Dry Needling – What is it?

Sep 16, 2019

Now before I tell you what it is, let me tell you that having been in practice now for over 12 years I’ve been to plenty of courses and post graduate classes related to physical therapy that I have used to further my knowledge and expertise in the field.  However, not much has excited me quite as much as what I’ve been learning over the last 3 years with spinal manipulation and dry needling.

I was first introduced to dry needling through Dr. James Dunning of the American Academy of Manipulative Therapy (AAMT) and later was able to complete my Certification in Dry Needling under him and one of his faculty, Thomas Perreault.

When I returned from the first course I felt like a whole new world was opening up to me.  I had not just learned another way to do something, rather I had learned a way to treat the most chronic and unreachable problems that had frustrated my clients and I for so many years! I also realized I could treat the other stuff more quickly and effectively with the addition of this new skill.

So what is it?

Dry needling, as defined by Dunning et al (2014) 1, then is “the insertion of monofilament needles (i.e. without any injectate) into muscles, ligaments, tendons, subcutaneous fascia, scar tissue and in the vicinity of peripheral nerve tissue.”

One of the most exciting aspects of dry needling to me is that I can get deeper than ever before.  I can insert that needle to bypass all the superficial layers and get down to those deeper problematic tissues that you just can’t reach from the outside.

The other key for me, as is suggested by many research studies, is that I can now stimulate not just biomechanical 2-4 but also chemical 5-6, endocrinological 7, vascular 8-9 and microcirculation 9 changes within the pathological tissue.

The effects don’t stop there; increasingly the research suggests dry needling can produce changes within the brain and spinal cord that not only provides pain relief through the body’s natural opioids but can also re-establish the body’s protective mechanisms against pain stimulation in the first place 10.

It sounds like acupuncture?

Although we do use the same needles, it’s important to understand that it is different to Traditional Chinese Medicine (TCM) Acupuncture.  While TCM acupuncture revolves around the movement of “qi” along meridians, dry needling is rooted in the western medical model.  A TCM acupuncturist would evaluate your tongue and pulse to determine where to locate the needles.  In contrast, we would complete a usual physical therapy evaluation identifying painful or involved tissues that we would target.

Another key difference between the two is the pathologies that each profession treats.  While we will only treat neuromusculoskeletal conditions a TCM Acupuncturist will treat a much wider range of pathologies such as stress, smoking cessation and wellness to name a few.

So what can we treat with dry needling?  

In no particular order it can be used as part of a comprehensive treatment plan for low back pain, neck pain, tension headaches, tennis elbow, golfers elbow, knee osteoarthritis, plantar fasciitis, carpal tunnel syndrome, RC syndrome, piriformis syndrome and many others.

The final question most people ask is, “Is it covered by my insurance?”  The simple answer is yes.  All insurances will cover this manual treatment.

Phil Chamberlain, MSPT, Cert. DN

 

  1. Dunning J, Butts R, Mourad F, Young I, Flanagan S, Perreault T. Dry Needling: A literature Review with implications for clinical practice guidelines. Physical Therapy Reviews; 2014: 19 (4), 252-265.
  2. Langevin HM, Bouffard NA, Badger GJ, Churchill DL, Howe AK. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction based mechanism. J Cell Physiol. 2006;207(3):767–74.
  3. Langevin HM, Bouffard NA, Badger GJ, Iatridis JC, Howe AK. Dynamic fibroblast cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo. Am J Physiol Cell Physiol. 2005;288(3):C747–56.
  4. Langevin HM, Churchill DL, Cipolla MJ. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. Faseb J. 2001;15(12):2275–82.
  5. Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008;89(1):16–23.
  6. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99(5): 1977–84.
  7. Ahsin S, Saleem S, Bhatti AM, Iles RK, Aslam M. Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee. Pain. 2009;147(1–3):60–6.
  8. Lee SH, Chen CC, Lee CS, Lin TC, Chan RC. Effects of needle electrical intramuscular stimulation on shoulder and cervical myofascial pain syndrome and microcirculation. J Chin Med Assoc. 2008;71(4):200–6.
  9. Loaiza LA, Yamaguchi S, Ito M, Ohshima N. Electroacupuncture stimulation to muscle afferents in anesthetized rats modulates the blood flow to the knee joint through autonomic reflexes and nitric oxide. Auton Neurosci. 2002;97(2):103–9.
  10. 10.   Dommerholt J. Dry Needling –peripheral and central considerations. J of Manual & Manipulative Therapy. 2011: 19 (4) 223-227.

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