Dry Needling – part 2
Who should perform dry needling?
This question is best answered by asking which Health Care Professional (HCP) has the most expertise in the field of Myofascial Pain and Dysfunction Syndrome (MPDS) and dry needling. South African (SA) trained Chiropractors study for 6 years and are the only HCP’s to study the subject of dry needling at undergraduate level. The subject of MPDS is commenced in third year, and includes thorough, intensive training in dry needling. This means that before Chiropractors qualify, they have had a minimum of 4 years honing these and other skills, before being allowed to treat members of the public.
There are other HCP’s who have a working knowledge of dry needling and perform it. However, this training is not performed at undergraduate level, and is commonly undertaken during short weekend courses post-graduate. Typically, this involves commencing with an introductory module, followed by a neck / back / extremity module conducted over ensuing weekends. These HCP’s then continue practicing these skills on their own patients over the proceeding month(s), followed by a further weekend course, and so forth.
As patients, it is important when deciding who to see for this procedure that one choose the HCP with the most expertise. If the foregoing information isn’t enough to convince the reader, then the following analogy hopefully helps settle this. When one is looking to change a light fitting in your home (not just the light bulb), does one ask one’s plumber who has a working knowledge of some electrical work?, or does one ask the electrician? Of course most of us will ask the electrician, as (s)he is the expert! Choosing a HCP to perform your dry needling should be no different.
Effects of dry needling
Dry needling has several effects on the trigger point (TP) and remote to that. It causes the following:
- Relief of muscle spasm.
- An endorphin rush, usually in the area being needled, which usually causes a numbing effect in the region. Endorphins are our body’s natural pain killers.
- An ‘ún-bundling’ of the matted, knotted area of the TP in the muscle.
- An effect via the gate control theory* at a cerebral level. Simply, the ‘new’ stimulus of dry needling “closes the gate” on the original stimulus of pain.
Are there different types of dry needling?
There are several methods of administering dry needling. Not one of these techniques has been shown to be more effective than another. These include (but are not limited to) the following:
- Fanning technique: this involves the needle being inserted and then fanned around whilst within the tissue.
- Static dry needling: the practitioner inserts the needle into the TP and leaves it in situ for a few seconds / minute(s).
- Twirling: similar to static needling with the addition of twisting the needle when inside the TP.
- Combination of static & twirling.
- Electrical stimulation: this involves the needle being inserted and having an electrical current applied to the top of the needle for several minutes.
What does one feel when being dry needled?
You should feel a small pin prick from the needle being inserted into your skin. Depending on the specific technique used by your Chiropractor (noted above), you may feel a twitch of the muscle, and some pain. Ideally, this should reproduce the pain (or other symptoms) you’ve been experiencing, or the area you’ve been experiencing these symptoms in.
How many treatments of dry needling can you expect?
This will vary. However, the average number of dry needling treatments required for most neuro-musculo-skeletal symptoms is approximately 4 to 5 treatments. Most patients require less.
What should you do after you’ve been dry needled?
Your Chiropractor should show you relevant stretches and recommend that you ice the needled region at home. It is important that you do this, as it assists the healing associated with the dry needling for optimal recovery.
What are the risks associated with dry needling?
There are generally very minimal risks associated with dry needling when performed by a trained HCP. However, there are some minor signs and symptoms, like post-treatment soreness, and mild bruising around the site needled (not dissimilar to an injection site). On occasion, fainting may occur. In a minority of patients, you may feel clammy / sweaty, cold, happy, or tearful. All these side effects are temporary and usually disappear quickly.
If you’re being treated in the chest area, in very rare cases the lung may be punctured. This may develop into a pneumothorax (air in the space between the lung and chest wall). This is serious, but panic should be avoided. It is important that you go urgently and directly to the hospital casualty department, should you experience any of the following symptoms:
- shortness of breathe that progressively worsens.
- sudden sharp pain on each breathe in.
- a bluish tinge to your lips.
- an inability to ‘catch your breathe’.
- Treatment for this rare but possible complication is very successful.
Ask your Doctor of Chiropractic any questions you may have. If you are prepared to try dry needling, you will need to provide consent to the Doctor.
Gate control theory
This theory was developed by two Physiologists, Melzach and Wall in the 1950’s. It has been revised several times since, but the essential principles remain the same. It postulates that our brains are daily being stimulated with several different stimuli, including pain when relevant. The original stimulus of pain repeatedly sends messages via slow twitch pain fibres to the spinal cord and brain. Dry needling over-rides this original stimulus, which causes an impulse (via the fast twitch pain fibres) to be sent to the spinal cord and brain, which “closes the gate” on the original pain.