Dry Needling - Brisbane MSK Clinic
What is Dry Needling?
Myofascial Dry Needling is just one of many treatment methods available at the Brisbane MSK Therapy Chronic Pain Clinic in (Morningside). Dry Needling is a form of myofascial release which treats MSK and fascial pain conditions by releasing myofascial trigger points with filament 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 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 myofascial 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 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 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. 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) 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 electrical stimulation is no better than Dry needling for the maintenance and rate of improvement in myofascial pain cases . 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 [19,31]. 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 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. 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 network. 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 [2,3,4,5,6,7].
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 . Research has continued to show the presence of myofascial trigger point involvement in a range of acute and chronic musculoskeletal injuries and conditions.
- Neck pain [6,8,9,10,11,8,12] (see Neck Pain article)
- Migraines or tension Headaches [4,12,13,14] (see Headaches article
- Back Pain [8,16,17] (see Back Pain article)
- Musculoskeletal aches associated with pregnancy (see back pain)
- Repetitive Strain Injury (see RSI article)
- Shoulder Pain [20,21,22]
- Bursitis pain (see General Bursitis Pain article)
- Sciatica (see back pain article)
- Myofascial Pain Syndrome [1,8,23] (see Myofascial Pain Syndrome article)
- Trapped nerves
- Chronic Pain (see Chronic Pain article)
- Knee pain
- Shin Splints(see Shin Splints article)
- Work-related injuries
- Foot Pain - Ankle Pain
- Jaw pain, such as Temporomandibular Joint (TMJ) 
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:-
- 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 or a stretching type feeling. Well-trained therapists should know how to increase or reduce the tension felt to the patient'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 method like a myofascial release treatment 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 patient) 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, 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 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 treatment method over another.
Other Myofascial Pain Relief - Treatment and Techniques
- 1) Rate and maintenance of improvement of myofascial pain with dry needling alone vs. dry needling with intramuscular electrical stimulation: a randomized controlled trial.
- 2) Dry needling versus trigger point compression of the upper trapezius: a randomized clinical trial with two-week and three-month follow-up.
- 3) Effectiveness between Dry Needling and Ischemic Compression in the Triceps Surae Latent Myofascial Trigger Points of Triathletes on Pressure Pain Threshold and Thermography: A Single Blinded Randomized Clinical Trial.
- 4) A sonographic comparison of the effect of dry needling and ischemic compression on the active trigger point of the sternocleidomastoid muscle associated with cervicogenic headache: A randomized trial.
- 5) Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial.
- 6) Evidence for the Use of Ischemic Compression and Dry Needling in the Management of Trigger Points of the Upper Trapezius in Patients with Neck Pain: A Systematic Review.
- 7) Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey.
- 8) Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis.
- 9) Effects of dry needling of active trigger points in the scalene muscles in individuals with mechanical neck pain: a randomized clinical trial.
- 10) Effects of dry needling of active trigger points in the scalene muscles in individuals with mechanical neck pain: a randomized clinical trial.
- 11) Effects of dry needling of the obliquus capitis inferior on sensorimotor control and cervical mobility in people with neck pain: A double-blind, randomized sham-controlled trial.
- 12) Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: a randomized clinical trial.
- 13) Dry Needling for the Treatment of Tension-Type, Cervicogenic, or Migraine Headaches: A Systematic Review and Meta-Analysis.
- 14) Effects of Dry Needling Technique Into Trigger Points of the Sternocleidomastoid Muscle in Migraine Headache: A Randomized Controlled Trial.
- 15) Effectiveness of dry needling for headache: A systematic review.
- 16) The effects of dry needling on pain relief and functional balance in patients with sub-chronic low back pain.
- 17) Short-term effects of two deep dry needling techniques on pressure pain thresholds and electromyographic amplitude of the lumbosacral multifidus in patients with low back pain - a randomized clinical trial.
- 18) The use of dry needling vs. corticosteroid injection to treat lateral epicondylitis: a prospective, randomized, controlled study.
- 19) Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis.
- 20) Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis.
- 21) The Long-Term Effectiveness of Trigger Point Dry Needling and Exercise for Individuals With Shoulder Pain: A Critically Appraised Topic.
- 22) Changes in Muscle Tone, Function, and Pain in the Chronic Hemiparetic Shoulder after Dry Needling Within or Outside Trigger Points in Stroke Patients: A Crossover Randomized Clinical Trial.
- 23) Comparison of dry needling and kinesio taping methods in the treatment of myofascial pain syndrome: A single blinded randomised controlled study.
- 24) Effectiveness of Dry Needling Therapy on Pain, Hip Muscle Strength, and Physical Function in Patients With Hip Osteoarthritis: A Randomized Controlled Trial.
- 25) Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial.
- 26) Effects of dry needling in HIP muscles in patients with HIP osteoarthritis: A randomized controlled trial.
- 27) Effects of Trigger Point Dry Needling on Neuromuscular Performance and Pain of Individuals Affected by Patellofemoral Pain: A Randomized Controlled Trial.
- 28) Added Value of Gluteus Medius and Quadratus Lumborum Dry Needling in Improving Knee Pain and Function in Female Athletes With Patellofemoral Pain Syndrome: A Randomized Clinical Trial.
- 29) The Effect of Dry Needling on Pain, Range of Motion of Ankle Joint, and Ultrasonographic Changes of Plantar Fascia in Patients With Plantar Fasciitis.
- 30) Preliminary Report on the Role of Dry Needling Versus Corticosteroid Injection, an Effective Treatment Method for Plantar Fasciitis: A Randomized Controlled Trial.
- 31) Efficacy of dry needling in patients with myofascial temporomandibular disorders related to the masseter muscle.
Massage and Myotherapy Registrations
Terry brings over 16 years of experience treating in the MSK Therapy field back to Brisbane from the UK. He is highly qualified with relevant education and training spanning from Certificate level through to higher education and a Masters. His training and experience cover many assessment methods, treatment types and soft tissue therapy (STT) skills. Besides the sixteen years of clinical experience, Terry has a further eight years of experience training and working at the highest physical performance levels within the elite British forces environment. He has a personal experience with a range of running injuries and a vast amount of professional treatment experience. He is still an avid distance runner to this day. Such knowledge has proved highly valuable in the treatment of elite-level athletes and members of the public. His ongoing sporting activities, experiences and interests have naturally led to him specialising in human performance and treating trauma and myofascial pain. He also taught as a senior course coach on the first myotherapy course in Brisbane. His skills are now available at the Morningside clinic, where he works as a Myotherapist.