Here is a link to the full article:
Since my first day at Maven I have
been intrigued by the application of dry needling. In school, I have learned
other techniques to address pain, but was never introduced to the dry needling
route. So naturally, I had to do a little more research to look into dry
needling to try and understand the application and process better.
The article I found to further
investigate dry needling was a clinical narrative review. A clinical narrative
review is just a fancy way of saying it is a story written by a clinician to
describe a clinical event or situation based on other research on that topic. The
clinical review I found was conducted by Leonid Kalichman PT, PhD and Simon
Vulfsons, MD. This study summarized the different methods of dry needling, and
it’s effectiveness discussed in other studies.
Myofascial pain is pain that arises
from the muscles or is related to the fascia and is commonly associated with
myofascial trigger points. Fascia is a layer of fibrous connective tissue that
surrounds muscles, groups of muscles, blood vessels, and nerves throughout the
body. Fascia can help bind structures together as well as permit smoother
movement over one another. Trigger points are highly localized, hyperirritable
spots in a taut band of skeletal muscle fibers. When a muscle trigger point is
stimulated, referred pain or a local twitch response can be elicited. Referred
pain is when pain is perceived at a location other than the site of the painful
stimulus. Muscle trigger point pain is a very common primary source of pain in
the United States. For example, muscle trigger points were the primary source
of pain in 74-96% of patients with musculoskeletal pain in an outpatient
physical therapy setting. Also, 85% of 283 patients with chronic head and neck
pain had active muscle trigger points. Many non-invasive methods like
stretching, massage, heat, electric stimulation, and prescription medications
have been used to address and alleviate chronic myofascial pain. However, no
single application of the listed treatments has been proven to be 100%
successful. Another way to treat myofascial pain is dry needling, a minimally
invasive procedure where acupuncture needle is inserted directly into a muscle
trigger point.
Dry Needling Methods: Dry needling was developed as a method to
treat musculoskeletal disorders. In numerous studies prior to this article, it
was found that dry needling was just as effective, if not more effective than
injections like corticosteroid shots. The two most common concepts of dry
needling are the radiculopathy and muscle trigger point models, radiculopathy
referring to a condition in which more than one or more nerves do not work
properly. Radiculopathy can result in pain, weakness, numbness, and/or
difficulty to control specific muscles. The radiculopathy model is based on the
idea that myofascial pain syndrome is always the result of peripheral
neuropathy or radiculopathy. The muscle will shorten and therefore create pain
and development of taut bands with muscle trigger points. An example of the
radiculopathy dry needling model is if the back muscles were shortened,
vertebral disc compression would occur, narrowing the discs between the
vertebrae and narrow the tunnels where the nerves run through, creating a
pressure that will ultimately results in a radiculopathy. According the muscle
trigger point model of dry needling, the effect of the needle insertion is
primarily caused by the mechanical stimulation of the muscle’s trigger point
with the needle. Dry needling a muscle trigger point is most effective when a
local twitch response at the site of stimulation is created. After the muscle
finishes twitching, pain and dysfunction decrease dramatically.
Effectiveness of Dry Needling in the Management of Muscle Trigger
Points: Many studies have looked at the effectiveness of dry needling for
muscle trigger point management and have found that direct needling of muscle
trigger points are an effective treatment to reduce pain compared to no
intervention at all. A common area of interest for dry needling studies is in
the low back since it is a very prevalent site for pain. From 35 studies that
used dry needling as an intervention to address low back pain, all found dry
needling to decrease pain and improve functionality of those who suffered from
chronic low back pain. Not only were the positive effects noticed immediately
at the end of the session, but at a short-term follow up of 8 weeks and a
long-term follow up of 20 weeks. This supports that dry needling has positive
long-term effects.
Deep vs. Superficial Needling: Initially, dry needling was done
when the needle was inserted superficially to the tissue immediately overlying
the muscle trigger point and was shown to have positive results, like a
decrease in sensitivity, even for the treatment of trigger points in deeper
muscles. Superficial dry needle insertion was seen as an easier procedure to
carry out because there was less pain experienced compared to deep dry
needling, minimal risk of damage to nerves, and blood vessels, as well as a
lower incidence of soreness after treatment. Two studies recently looked at the
effectiveness of superficial dry needling in combination with active stretching
exercises, stretching exercises alone, or no treatment at all. After 6 weeks of
the selected interventions for each group, the superficial dry needling and
stretching group had significantly less pain compared to the stretching group
and no intervention group.
Some studies have explored the idea
of comparing superficial dry needling to deep dry needling. In a study that
looked at anterior knee pain, pain measurements decreased significantly in both
groups and remained low at both 3 and 6 months. In another study that compared
superficial and deep dry needling for myofascial lumbar pain, there was no
difference in decrease of pain between the groups at the end of the treatment,
however, at a 3 month follow up, the deep dry needling group had significantly
better pain that the superficial dry needling group. These studies show that
not only is deep dry needling is just as effective as superficial dry needling,
but also can have great long-term effects. This can be due to the fact that the
pain receptors in the muscles are deep, and will respond better to the deep dry
needling technique.
Conclusion: Overall, from this article, I found that the
effectiveness of dry needling as a treatment option for myofascial pain and
muscle trigger point pain has been confirmed to be successful in many studies
prior to this article. Also, the deep dry needling method has been shown to be just
as effective, if not more effective, than the superficial dry needling
technique. The final suggestion from this article is the need for additional
research to further evaluate the effectiveness of dry needling as well as dry
needling techniques. So stay tuned!
