What is Dry Needling?
Dry Needling (DN) involves identifying and treating Myofascial Trigger Point (MTrP) pain with fine filament dry needles. Tissue tension often leads to myofascial pain, and releasing this can provide relief. The method 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 the consumer is happy with. Some therapists may use multiple needles at the same time.
Some people do not like needles for many reasons and this is not an issue. There are other ways to get similar and good results without the use of needles and many techniques are available at the Brisbane MSK Clinic in Morningside. Consumers need to feel at ease and not feel forced into any treatment type. It is vital to explain the pros and cons of each option. Needles, by their very nature, are an invasive form of treatment, and there are risks. However, needling can work very precisely and produce some really good results. As with many techniques, needling may not be suitable in all cases and due to contraindications.
Is Dry Needling painful?
As with injections, what one feels often depends on the practitioner's knowledge and skill when performing the technique. 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 like hair and not designed to cut tissues. Hence, the insertion and removal of the needles is often unnoticeable. When a needle contacts a trigger point (TrP), one tends to feel a tensioning of tissue around the needle (twitch response). The feeling may seem similar to a 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 consumer 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 tissue and fascia, and not just muscles. The fascial network 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. Some therapists use this method to treat inflammatory type conditions, such as Tennis Elbow (lateral epicondylitis), Achilles Tendinopathy etc. The method can prove painful, and there are many other effective ways to treat such conditions without creating so much pain. Electrical stimulation (ES) is another method used in some MSK therapy clinics. The method involves passing electrical current between inserted needles. Practitioners at TotalMSK in Brisbane "DO NOT" practice hypodermic, electrical stimulation or pecking techniques.
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 and made to cut through tissues. Wet needling involves injecting an anaesthetic or a steroid solution into a TrP via the needle. Unlike dry needles, such hypodermics are made to pierce structures like arteries, among other things. The only people who can perform Wet needling are medically trained Doctors. Many of the drugs used in wet needling would require doctor 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 results were very similar yet without the extra risks. Equally, there is growing evidence of the negative effects of cortisone injections on fascia and joints longer-term. Hence, time will tell as to if the practice has a longer-term future.
What does the Myofascial Release feel like?
Although there are many forms of myofascial release (MFR), the sensation one might feel during the release may vary somewhat. Many 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. The application of such techniques often creates a sense of tension or muscle contraction of the tissues under treatment. Such sensation typically builds during treatment even if the therapist makes no changes in technique application. One usually feels a melting type sensation as the myofascial trigger point releases. Tissue tension typically releases over a wider area than the treatment area due to the fascial network. The time taken to create a release can depend on the technique used and the therapist's skill. 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 that one may feel from methods like Soft Tissue Release (STR) and Positional Release Technique (PRT) is a similar melting sensation. Equally, the level of discomfort felt before the release may vary between techniques and the therapist's skills.
Medical Acupuncture is often used in treating:-
Dry needling can prove effective in treating a wide variety of musculoskeletal and myofascial type conditions. One can use the method as a stand-alone treatment or in conjunction with other techniques. However, needling may not be the most effective option in any given situation. One can use needles precisely, so some soft tissues may be more easily accessible using a needle. 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 treatments outcomes arise from combining the therapist's skillset with the consumer's unique circumstances to identify the best tool to achieve the end goal. Sometimes a consumer may request a specific and contraindicated technique or find that another method would prove better. Typical conditions treated using needling in an MSK Therapy clinic may include:-
- Acute and chronic Musculoskeletal / MSK conditions.
- Muscle tension and pain.
- Acute and Chronic Myofascial pain
- Sports injuries.
- Work related injuries
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 technique. 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:-
- Bruising / Bleeding
- Nerve Pain
- Snapped needle
- Congential abnormalities
As with injections, there is a risk of infection as the needle pierces the skin and could transfer bacteria from the skin surface into the body. Good hygiene practices minimise the possibility of such infections. Therapist hand sanitisation is critical when using dry needles, as is cleaning the skin with a 70% plus pre-injection swab. Some therapists also wear medical grade gloves while needling. Often sterile single-use needles are used in treatments too. It is possible to get re-usable needles, which need sterilisation and present other risks (see later).
The filament needles used in Dry needling are very thin and rarely felt during needle insertion or removal. However, it is possible to feel pain during Dry needling, which has more to do with the therapist. The therapist's anatomy knowledge, palpation skills and needling technique can make a huge difference. It is quite normal to feel a change in tissue tension around the needle, much like a muscle contraction of stretching feeling. Well-trained therapists should know how to increase or reduce the tension felt to the consumer's level. Two other possible sources of pain related to a needle contacting a vein or nerve are covered below.
Bruising / Bleeding
Bruises or bleeding can occur if a needle pierces a vein or capillary. Veins are relatively soft, and the filament needles used in Dry needling can pierce these. However, arteries are far more robust, meaning it would be challenging to pierce one of these. A therapist's anatomy knowledge, training, palpation skills and needling technique manage these risks. The therapist's anatomical knowledge and even visual inspection affect needle placement. Although the main blood vessels are similar between people, there are often slight differences, especially in the smaller vessels. If a needle were to puncture a small vein or capillary, one might feel a slightly localised tingling sensation and possibly see a tiny drop of blood on needle removal. Hypothetically, piercing a large vein might result in a large bruise, though the risk should be minimal with a well trained professional.
Much like arteries, nerves are robust and are not likely pierced with a dry needle, unlike a vein. However, a Dry Needle can contact a nerve, which would result in instant nerve type pain along the nerve path. Much like veins, the risks associated with a therapist causing nerve pain are dependent on their anatomy knowledge, training, palpation skills and needling technique. One is only likely to feel such nerve pain while a needle is in contact with a nerve.
Snapped needles can typically occur with re-usable needles, as they are mechanically stressed when used and sterilised. Hence, most people use single-use needles, though there is still a very low risk.
Dry needling of muscles in the upper body (torso) can have additional risks, such as a potential Pneumothorax. As with other risks, a therapist's anatomy knowledge, training, palpation skills and needling technique are crucial in managing such risks. The needle length, depth, angle, and location are hugely important when working on the thoracic and lower neck muscles. Besides risk management strategies, another option is for the therapist to remove the risk altogether and use a less invasive non-needling technique myofascial release technique.
There have been cases of primary care health practitioners accidentally causing either an infection or pneumothorax due to congenital abnormalities. For example, there was a case of a professional causing a pneumothorax after dry needling one of the shoulder muscles. Normally, the scapula is solid bone, so needling the infraspinatus muscle would present minimal risk. However, the congenital abnormality meant a physical hole existed in the scapula. Hence, the needle could pass through the hole and between the ribs, piercing the pleura. Nobody (the professional or consumer) was aware of the congenital abnormality. The incident resulted in the needling technique for such muscles changing to air on the side of caution. Effectively, this means a very shallow needle angle, needle length and depth. There are relatively few muscles within the body that require a long needle 75-80mm, such as the Gluteus Medius or Minimus. Such muscles are relatively deep within the body and are only accessible with a long needle. However, there are occasions where a long needle might prove appropriate at a very shallow angle. It is more common to use needles between 13mm and 25mm in most treatments. In essence, the needle length only needs to be long enough to access the muscle under treatment. The needle handle prevents needles from being inserted further than the needle length and is another form of risk management.
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. The base level is at the diploma level in remedial massage in Australia. 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 then 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 on 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 consumers 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 then eight days of practical. Also, he has been treating MSK conditions for over 15 years with his Myotherapy skills. His education includes a medically-based masters level 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 wider scope 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 other kinds of techniques. One such method involves working with Ashi points, which have relevance to energy flows. Energy flows such as Qi and Chi have major importance 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 more recent fascial network research. Research into the fascial network 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 type of treatment over another.
Other Myofascial Pain Relief - Treatment and Techniques
Massage and Myotherapy Registrations
Terry brings over 15 years of experience working in the MSK Therapy field back to Brisbane from the UK. He is highly qualified with training and experience covering many assessment methods, treatment types and soft tissue therapy (STT) skills. Terry's sporting activities, experiences and interests have naturally led to him specialising in the treatment of trauma and myofascial pain relief. He also taught as a senior course coach over seven years ago on one of the first myotherapy courses in Brisbane. His skills are now available at the Morningside clinic, where he works as a Myotherapist.