Presentation on a relatively new form of rehabilitative treatment offered at Hummel Physical Therapy

1. Dry Needling
Carly Holthausen
Clemson University
HLTH 4200
December 2015

2. Introduction.
 Dry needling is an invasive, therapeutic treatment for pain in which a trained
physical therapists inserts a very thin filament needle into your muscle
directly at your myofascial trigger point(s)
 Persistent pain causes your nerves to become “sensitized” in your
extremities, spinal cord and brain. Dry needling works to deactivate these
“sensitized” nerves
 The needle is inserted into a trigger point, (potentially) causing a muscle
spasm in that location.
 This type of muscle spasm is called a local twitch response
 The twitch response helps break the cycle of pain by stimulating the body’s
own healing capabilities (i.e. the anti-inflammatory effect)

3. Myofascial Trigger Points (MTP).
 Defined as “hyperirritable nodules of tenderness in a palpable taut band of
skeletal muscle that can refer pain to a distant point and also causes distant
motor and autonomic effects”
 Caused by some muscle fibers shortening and forming taut bands in response to the
release of calcium ions from damaged fibers or excessive amounts of acetylcholine from
the motor end plate
 Persistence of MTrPs in neck and shoulder muscles for long periods will result in
 headache
 neck and shoulder pain
 dizziness or vertigo
 limited neck and shoulder range of motion
 abnormal sensation, autonomic dysfunction, and disability

4. MTP Prevalence.
 Epidemiological surveys have shown that 30% to 85% of the population in the
United States has MTP pain
 Often goes undiagnosed
 Common and significant clinical problem, resulting in 15% of general medical
visits

5. Types of MTP.
 Active – spontaneous and produce local or referred pain to remote structures
 Latent - would not produce any symptoms unless evoked by an external
stimulant
 A recent survey of 72 patients with shoulder pain showed that active MTrPs
were prevalent in the infraspinatus (77%) and the upper trapezius muscles
(58%), whereas latent MTrPs were prevalent in the teres major (49%) and
anterior deltoid muscles (38%)

6. Treatments for MTP.
Treatment Methods
 Dry Needling (DN)
 Widely used due to simple operation and good efficacy
 Wet Needling (i.e. lidocaine/local anesthetic injection)
 Ischemic Compression
 Physiotherapy
 Laser
 Oral medication

7. Dry Needling Defined.
 minimally invasive procedure in which an acupuncture needle is inserted
directly into an myofascial trigger point (MTP), with the goal of deactivating
the trigger point
 32-gauge acupuncture needle inserted into the palpably painful nodule using a
superficial (10-20 mm) or deep (25-40 mm) needling technique
Benefits
 Immediate reduction in local, referred and widespread pain
 Restored range of motion and muscle activation patterns
 Effective in cases where localized treatment may only produce temporary relief

8. How DN Works.
 The exact mechanisms of dry needling are unknown, but there is scientific
evidence that supports the idea that inserting a needle has a positive effect
on the electrical and chemical communications that take place in our nervous
system
 There are mechanical and biochemical effects
 Biomechanical  studies at the National Institutes of Health have shown that
inserting a needle into trigger points can cause biochemical changes that assist in
pain reduction
 Mechanical  this treatment (ideally) elicits a “local twitch response”, a spinal
cord reflex, that breaks the pain cycle
 Essentially, inserting needles into trigger points in the body stimulates the
body’s natural healing response, inhibiting the transmission of pain signals in
our spinal cord and increasing the release of our own pain relieving chemicals
within our brains

9. Acupuncture Defined.
 “the use of needles inserted into and removed from the human body and the
use of other devices, modalities, and procedures at specific locations for the
prevention, cure, or correction of any disease, illness, injury, pain, or other
condition by controlling and regulating the flow and balance of energy and
functioning of the person to restore and maintain health”
http://boutiqueacupuncture.com/wp-content/uploads/2012/10/Needles.jpg

10. Dry Needling vs. Acupuncture
 71% correspondence between MTrPs and acupuncture points
 HOWEVER trigger points are firmly anchored in the anatomy of the neural and
muscular systems, while acupuncture points are associated with an
anatomically non-existent system of meridians, which carry Yin (spirits) and
Yang (blood)

11. DN Effectiveness
 Pain reduction, measured using various assessments, is significantly
correlated with manipulated MTP status (from active to latent) through dry
needling
 Treatment has been connected with a significant, clinically relevant reduction
in pain compared with baseline values, as well as improvements in mood,
function, and ROM

12. Sources
 http://www.sciencedirect.com/science/article/pii/S1356689X15001526
 http://www.sciencedirect.com/science/article/pii/S0003999315000039
 http://www.sciencedirect.com/science/article/pii/S1556370714000078
 http://www.sciencedirect.com/science/article/pii/S1934148215000520
 http://www.sw.org/physical-medicine-rehabilitation/dry-needling
 http://www.lindept.com/dryneedling.pdf