What is dry needling?
Functional dry needling (FDN) is a skilled intervention that uses a thin filament needle to penetrate the skin and stimulate underlying myofasical trigger points (MTrPs) for the management of neuromuscular pain and movement impairments. Functional dry needling is a technique used to treat dysfunctions in skeletal muscle, fascia and connective tissue. By inserting a needle into trigger points, favorable biochemical and mechanical changes take place, which aid in reducing pain. By reducing pain and improving function will lead to improved activity and participation.
Dry needling has been proven to reduce muscle tension, promote healing, and increase range of motion.
How does it work?
Based on pioneering studies by Dr. Jay Shah and colleagues at the National Institutes of Health, we know that inserting a needle into trigger points causes favorable biochemical changes, which assist in reducing pain message transportation. Eliciting the so-called local twitch response, which is a spinal cord reflex, assists in breaking the pain cycle by restoring normal neuromuscular function. The mechanical and neuromuscular effect provides an environment that enhances the body’s ability to heal which ultimately reduces pain.
Who does it?
In 2009, the Wisconsin Physical Therapy Examining Board approved dry needling as falling within the scope of practice of licensed physical therapists that have had organized training. Dave Nissenbaum is trained in dry needling therapy and has completed 3 dry needling courses (totaling over 80 hours of training) and has been utilizing dry needling as a treatment option for over 3 years.
What is a myofascial trigger point?
A myofascial trigger point is an area of multiple contractions knots or taut bands palpated within muscles and surrounding fascia, which are involved in the development and continuance of the pain cycle. Trigger points cause local pain or refer pain to more distant locations. These taut bands restrict pain free mobility and limit muscle function as well as smooth coordinated movement.
What conditions does it treat?
Dry needling can be used to assist in treatment of multiple musculoskeletal diagnoses. Conditions include but are not limited to:
- Back and neck pain
- Pinched nerves
- Herniated discs
- Shoulder pain
- Rotator cuff syndrome
- Labral tears
- Tennis elbow
- Carpal tunnel
- Golfers elbow
- Headaches and migraines
- Jaw pain
- Quadriceps strains
- Hamstring strains
- Calf tightness and spasms
- Achilles tendonitis
- Plantar fasciitis
- Joint pain
Some of the above problems may be more from joint issues than muscle, but surrounding muscles will be loaded with trigger points that are often causing or a result of the problem and contributing to pain and movement.
Is dry needling the same as acupuncture?
Dry needling and acupuncture use the same tool, a small diameter, and solid filament needle. Dry needling is based on Western medicine and extends from models of functional anatomy and soft tissue mobilization, myofascial release and trigger point therapy. Acupuncture stems from Oriental or Eastern medicine. If you are seeing an acupuncturist we will encourage you to continue. We are happy to work with your acupuncturists as well in your recovery.
Is dry needling painful?
Most patients do not feel the insertion of the needle but do feel a local twitch response in the muscle. When the local twitch response is elicited, most patients experience a very brief (less than a second) painful response. Patients have described the twitch as a cramping sensation or a little electrical shock. Although the local twitch response can be uncomfortable, this is the desired reaction needed to interrupt the pain cycle. Your PT will make every effort to make your experience comfortable and therapeutic.
How do I need to prepare?
You should wear loose fitting clothes, shorts for easy access to your painful areas. Be well hydrated before and after treatment.
Before your first treatment: Please inform your physical therapist about use of blood thinners (warfarin, Coumadin, etc.), recent surgeries, systemic infections, pregnancy, having any implanted devices or immunosuppressant medications prior to treatment. These are not absolute contraindications but do need to be discussed with your Physical Therapist.
Are the needles sterile?
Yes, we use only sterile, disposable needles.
What side effects can I expect?
After the treatment, patients may experience muscle soreness over the treated area and into areas of referred symptoms. This does not always occur but should be expected and is considered normal. Soreness can last anywhere from a couple of hours to 48 hours. Make sure to indicate to your Physical Therapist at a follow-up appointment how long the soreness lasted. Bruising from the treatment is possible but is not of concern. It is common to feel tired/fatigued, energized, and emotional after treatment. There are times when treatment may exacerbate your symptoms. This is normal and may indicate that you need follow up treatment sooner. If this occurs, let your physical therapist know.
Are there any risks to this procedure?
As with any medical treatment and procedure, there are possible side effects and complications. While complications are uncommon, they do sometimes occur and must be explained prior to treatment.
- Dry needling can cause “post-needling soreness”. Please let your Physical Therapist know if this occurs.
- There is very small risk of infection. Your physical therapist is certified in performing dry needling and knows how to take the necessary precaution to minimize your risk, therefore infections are very rare.
- A needle may be placed inadvertently in a superficial artery or vein. If this occurs there is a possibility for a bruise to develop. This is not uncommon. The needles are small so the likelihood of any significant tissue trauma is unlikely.
- If a nerve is touched, it may cause a pricking sensation, which is usually brief but may last for a few days.
- When a needle is placed close to a chest wall, there is a rare possibility of pneumothorax (needle puncturing the lung which may cause air in the chest cavity). This may cause pain or shortness of breath and can last several days to weeks. More severe punctures may require hospitalization and re-inflation of the lung. All PRO physical therapists performing dry needling are certified in this procedure and know the precautions to take to avoid this occurring. It is a very rare complication.
What should I do after my appointment?
We highly recommend increasing your water intake for the next 24 hours after treatment to help avoid or reduce soreness. We also recommend soaking in a hot bath to help relieve post treatment soreness and to soften the symptoms associated with the treatment. After Functional dry needling, you may do the following based on your comfort level.
- Work out gently and stretch
- Participate in normal physical activity
- Massage the area
- Use heat or ice as preferred for post treatment soreness
- If you have prescription medication continue to take them as prescribed.
Why doesn’t my doctor know about this?
In the United States, dry needling is a relatively new method for treating myofascial pain and not everyone is aware of this effective modality. Please refer your physician to https://www.kinetacore.com/ for more information. Our therapists would be happy to discuss dry needling with your doctor.
How many treatments do I need?
The musculoskeletal system is under constant pressure from gravity, stress, work, etc. A regular exercise program combined with good posture and maintenance of core muscle strength can prevent many problems. If the pain comes back and trigger points become painful and dysfunctional, “tune-ups” are recommended to treat and prevent serious problems.
Is it covered by insurance?
Unfortunately, at this time, dry needling is not covered by insurance. The assessment, manual treatment and exercise performed in conjunction with/during dry needling is, however the time actually spent inserting the needle (which is often a few seconds to a few minutes) is not. At Pro Physical Therapy we have a $10 charge per visit to cover the cost of the needles. The remainder of your visit will be billed to the insurance company.