Dry Needling – part 1

Dry Needling – part 1

Your Chiropractor has recommended that you consider dry needling, and you have opted to ‘think about it’ before committing. This blog post provides more information on the topic.

Brief history of dry needling?

Dry needling forms part of a broader subject known as Myofascial Pain and Dysfunction Syndrome (MPDS). Dry needling was developed and pioneered by two American medical doctors, Janet Travell and David Simons in the 1950’s. Whilst studying Medicine, Dr Travell realised that identical neuro-musculo-skeletal symptoms were being attributed to different causes, depending on which specialist saw the patient(s). For example, during her time spent in the Neurology department, all arm pains (as an example) were attributed to a pinched nerve.

The identical arm pains in the Cardiology department were attributed to referral from the heart, and in the Orthopaedic department, the same arm pains were due to referral from the shoulder. Dr Travell questioned whether there could be a common denominator instead of all these different causes. After much investigation, she and Dr Simons found the common factor to be the muscles – with attendant trigger points.

Dry needling vs (Traditional) Acupuncture vs IntraMuscular Injection

One of the only similarities is that dry needling and acupuncture use very thin needles without any medication. Yet patients often ask what the difference is between dry needling and acupuncture. The main differences include but are not limited to the following:

  1. Dry needling is generally painful, whereas acupuncture is usually painless.
  2. Dry needling generally uses only one (maybe two) needles at a time, whereas acupuncture uses several needles at once.
  3. Dry needling is generally performed at the site of pain, or close to where the trigger point (TP) may refer to, whereas acupuncture will be performed at the site of pain as well as remotely from that site.
  4. Dry needling is a western medical, scientific technique whereas acupuncture forms part of Traditional Chinese Medicine.
  5. There are no religious connotations related to dry needling, whereas there may / may not be with acupuncture.

Dry needling is different to an injection in that it is not injecting anything, and the needle is not as thick as a hypodermic needle.

What is a trigger point (TP)?

A TP is a ‘knot’ in a tissue. This tissue is most commonly muscle, but TP’s can exist in ligaments, tendons, or periosteum (lining around the bone). One of the clinical features of a TP includes (but is not limited to): being present in a tight, ropey palpable band of tissue. Some authors have stated that TP’s are accumulations of calcium or a collection of nerve endings. Neither of these theories has been shown to be correct. Others have said that TP’s don’t exist as they cannot be seen on an x-ray, ultrasound, or microscope. However, they have actually been identified on electron microscope, where muscle fibrils (which make up a muscle fibre) have been shown to be knotted and matted where the TP is situated.

Clinical findings of a TP

There are approximately 5 clinical indicators for identifying a TP, either when palpating or needling. They are in no particular order:

  1. A Jump Sign. This is usually elicited by the patient, and involves flinching, jumping, screaming, or some other exclamation when the practitioner has located the TP.
  2. A Twitch Response. This is usually seen in a muscle, and involves a sudden twitch of the muscle when the TP is located.
  3. Erythema. This is a reddening of the skin immediately surrounding the TP, usually visible immediately following dry needling.
  4. Reproduction of symptoms. It repeats the symptoms the patient has been experiencing, either local to the TP or remote from there.
  5. Referral of pain. This may be similar to the previous point 4. It occurs either immediately surrounding the TP, or to a distant location that the TP normally refers symptoms to.