Dry Needling - Brisbane MSK Clinic

What is Dry Needling?

Dry Needling is a form of myofascial release technique, which uses fine needles to treat myofascial trigger points, reducing muscle tension and pain. Tissue tension often leads to myofascial pain, and releasing this can provide relief. Myofascial Trigger Point treatment with needles involves inserting a needle into an MTrP or TrP for short, to create a myofascial release (MFR). The needle depth and how tension is applied affect what one feels. A good therapist can palpate (feel) tissue tension via the needle handle. It is then possible to fine-tune the tissue tension level to one that suits the patient's comfort level. Some therapists may use multiple needles at the same time.

Some people do not like needles for many reasons, which is not an issue. Many other fascial release techniques are available at the Brisbane MSK Clinic in Morningside and do not use needles. Consumers need to feel at ease and not pressured into one treatment type. It is vital to explain the pros and cons of each option. Needles, by their very nature, are an invasive treatment, and there are risks. However, needling can work very precisely and produce some excellent results. As with many techniques, needling may not be suitable in all cases due to treatment contraindications, hence the importance of other treatment options.

Is Dry Needling painful?

As with injections, what one feels often depends mainly on the practitioner's knowledge and practical technique skills. Anybody who has ever had an injection knows that the experience can vary from one practitioner to the next. However, the needles used in dry needling are different from those used for injections (see later Dry and Wet Needling). The filament needles used in dry needling are thin, almost hair-like and not designed to cut tissues. Hence, it is pretty common to either not feel or barely feel the insertion and removal of the needle. When a needle contacts a myofascial trigger point (MTrP), one tends to feel a tensioning of tissue around the needle (twitch response). The feeling may seem similar to a strong muscle contraction or stretch, a kind of deep ache, though not necessarily pain. A good therapist can easily control the contraction (tension) level felt through their palpation skills and technique. The patient must be comfortable with the level of tension felt during the treatment, and the therapist should work to achieve this. The needle works with connective tissues and fascia, and not just muscles. The fascial system is hugely relevant to how tissue tension is applied or reduced via the needle. If a needle were to contact a nerve, one would feel nerve type pain along the nerve path. Should a needle reach a vein, one might notice a slight tingling sensation and possibly develop a bruise (see the risks and risk management section later).

There are also many needling techniques, and some are likely to prove more painful than others. The pecking needling technique involves repeatedly inserting and removing the needle over a treatment area. The method can prove painful, and some therapists use the pecking method with inflammatory type conditions, such as Tennis Elbow (lateral epicondylitis), Achilles Tendinopathy etc. However, there are other needling techniques and, indeed, other myofascial release techniques that are less painful and work extremely well in treating such inflammatory conditions. Electrical stimulation (ES) or Electro Needling is another method used in some MSK therapy clinics. The method involves passing electrical current between inserted needles, which can prove uncomfortable. Equally, some evidence suggests that Electro Needling is no better than Dry needling for the maintenance and rate of improvement in myofascial pain cases (Brennan et al., 2021). Practitioners at TotalMSK in Brisbane "DO NOT" practice hypodermic, electrical stimulation or pecking techniques and prefer to use less painful yet effective techniques with patients.

Why is the technique called Dry Needling?

The term "Dry" refers to the needles having a solid core, a diameter range from 0.12mm to 0.30mm and varying lengths. Hypodermic needles are hollow, tapered tubes made to cut through tissues. Wet needling involves injecting an anaesthetic or a steroid solution into a TrP via the needle. Unlike dry needles, the design of such hypodermics is to pierce structures like arteries, among other things. The only people who can perform Wet needling are medically trained Doctors. Many drugs used in wet needling require a doctor's prescription anyway. There are also more risks with injecting, hence why only some medical doctors now do this. Wet needling led to the "Dry" version after finding that the effectiveness of the methods was very similar and without additional risks of injecting (Navarro-Santan et al., 2020; Uygur et al., 2019). Medical Doctors have a wealth of other knowledge and skills, so one could question the cost-benefit of injecting corticosteroids, whether ultrasound-guided or not. There is also growing evidence of the negative effects of cortisone injections on fascia and joints longer-term. Hence, time will tell if the practice has a longer-term future.

What does the Myofascial Release feel like?

Although there are many types of myofascial release (MFR), the sensation one might feel during the release may vary somewhat. Many Direct Myofascial Release techniques that work directly with trigger points (TrPs) tend to have a similar feeling. Treatment methods like Neuromuscular Therapy (Neuromuscular Technique), Acupressure and Dry Needling have a similar tissue release feeling. Applying such techniques often creates a sense of tension or muscle contraction of the tissues under treatment. The sensation typically builds during treatment even if the therapist makes no changes in technique application. One usually feels a melting-type sensation as the release occurs. Tissue tension typically releases over a wider area than the treatment area due to the fascial system. Equally, trigger points often produce a deep aching and referred pain pattern, which may briefly recreate the patient's pain symptoms during treatment. The time taken to create a release can depend on the technique used and the therapist's skill. There is good evidence that Dry Needling has similar effectiveness to ischemic compression methods (neuromuscular therapy) in treating myofascial trigger points (Ziaeifar et al., 2018; Benito-de-Pedro et al., 2019; Togha et al., 2020; Behrangrad et al., 2020; Cagnie et al., 2015; Fleckenstein et al., 2010).

The release may take under ten seconds or up to two minutes. Some myofascial release techniques do not specifically identify and treat trigger points. However, the release sensation one may feel from methods like Soft Tissue Release (STR), and Positional Release Technique (PRT) is similar to that of a melting sensation. Equally, the level of discomfort felt before the release may vary between techniques and the therapist's practical skills.

Medical Acupuncture is often used in treating:-

There is a decent level of clinical-based research supporting the use of dry needling as an effective treatment for a wide variety of musculoskeletal and myofascial pain conditions. Other myofascial release methods may not have the same level of research evidence. However, that does not mean that other techniques are ineffective due to limitations of research. In brief, research limits variables and involves set protocols for each technique under investigation, meaning that people receive exactly the same treatment or non-treatment. Such a process does not account for unique and individual patient factors. Hence, a purely standardised treatment process will not likely produce optimal results. Equally, although one can use the needling as a stand-alone treatment, one might often use the method in conjunction with other techniques, which has implications for the quantity of existing evidence-based research. Notably, a decent level of research exists about Medical Acupuncture because the technique is popular with many regulated health professions, many of which require a research element as part of qualifying.

Needling may not be the most effective treatment for myofascial release in any situation. It may not be possible due to the location of the tissues requiring treatment, patient preferences or contraindications. One can use needles precisely, so some soft tissues may be more easily accessible using a needle than other methods or even more comfortable. Equally, tissues may even respond better to needling over another technique. A good practitioner will have the training, experience, skills and knowledge to apply multiple techniques (tools). The best treatment outcomes arise from combining the therapist's skillset with the patient's unique circumstances to identify the best means to achieve the end goal. Myofascial pain syndrome is widespread, with some research suggesting that up to 85% of the population will experience it at some point in their lifetime (Lew et al., 2021). Research has continued to show the presence of myofascial trigger point involvement in a range of acute and chronic musculoskeletal injuries and conditions.

Conditions clinic:-

• Neck Pain (Cagnie et al., 2015; Lew et al., 2021; et al., 2020; Arias-Buría et al., 2020; Murillo et al., 2021; Valiente-Castrillo et al., 2021)(see Neck pain article)
• Headaches, Migraines and tension (Togha et al., 2020; Valiente-Castrillo et al., 2021; Pourahmadi et al., 2021; Rezaeian et al., 2020)(see Headaches article
• Back Pain (Lew et al., 2021; Loizidis et al., 2020; Wang-Price et al., 2020)(see Back Pain article)
• Musculoskeletal aches associated with pregnancy (see back pain)
• Repetitive Strain Injury (see RSI article)
  • Tennis Elbow pain (Uygur et al., 2021; Navarro-Santan et al., 2020)(see Lateral Epicondylitis - Tennis Elbowarticle)
  • Carpel Tunnel Syndrome
  • Golfer's Elbow pain (see Medial Epicondylitis - Golfer's Elbowarticle)
• Shoulder Pain (Navarro-Santana et al., 2021; Matsel et al., 2020; Hernández-Ortíz et al., 2020)
• Bursitis pain (see General Bursitis Pain article)
  • Subacromial Bursitis (see Shoulder Pain and Subacromial Bursitis article)
  • Trochanteric Bursitis (see Hip Pain and Trochanteric Bursitis article)
• Sciatica (see back pain article)
• Myofascial Pain Syndrome (Brennan et al., 2021; Lew et al., 2021; Yasar et al., 2021)(see Myofascial Pain Syndromearticle)
• Trapped nerves
• Chronic Pain (see Chronic Pain article)
• Osteoarthritis (Ceballos-Laita et al., 2021; Ceballos-Laita et al., 2020; Ceballos-Laita et al., 2019)
• Knee pain
  • Knee pain ITB (see Iliotibial Band Syndrome article)
  • Patellofemoral Pain Syndrome (Behrangrad et al., 2020; Ma et al., 2020; Zarei et al., 2019)(see Patellofemoral Pain Syndromearticle)
• Shin Splints(see Shin Splints article)
• Work-related injuries
• Foot Pain - Ankle Pain
  • Plantar Fasciitis (Moosaei et al., 2021; Uygur et al., 2019)(see Plantar Fasciitisarticle)
  • Ankle Injuries (see Ankle Injury article - Inversion and Eversion injuries)
  • Achilles Tendinopathy (see Achilles Tendinopathy) article
• Jaw pain, such as Temporomandibular Joint (TMJ) Pain. (Özden et al., 2020)

Are there any risks with Dry Needling?

Any form of treatment that pierces the skin has risks, and a therapist should fully explain these. Therapists manage the risks associated with dry needling through a combination of anatomy knowledge, training and practical technique skills. One should only agree to treatment once one is confident with the therapist's explanation of risks and the management or mitigation of these. Possible risks may include:-

• Infection
• Pain
• Bruising / Bleeding
• Nerve Pain
• Snapped needle
• Pneuomothorax
• Congential abnormalities

Overall the risks associated with Dry needling are easily managed by a well trained and competent practitioner. As with any treatment, the possible benefits of any method should outweigh the risks and depend on individual circumstances.

Therapist Training / Education

Dry needling courses require a base level of anatomy training, and, in Australia, a diploma in remedial massage meets the requirements. Palpation skills training is not part of the Australian massage qualifications, based on our principal's experiences teaching at certificate level through to advanced diploma. Dry Needling courses can take as little as 1-2 days. The amount of hands-on practice can vary from one day to more. Due to time constraints, short courses are only likely to cover the practical needling of fewer muscles. Course duration can impact what somebody has the training to treat and thus insurance cover. The practical aspect of the course allows a therapist to gain practice inserting needles in specific muscles under guidance. As therapists work with each other during such courses, one learns what it feels like to treat specific muscles. The process allows one to fine-tune the technique and avoid creating pain. As with other treatment methods, it is a myth that treating myofascial pain requires creating lots more pain to get relief. All of these factors can play a part in the experiences patients have. Some courses may teach other forms of dry needling, like pecking or electro-stimulation (ES). Terry has been using Dry Needling since 2016, and the course he chose involved theory and eight days of practical work. Also, he has been treating MSK conditions for over 16 years with his Myotherapy treatment skills. His education includes a medically-based master's degree, which he did before his DN training.

Acupuncture vs Dry Needling

Although one uses needles in Acupuncture and Dry Needling, there are differences in approach. Acupuncture is a regulated health profession, and training takes years. Philosophy also plays a part in how one works. Dry Needling only works with trigger points and so has limits of scope. Acupuncture has a much broader range of practice than dry needling. Scope refers to the type of things one can treat. Acupuncturists often treat addictions and infertility, among other things. They also learn lots of different kinds of techniques. One such method involves working with Ashi points related to energy flows. Energy flows such as Qi and Chi are important in Acupuncture and even the siting of needles. The term Meridians also refers to the flow of energy in the body. Research papers define Ashi points, and Myofascial Trigger Points differently, which affects the treating approach. Western medicine acupuncture or dry needling does not aim to treat energy flows, purely myofascial trigger points and pain. Research has shown similarities between ancient Chinese meridians and recent fascial system research. Research into the fascial system dates back a few decades and has involved much medically-based anatomy work. In essence, the treating approaches are very different, and there are often many ways to achieve a similar outcome. Also, sometimes people may get on better with one treatment method over another.

Other Myofascial Pain Relief - Treatment and Techniques

• Soft Tissue Release - STR
• IASTM treatment - Instrument-Assisted Soft Tissue Mobilisation
• Gua Sha treatment
• Muscle Energy Technique - MET
• Neuromuscular Therapy - NMT
• Positional Release Technique - PRT

Other related articles

• Biotensegrity and how everything is connected
• Soft tissue repair, healing and scar tissue
• Soft Tissue Adaptation to activity and injury