What is dry needling?
Dry needling is a minimally invasive technique involving the use of a sterile, fine filament needle that is pushed through the skin, into the muscle to stimulate a trigger point. The term ‘dry’ is used because there is no administering of any substance into the body, as opposed to injections (wet needling).
As physiotherapists who deal with musculoskeletal pain in our practice, dry needling can be an effective adjunct to our array of treatment options to treat your pain.
While this technique is not taught in the undergraduate physiotherapy course in Singapore, our physiotherapists at Heartland Physio went through a professional dry needling certification course conducted by GEMt (Global Education of Manual Therapists). This allows us to be competent in administering dry needling as a form of treatment, safely and effectively to ease our client’s pain when they come through our clinic.
How does dry needling ease your pain?
In a nutshell, dry needling is used to treat pain associated with myofascial trigger points. Epidemiologic studies have shown that up to 85% of people experiencing pain in a primary care clinic setting have pains associated with a myofascial trigger point.
What is a trigger point?
Trigger points are taut and hyperirritable spots located along the skeletal muscle, often formed as a result of a direct or indirect form of injury to the muscle. These taut bands often cause shortening of the affected muscles putting them in a guarded and contracted state. This can cause tightness, pain, weakness and reduced flexibility of the muscles. With the muscles in a contracted and protective state, it can limit the flow of oxygen-rich blood from reaching the area. The lack of oxygen to the muscle causes chemical imbalances and hypersensitivity to the area, leading to pain, tenderness, and dysfunction.
This injury comes in a common form of direct trauma or strain to the muscle. When a muscle gets injured, tiny tears are formed along the muscle fibers. However during the healing process, sometimes these muscle fibers get twisted and knotted, thus forming taut bands known as trigger points.
Other times, compression of the nerve roots located along your spine can affect the muscles that are supplied by the nerve. This might cause muscle weakness, altered movement patterns and reduced function, often leading to pain. Poor posture and muscle imbalances can also lead to altered movement patterns, reduced function, and pain. As a result, your body will learn to avoid pain and guard itself against pain, causing the muscles will often go into a contracted and protective state forming trigger points.
How does dry needling work?
A thin filament needle will be inserted through the skin and into the muscle, stimulating the trigger point directly. This will elicit what is known as a twitch response from the area. Twitch response comes as a result of a brief and sudden contraction of a trigger point.
This twitch response provides mechanical stress to the trigger point, which disentangles the taut bands allowing the muscle to return to its normal resting length. With the muscle in its normal resting length, there is less guarding against the muscle, allowing a better flow of oxygen-rich blood to the area. This can reduce pain and allow for better activation of the muscle to improve your pain and function.
On a physiological level, a twitch response corrects the chemical imbalance in the area, reducing hypersensitivity and pain. Eliciting a twitch response also stimulates pain inhibitory neurotransmitters in your nerve fibers. These pain inhibitory neurotransmitters work by blocking the pain sensation from reaching your brain, providing you with pain relief.
Through the combination of the mechanical and physiological effects of dry needling, you will experience pain relief, improved flexibility, range of motion and better muscle activation. This will go a long way towards improving your function and achieving your goals during your physiotherapy sessions.
How does a ‘twitch response’ feel like?
You will feel the muscle twitching, along with some muscle soreness. You might feel some discomfort when undergoing dry needling, which is why at Heartland Physio, we employ a “fast in, fast out” method.
Once we insert the needle into the trigger point, it will elicit a twitch response. When the first twitch is obtained, the needle will be moved up and down in a quick manner lasting no more than 10-15 seconds. As the needle is manipulated in the short 10-15 seconds, the twitch response from your muscle will also diminish as your muscle return to its resting length.
Another method we use at Heartland Physio to ease you into dry needling treatment is the use of an electrical point stimulator. This method generally produces a ‘lesser’ twitch response, which minimizes the discomfort and muscle soreness you might feel.
This method also involves the insertion of the needle into the trigger point. However, instead of moving the needle up and down to elicit a twitch response, we will use an electrical point stimulator to generate light waves of electrical current through the needle to generate a twitch response instead.
What are the conditions that can be treated by dry needling?
For direct injuries, common examples include:
- Rotator cuff tendinitis
- Lateral epicondylitis
- Medial epicondylitis
- Patella tendinitis
- Achilles tendinitis
- Plantar fasciitis
These are conditions often caused by overuse, strain or direct trauma to the muscles. As mentioned earlier, these injuries form tiny tears along the muscle fibers that may lead to trigger points. This may lead to pain, tightness, weakness and reduced flexibility of the muscles.
With dry needling, it provides pain relief, improved flexibility, range of motion and better muscle activation. Upon achieving these effects, you can begin working on the muscles to strengthen them in your physiotherapy sessions. This will allow you to achieve better movement in your daily or sporting activities as you go through your recovery phase.
For indirect injuries, common examples include:
- Postural related pain:
- Scapula dyskinesia
- Non-specific lower back pain
Due to poor posture, our muscles adopt a less than ideal resting position. This often leads to altered movement patterns and formation of trigger points, causing pain and making it difficult for you to correct your movement pattern. Through dry needling, it allows the muscles to return to their normal ideal resting position. With a reduction in pain and better muscle activation, you can correct your posture and movements in an ideal and pain-free manner. Through the guided practice during your physiotherapy sessions, it will go a long way to ensure you can perform your movements and adopt a better posture without pain.
For nerve root compression, this includes:
There are muscles located along our spine to provide support. These muscles are known as paraspinal muscles. Sometimes, the paraspinal muscles might be shortened or tight as a result of a disc injury or poor posture. This can result in the narrowing of the intervertebral foramen where your nerve roots exit from the spinal cord. Due to the limited space in the intervertebral foramen, narrowing of the intervertebral foramen can cause nerve root compression leading to symptoms of numbness and ‘shooting pain’ along the nerve fibers.
Through dry needling, it can reduce the tightness and allow the paraspinal muscles to return to its optimal resting length. This can increase the space within the intervertebral foramen and reduce your symptoms. With a reduction of symptoms, you can focus on achieving an ideal posture that does not compress on the nerve roots, allowing the nerve roots to recover.
What can I expect when I undergo dry needling?
During your physiotherapy session, we will first perform a thorough examination to determine if the source of your pain is contributed by a myofascial trigger point. Should the source of pain originate from a trigger point, we can advise on using dry needling as a form of treatment to ease your pain.
We will provide you with information regarding dry needling and explain the process to you. It is imperative for us that you give us your consent before we proceed to perform dry needling on you.
The trigger point areas are located with simple palpation techniques along the muscle fibers. Dry needling will be performed in a sterile manner, where we will be wearing gloves and wiping the area down with an alcohol wipe before the insertion of the needle.
As mentioned earlier, you might feel some twitching and muscle soreness during the short period of the dry needling process. The muscle soreness might last for the next 24 to 48 hours after dry needling. Do drink lots of water to allow the muscle to recover during this period.
On rare occasions, you might experience some slight bruising or bleeding around the area. This is often due to the breakage of some capillaries under the skin. The bruises usually resolve in a few days while bleeding resolves almost instantaneously with some pressure applied to the area. Your physiotherapist will also provide further advice for you if needed.
Should you have more enquires, please feel free to contact us today.