Dry Needling 101
“Dry needling—so that’s like acupuncture, right?”
Not quite. In recent years, dry needling has gained significant popularity and traction in the rehab world. And for good reason. In my opinion, dry needling is the most effective treatment I offer in my office as far as soft tissue therapy goes. But like a lot of things, there are quite a few questions and misconceptions surrounding it. I myself was a pretty big skeptic before ever trying it. So pull up a chair, grab a cup of coffee, and we’ll address some FAQs and break down everything you need to know about dry needling.
First of all, what is it? Put simply, dry needling is the insertion of a very thin needle into a trigger point in a muscle to reduce tension, diminish pain, or even act as a stimulus to “wake up” an under-active or inhibited muscles.
What’s a trigger point? Myofascial trigger points (commonly referred to as muscle “knots”) are one of the most overlooked causes of acute and chronic pain. Your muscles are made up of lots and lots of bundles of fibers. Think of a trigger point as some of these fibers getting stuck together and balled up. This inhibits your muscle from functioning optimally, and these spots can become massive pain generators. What’s even crazier is that these trigger points can actually refer pain to other parts of your body. For example, you have a muscle called your subscapularis that sits right underneath your shoulder blade. A trigger point in this muscle can actually refer pain to your wrist in a bracelet distribution. Ever consider that your wrist pain might be coming from a muscle way upstream underneath your shoulder blade? I’m sure you’ve heard before that “everything in the body is connected”. Well, it truly is. I’ll include a few more examples of these referral patterns below. (For more resources/information on this, check out the work of Travell and Simons.)
How does dry needling work? The first step in dry needling is to identify these trigger points and determine if they are, in fact, pain generators. We identify them through palpation (touch). If pressing on one of them is painful, causes referred pain, or recreates your pain, there’s a good chance this trigger point is a pain generator and needs to be treated. Next, we insert and direct the needle toward this specific trigger point. The needle gets placed into the muscle fibers and helps to release it. Another goal of needling is to actually produce a controlled acute inflammatory response. This helps stimulate the healing cascade and bring necessary cells and blood flow to the area to induce healing.
Does it hurt? Everyone’s favorite question. This answer is extremely variable from person to person and also dependent on the area being needled. Here’s what I can tell you. The needles are extremely thin, so you usually don’t feel them initially going in. However, when the needle reaches the trigger point, there is usually a “twitch response” in the muscle. This can often feel like pressure or, at most, a deep ache. From my experience, the needling process is usually mildly uncomfortable but nothing crazy—a “good hurt”, if you will. And the relief afterwards certainly makes the discomfort completely worth it. I promise it’s not as scary as it seems, and you’ll be ok. 🙂
Are there different dry needling techniques? There are two main dry needling techniques we utilize in our office: the e-stim method and the piston method. The technique we use always depends on the area being treated, severity of the case, and, most importantly, patient preference/tolerance. The e-stim method involves inserting the needles and hooking them up to an e-stim (electrical stimulation) device which causes the muscles to repeatedly contract involuntarily. The piston method does not utilize the e-stim unit but instead involves repeatedly directing the needle into the trigger point until it releases.
Common things we treat with dry needling: Dry needling has a WIDE array of uses, but the most common things we use dry needling for in our office are headaches, TMJ pain, shoulder pain, and low back pain. Other conditions we treat include sciatica, Achilles tendinitis, knee pain, hip impingement, tennis elbow, plantar fasciitis, and ankle sprains/swelling, just to name a few.
Is dry needling safe? Most people are surprised to find out that dry needling is incredibly safe. There are two main risks with dry needling: bruising and soreness. Oftentimes there are superficial blood vessels overlying the area of the muscle needing to be treated. Although we try to avoid this, sometimes a vein gets hit in the process. This is totally not a big deal—you may just have a little bruise afterwards, but nothing to be worried about. Soreness varies from person to person, but most people can expect to feel mild soreness for about a day after their needling session. Again, this is no big deal, it usually just feels like you worked out that muscle really hard, and it will subside in a matter of time. At The Body Lab we have extensive training and experience with dry needling and are anatomy experts! Although everyone’s anatomy can vary, rest assured that we have a lot of knowledge about the structures in the area where we are working, and it’s our priority to make sure you are comfortable.
I know someone who got really flared up from dry needling. Is this possible? Actually, yes. For more info on this, visit our blog post on protective tension and why dry needling without proper rehab can sometimes cause flare-ups in pain. (Don’t worry, we will always provide you with proper exercises in our office to ensure this doesn’t happen.) It is crucial to receive dry needling from a clinician who is well-versed in human movement!
What’s the difference between dry needling and acupuncture? Great question! Although these two techniques use very similar thin-filament needles, they are completely different procedures. Acupuncture is based in Chinese medicine principles and focuses more on meridians (i.e. “pathways” in the body), chi, and energy flow. Needles are directed in a way to remove blockages in meridians, restore energy flow, and therefore bring balance back to the body. Needles in acupuncture are also traditionally inserted more superficially (usually within just the first few layers of skin) than in dry needling. Dry needling, in contrast, is focused more on the musculoskeletal system and aims to relieve pain and tension produced by trigger points. These needles are typically inserted deeper into the muscle belly. Although we do not perform acupuncture in our office, we have a fantastic acupuncturist in our network who we’d be more than happy to refer you to if you are interested in this service.
If you still have questions about dry needling, don’t hesitate to reach out! And as always, we offer free phone consultations if you’re wanting to chat a little more about your specific pain or injury and how dry needling could potentially benefit you.