Dry Needling: What's the Point?
I joke all the time with my patients that it is quite amazing that I can convince someone to let me stick a needle in their muscle within 30 minutes of meeting them. Taken out of context, this sounds like I’m some sort of strange cult leader or voodoo witch doctor. Of course, I am neither of those things (unless you consider running/triathlon a cult), and am just a Physical Therapist who really wants to help you get back to what you love.
So, what is dry needling? Why does it help? What does it feel like?
Dry needling is the intramuscular use of a filiform, acupuncture-style needle with the intention of decreasing pain and impaired muscle function caused by trigger points within the targeted muscle. A trigger point is a tight band of muscle that may be tender to the touch or even painful at rest. Trigger points form within a muscle due to repetitive use, prolonged postures, or unaccustomed activities. They can be either active or latent, where an active trigger point causes pain at rest and referred pain to other parts of the body, and a latent trigger point being tender to the touch and less problematically painful. While there has been a lot of research on what exactly causes these “knots” within the muscle, as well as the neurophysiological and chemical underpinnings of trigger points, there is still a lot we don’t know. However, we do know that there is a significant contribution of the nervous system and the way the nervous system interacts with the muscle.
My favorite analogy is to think of a muscle as a factory. The muscle is trying to produce a product (muscle contractions) efficiently and appropriately, with the demand depending on how active (or not) the human whom this muscle belongs to. Generating this product requires energy, and in turn involves a significant exchange of waste. So if we go back to our factory analogy, the factory requires energy to produce its product, and therefore there is a certain conversion of material and exchange of waste. In normal circumstances, the factory has everything it needs and is able to operate smoothly. In the case of a trigger point, this process is disrupted. The quantities of material are all wrong, the machines are not working efficiently, and the chimneys to the factory are shut, trapping the waste inside. Therefore, this impairs the ability of the factory to produce its product.
Bringing this back to trigger points and muscles, a trigger point is a problem with the metabolic processes and the signal of nerve to muscle. The “error”message that results is pain and poor muscle function.
By contacting the trigger point with a needle, we aid in the reset of this process. We can get the machines working properly and open the chimney. Again, the exact mechanisms are not fully understood, but this treatment has a profound effect on the nervous system, as do other forms of manual therapy, such as joint mobilization, massage, “scraping”, cupping, etc.
So, what does it feel like? What should you expect?
Usually people barely feel the needle breaking the skin, with more sensitive (feet, hands, lower back) areas as an exception. Once the needle contacts the muscle, the patient may feel a dull ache, cramping, pain distant from the treatment site (also called “referred pain”), or a muscle twitch. The muscle twitch is very important in that this is the response of the precise contact of the trigger point. While the twitch is not necessary to achieve a positive treatment response, it oftentimes is correlated with efficacy. This can be alarming to the patient and is certainly an odd sensation, but this is completely normal. Dry needling is certainly not a comfortable technique, and tolerance varies from patient to patient and depends upon the muscle being treated. For example, someone with a past trauma or the sensation of a familiar pain brought on by dry needling treatment can elicit an emotional response that combats the therapeutic response of trigger point mitigation. This is why a careful history and precision of treatment by the provider is key.
Dry needling is a very safe technique. Providers are skilled in anatomy and are able to steer clear from the arteries, nerves, and lungs. Side effects may include mild bruising, sweating, mild fatigue, and muscle soreness. Muscle soreness from Trigger Point Dry Needling can last 24-48 hours after treatment, and feels very much like exercise-induced soreness. People with bleeding disorders, active infection, currently pregnant or may become pregnant, open wounds, venous disease, or on certain medications are at higher risk and this is screened out by the provider prior to treatment.
As a Physical Therapist and patient myself, I have found excellent results with dry needling and can vouch that the discomfort of being needled is worth the positive response. IF you have any questions about dry needling, ask us!
Keep going, you’ve got this,
Kacy Seynders, PT DPT