BASICS OF DRY NEEDLING

3. What is dry needling?
•Dry needling is a procedure where filiform
needles are tapped through the skin to the
target tissue to bring about a therapeutic effect.
•No medicine is delivered, thus it is called ‘dry’,
compared to injections, which are ‘wet’.
Other names/variations are IMS, TrP DN etc.

4. • Dry needling is another tool in the armory of
physiotherapist.
• When used purposefully dry needling works well in
various musculoskeletal and neuro muscular
conditions.

5. Is it acupuncture?
• “ From a physical therapy perspective, TrP-DN
has no similarities with traditional
acupuncture other than the tool.”- Jan
Dommerholt.

6. APTA
• Recognizes dry needling as being part of the
Physical Therapist professional scope of
practice.

8. TYPES/TECHNIQUES OF DRY NEEDLING
• Pistoning- rhythmic & multidirectional passes into
tissue.
• Superficial- reduce or eliminate post-Rx soreness.
• Trigger point- LTR; causing local or widespread
myofascial pain.
• Neurofunctional- leaving needles in mm, sensory or
motor effects (motor point).
• Tendon or ligament-
• Periosteal pecking
• Needle manipulation
• Intramuscular electrical stimulation (PENS)
• Needling with cupping

9. NEEDLES
• Needles can be as short as 12.5 mm or as
long as 100 mm & 0.25mm IN diameter. the
choice of needle is based on the target tissue
and specific techniques used.
• Disposable filiform acupuncture needle with
guide tube is used. (filiform= solid)
• Guide tube minimizes pain

11. Disposable sterile needles packed

12. Needles with guide tubes

13. Needles sans guide tube

14. THERAPEUTIC EFFECTS
• Pain reduction by counter irritation &
release of neurotransmitters
• Pain reduction by resolving trigger point
• Promotion of healing by fibroblastic
activation
• Promotion of healing by increasing local
blood supply

15. PHYSIOLOGICAL EFFECTS
• Healing effects
• Effects on trigger points
• Analgesic effects

16. COMMEN INDICATIONS
• Acute/chronic tendonitis
• Overuse injuries
• Scarring & postsurgical pain
• Carpal tunnel
• Sciatic pain
• TMJ
• Myofascial pain
• Headaches & whiplash
• LBP
• Neuromuscular firing problems
• Decrease spasm/increase muscle extensibility

17. RELATIVE CONTRAINDICATION
1. Abnormal Bleeding Tendency: anticoagulant
therapy , thrombocytopenia
2. Compromised Immune System:
3. Vascular Disease
4. Diabetes
5. Pregnancy: one in four to five pregnancies may
naturally terminate in the first trimester.
6. Frail Patients
7. Epilepsy

18. Absolute Contraindications:
1. In a patient with needle phobia
2. Unwilling patient - patient beliefs, fear etc
3. Unable to give consent - age-related,
communication ,cognitive
4. History of untoward reaction to needling (or
injection) in the past
5. Medical emergency

19. RISKS
• Pneumothorax-Dry needling may puncture pleura
and cause pneumothorax.
• Blood Vessels- with DN there is a potential of injury
to blood vessels. Palpating for a pulse to locate an
artery prior to DN minimizes the risk.
• Nerve- with DN there is potential for injury to
nerves.Special consideration needs to be given in
relation to the spine and in the posterior sub
occipital area.the brain stem is accessible through
the foramen magnum.

20. RISKS
• Organs- Anatomical knowledge of internal
organs is important as with DN there is
potential for injury to internal organs such as
the kidney or penetration into the peritoneum
cavity.
• Others- Stuck, bent, broken needle.Forgotten
needle, forgotten patient. Euphoria

21. MINOR ADVERSE EFFECTS
1. needling pain/soreness
2. aggravation of symptoms
3. faintness, drowsiness

22. PROCEDURE

23. HOW IS IT PERFORMED?
• FIRST TAKE WRITTEN CONCENT WITH PATIENT
BEFORE PROCEDURE.
• EXPLAIN THE PROCEDURE TO PATIENT BEFORE
PERFORMING.
• PERFORM PROCEDURE WITH OR WITHOUT GLOVES.

24. • Choice of needle is dependent upon depth of
target tissue.
• With careful precision the structure to be
needled is chosen. Then sterilized disposable
needles are pierced through the skin into the
target tissue.
• The needles are kept inserted for a span of 30
seconds to few minutes and then withdrawn
and disposed properly.

25. VET-DRY NEEDLING

26. References
1. Dommerholt et. al, Trigger point dry needling.
2. Baldry P. Acupuncture treatment of fibromyalgia and
myofascial pain. Fibromyalgia syndrome. Elsevier,2010:149
3. Cummings TM, White AR. Needling therapies in the
management of myofascial trigger point pain: a systematic
review. Arch Phys Med Rehabil2001; 82: 986–92.
4. Furlan AD, van TulderMW, et al. Acupuncture and
dry-needling for low back pain. Cochrane Database
Syst Rev 2005;(1):CD001351

27. 5. Travel and Simon’s Myofascial pain and dysfunction
the trigger point manual
6. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo
microanalytical technique for measuring the local
biochemical milieu of human skeletal muscle. J Appl
Physiol 2005;99:1980-1987.
7. Lundeberg T, Stener-Victorin E. Is there a physiological
basis for the use of acupuncture in pain?Int Congress
Series 2002;1238:3-10.

28. THANK YOU