnancy, or in a few other medical situations). The needles are very fine, and you barely feel them go in. Once the needle is in, people sometimes feel some aching; others feel not much at all. On occasion the needle may cause a small muscle twitch, which is a great sign that the needling will have a positive effect on relaxing the muscle.
How does dry needling work?
One of the aims of dry needling is to provide pain relief. Most common pain impulses are carried by type C nerve fibres. Dry needling stimulates more type A nerve fibres. Type A fibres conducts much quicker that type C. Our brain can only interpret a fixed amount of sensory input at a time. This is described as a gate and only so many impulses can pass through at a time, the rest doesn't get through. Therefore if we overload the system with A fibres from needling it has the effect of blocking large amounts of C fibres. They therefore never reach the brain and you feel less pain. This is commonly referred to as the 'Gate Control Theory of Pain.' By blocking the pain the associated muscle spasm will relax.
Needling also stimulates the release of certain natural opoids like endorphins in the brain stem and spinal cord. These opoids provide natural analgesia.
With needling we also aim to cause microtrauma in the tissue. This is in the form of slight bleeding/bruising. This would bring oxygenated blood and nutrients to structures (like tendons) that generally have a poor blood supply and therefore heal slowly. The bruising also triggers a response in the cells to start the normal healing process to resolve the bruising, this then also adds to healing the injury quicker. It basically tells your body that there is an injury and helps to start the process to heal it again.
Dry needling targets trigger points in muscles. A trigger point is a hypersensitive region within a muscle (like those tender ‘knots’ or lumps that you can feel when you are stressed!). With muscle trigger points or knots there is associated nerve abnormalities. Our nerves are electrical structures that gets polarised (triggers muscle contraction) or depolarized (muscle relaxes). With trigger points the nerve becomes permanently polarised and is unable to depolarize. The needle ruptures numerous cells as it enters the tissue. This results in a lot of positively charged Calcium to be released in the area which can have a immediate depolarizing effect on the nerve. This is normally associated with the muscle twitching as it relaxes.
In traditional acupuncture, the needles are not necessarily placed into trigger points, but rather points along energy channels in the body. These ‘meridians’ or energy channels follow the eastern philosophy, and are therefore not in regular anatomy texts. I believe that acupuncture can be very effective however I prefer the more scientific application of dry needling and use it regularly in my practice.
When do I feel better?
For the rest of the day after a dry needling session, your muscles can feel achy and tired, a bit like they have done a big workout at the gym. It is a good idea to drink plenty of water, and rest if tired. If you are used to the needling, it should be fine to continue your normal sport that day, but after your first time, you may choose to take a day off.
Some people feel better straight away, others feel better a day or two later, and some (only a few I hope) may not feel much change. If your condition is ongoing/chronic, regular dry needling may be an effective way of managing it. For most people a course of 3 to 6 treatments can make considerable changes in muscle tension. For the lucky ones, a single session will sort them out.
Does it hurt?
The needles we use in dry needling is very thin solid needles (not hollow like injection needles). Therefore it makes a much smaller hole which hardly ever bleeds. It is however a needle and you will feel a bit of a needle prick. Then normally you feel a dull ache as we hit the trigger point. You can also feel occasional twitch in the muscle as it releases. Or most patients it is hardly painful. For those patients with a phobia for needles it may be very painful. I normally suggest using other treatment options for those patients.
What are the risks?
-The main risk with dry needling would be a pneumo-thorax due to a needle entering the lung. There is only a risk when needling over the chest area. This however should never happen if a trained physiotherapist is doing needling on a patient. There are specific safety precautions that we follow to ensure absolute minimum risk. All our physiotherapists are trained in Dry Needling.
- With any needle there is a risk of infection. Proper precautions are taken to minimise the risk.
These are the main risks involved and we have never had a case in my practice for as long as we have been in practice.
If you have any further questions please feel free to contact us and we can explain it in more details.