Discover Dry Needling
Dry needling is an incredible tool that physical therapists now use as part of their manual therapy with patients. It’s called dry needling because there is no substance we are inserting or extracting from the body, however we are inserting a needle invasively into the skin. It is out of a physical therapists scope to insert needles for collecting blood or administering medication, which would be considered use of a wet needle.
A common question from someone interested in dry needling is “How is it different from acupuncture?” The way I like to describe it is that both professions are using the same tool but to treat the body differently. A fair analogy is that in grade school and college we’re taught math. Algebra, pre calculus, geometry, it’s all taught the same, but is used differently by architects, engineers, and accountants. When a physical therapist vs acupuncturist assess your body, they plan their needling differently, and that’s a good thing. We want various means of treatment in healthcare because the body is complex, mysterious, and there’s usually not one perfect answer!
What a PT, MD, chiropractor, and acupuncturist would all agree on, is that needling has proven to be quite beneficial in the healing process. Physical therapists often but not always insert the needles into a trigger point, or what we commonly thing of as a painful knot. There is debate about what all causes a trigger point, but it is evident that these bundles of muscle fiber have an excess of a chemical called acetylcholine.
When inserting the needle into a trigger point, it does three specific things at the insertion site, and for the body as a whole. We’ll talk through this a little, because I want you to feel like you have an idea of what is actually going on.
When a needle or any foreign object is invasively inserted into the body it:
1. Induces an inflammatory response
2. Resets the neuromuscular junction (WHAT does that mean.. yes we’ll talk about it!)
3. Stimulates an internal opioid release
In easier terms, when we dry needle a problematic area, we are intentionally inflaming, in order for it to then to repair and remodel.
The first step is inflammation. This is a combination of a chemical and vascular response, where more blood and inflammatory agents are brought to the site with the goal of preventing bacteria or infection from entering the body and initiating a healing process. Since a dry needle is quite thin, only 1/10 the size of a standard blood drawing needle, the inflammatory process is small… you will likely not even notice any visible changes.
Next, resetting the neuromuscular junction. The neuromuscular junction refers to the connection where a nerve and muscle meet and communication occurs. Needling allows a release and exchange of chemicals. one particular goal is to clear excessive acetylcholine that’s hanging out around the trigger point. we discussed too much acetylcholine can contribute to a trigger points inability to heal itself. Clearing excess acetylcholine allows calcium to utilized better in order to promote further muscle healing.
Third, when the body recognizes that it has a foreign object (or in our case, purposefully inserting a needle), it triggers a natural pain modulating system to occur. For example: You have been feeling pain a certain way and that’s why you’re at the clinic for needling. Maybe it’s your shoulder, maybe hip, etc. When you undergo the treatment, your body reorganizes the pain pathways, by the release of opioids and non opioids working together. We think of opioids as the addictive pain pills we have to be careful of taking post operatively, but we actually already have natural opioid receptors in the body, who’s purpose is to respond to pain and work alongside other chemicals for pain management. The take away is that these pain organization systems are all stimulated to remodel when dry needling occurs.
Now, There are some situations in which dry needling is not appropriate, and your physical therapist can discuss this with you personally. But overall, there are very few contraindications to treatment with the use of dry needling.
The last question I hear is, is it painful? Sometimes it is a little painful, because we are often seeking to insert the needle at trigger point, where the muscle is not getting proper nutrition, or blood flow, and referring pain. But needling discomfort is tolerable, it’s really not bad. And it’s not that long. About 15-20 minutes is very effective. The pro’s of trying DN far outweigh the discomfort during the procedure. Soreness is common after but usually subsides by the following day.
Immediately after your session, high intensity exercise isn’t ideal because your tissues are going through some reworking. However movement immediately after IS important. Pilates work and mindful postural and spinal alignment strategies are super helpful to center your body now that you have ideally created a little more balance. You honestly feel better performing some movement, rather than keeping yourself stationary or immediately using heat or ice.
If you’d like to learn more about dry needling services at Balanced Physical Therapy, visit our website to schedule a free discovery call with Michelle or Bridget!
Butts, Raymond; Dunning, James. Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A clinical resource guide for health care professionals. 2016.