Validity of Dry Needling

This entry was written by Valerie Lanza SPT (Student from University of the Sciences in Pennsylvania)  based on a research paper by Dr. Leonid Kalichman, PT, PhD and Simon Vulfsons MD. Edited by David Kwon, DPT, CSCS.

Here is a link to the full article:

Dry Needling in the Management of Musculoskeletal Pain

Article Citation: Kalichman L, Vulfsons S. Dry Needling inthe Management of Musculoskeletal Pain. JABFM.2010;23(5):640-646.

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!