From the Guidelines
Dry needling is a therapeutic technique that may be used to alleviate pain and improve function, primarily for treating myofascial pain, muscle tension, and movement impairments, although its efficacy is unclear and requires additional evidence 1.
Definition and Mechanism
Dry needling involves the insertion of thin, solid needles into specific trigger points or tight muscle bands. The procedure is thought to create a small lesion in the muscle tissue, triggering a local twitch response and initiating a healing process, which may release muscle tension, improve blood flow, and stimulate the body's natural pain-relieving mechanisms.
Indications and Usage
It is used by physical therapists, chiropractors, and other healthcare providers to help patients with conditions like neck pain, back pain, headaches, tennis elbow, and various musculoskeletal disorders. However, the current evidence does not strongly support its efficacy for these conditions, and its use should be weighed against clinical expertise and patient preferences 1.
Comparison with Acupuncture
Dry needling differs from acupuncture in its focus on treating muscular trigger points rather than traditional Chinese medicine concepts of energy flow. While some studies suggest that dry needling may be beneficial for certain conditions, such as patellofemoral pain 1, the evidence is not yet conclusive, and more research is needed to fully understand its effects.
Considerations for Use
Given the unclear efficacy of dry needling, practitioners should remain alert to new information and weigh its use with their clinical expertise and patient preferences 1. Patients should be informed of the potential benefits and risks, including temporary soreness, and be closely monitored for any adverse effects. As with any therapeutic technique, the decision to use dry needling should be made on a case-by-case basis, considering the individual patient's needs and circumstances.
From the Research
Definition and Indications of Dry Needling
- Dry needling (DN) is a technique that involves inserting a thin filament needle through the skin to target myofascial trigger points for the treatment of musculoskeletal pain and dysfunction 2.
- It is an evidence-based treatment technique that is accepted and used by physical therapists in the United States, focusing on releasing or inactivating muscular trigger points to decrease pain, reduce muscle tension, and assist patients with an accelerated return to active rehabilitation 3.
- DN is indicated for the management of musculoskeletal pain, including myofascial pain syndrome, which can affect up to 10% of the adult population and can account for acute and chronic pain complaints 4.
Mechanism and Techniques
- The deep method of dry needling has been shown to be more effective than the superficial one for the treatment of pain associated with myofascial trigger points, but the superficial technique is recommended over areas with potential risk of significant adverse events, such as lungs and large blood vessels 4.
- Dry needling may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes 5.
- The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature 5.
Safety and Adverse Effects
- Adverse effects (AEs) with dry needling can be mild or severe, with overall incidence rates varying from zero to rates of approximately 10 percent 3, 6.
- Known significant AEs from small diameter needle insertion include pneumothorax, cardiac tamponade, hematoma, infection, central nervous system injury, and other complications 3.
- Post-needling soreness and bent needles were the most common AEs, with most severe events rarely reported 2.
- A safe and evidenced-based implementation of the procedure is based on a thorough understanding of the underlying anatomy and the potential risks, with risks communicated to patients via informed consent 3, 6.