03/10/20 (6 Minute Read)
Jake Nalepa from Body, Nutrition & Movement Therapy has worked with World number ones in tennis, Olympians, billionaires and celebrities. He specialises in Strength and Conditioning and manual therapy and he took these areas of expertise to the next level when he co-founded BNM Therapy alongside Sophie Conroy. There, they stand up for than a quick fix to poor lifestyles, they help busy professionals reach their goals with specific and tailored plans.
Any mention of needles is normally received with a shade of panic on a person’s face. Despite our deeply ingrained dislike of needles, the therapeutic form of this treatment has grown in popularity over the last decade. Some people swear by it, some avoid it like the plague. As is the case with most things in life, the truth lies somewhere in between.
Dry needling is an invasive procedure where a very specific type of needle is inserted into the skin and muscle. The idea behind this procedure is aimed at myofascial trigger points (commonly referred to as “knots”). Trigger points can be described as hyperirritable spots in the skeletal muscles, they often feel like a nodule. Trigger points can be active (you feel local or referred pain upon stimulation of the muscle) or latent (pain free, unless stimulated, but still impact on the mobility aspect – limiting it). Both types of trigger point can cause hyperalgesia – increased sensitivity to pain (ever got a massage and someone hit something that made you jump up?).
Trigger points
I am very briefly going to explain what a trigger point is because there is a lot of confusion regarding this. Muscles can’t get “tangled up” as some of you may have heard. The process is more biochemically elaborate. There is general agreement that trauma and/or overuse lead to the development of trigger points – which are taut (tight/stretched) bands within the muscle. It is associated with excessive release of acetylcholine from the motor end plate. (1)
These taut bands are a natural and protective produce of our bodies. It is a physiological response in the presence of actual or potential muscle damage. Think about what happens after a heavy gym workout and you experience the post training pain, or when you overreach trying to get something from a high shelf.
The pain itself is caused due to a limited blood flow in the area, also called hypoxia. This leads to a decreased pH which activates the muscle pain receptors. This process is normally temporary. However, when the damage sustains/repair process doesn’t conclude – it leads to sustained pain.
What does dry needling do?
Inserting a needle into the trigger point/muscle, mechanically stimulates the area which in result has an analgesic effect (relieves pain). (2) This stimulus causes a local twitch response. LTR (local twitch response) is a brief and brisk contraction of the taut band within the muscle fibers.
The hypothesis here is that this stimulus leads to increased regeneration in the area, leading to repair of the damaged tissues as well as eventual remodelling.
What does a Dry Needling treatment look like?
When you arrive at the clinic, your therapist will take a thorough history. Given your issue is musculoskeletal in nature, you will be assessed for the range of motion (ROM) and any restrictions/limitations will be noted.
The therapist will palpate the area that is causing pain and potential trigger points will be identified.
Dry needling is one of numerous treatments so bear in mind that you don’t have to agree to this form of treatment. For the sake of this article, let’s assume you’re totally cool with getting poked with needles by your therapist.
A needle will be inserted into the area. Due to the increased sensitivity you may experience a sharp, instant outburst of pain when a trigger point is “hit”. This should be temporary. If pain persists, ask the therapist to remove the needle immediately.
There are a few grades when it comes to needling – all depending on the amount of times the needle is left in the muscle. This can be anything from several seconds up to 10 min.
Next, you will be reassessed for pain and range of movement. This should improve after a successful treatment.
Appropriate stretching programme should be prescribed as the changes post dry needling are not permanent. The immediate reduction in pain and increase in range of movement will most likely dissipate over the next few days if you do nothing.
Is dry needling for you?
Dry needling is an invasive form of treatment, therefore all the pros and cons need to be considered. Whilst generally safe, it is not suitable to some of us. People with a needle phobia should stay away! Therefore, before receiving a dry needling treatment – make sure you disclose all your conditions to the therapist.
Evidence
How successful your treatment is will often come down to how good your therapist is and locating and treating the trigger points. This is why you should always look for experienced practitioners, with a proven track record.
Dry needling can help restore range of movement and muscular strength, though these results can be temporary. One particular review found that dry needling, in combination with other treatments, can be beneficial for low back pain. (3) Dry needling can also decrease pain in patients with certain conditions. (4)
Unfortunately a lot more research needs to be concluded to say that dry needling is a definite way to reduce pain and help with faster recovery to certain injuries. When conducted in a safe way, dry needling is one of many modalities that leads to recovery.
Always consult with your therapist to see which form of treatment will work best for you.
Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012 Oct;16(5):439-44. doi: 10.1007/s11916-012-0289-4. PMID: 22836591; PMCID: PMC3440564.
Chen JT, Chung KC, Hou CR, Kuan TS, Chen SM, Hong CZ. Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil 2001; 80: 729–35.
Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1.
Ana Mendigutia-Gómez, PT, PhD, Carolina Martín-Hernández, PT, Jaime Salom-Moreno, PT, PhD, César Fernández-de-las-Peñas, PT, PhD. Effect of Dry Needling on Spasticity, Shoulder Range of Motion, and Pressure Pain Sensitivity in Patients With Stroke: A Crossover Study. DOI: http://dx.doi.org/10.1016/j.jmpt.2016.04.006
