Dry Needling

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Intramuscular Stimulation (IMS)

IMS

In IMS, the needle is inserted directly into the trigger point or taut band. This triggers a local twitch response (LTR) of the taut band. The LTR is perceived by many patients as a sensation of muscular release and is a sign that the right trigger point was needled. In addition, there is evidence to support the therapeutic value of the LTR in enhancing the release of fascia related adhesions, as well as to reduce inflammation around the Trigger Point.

Intramuscular Electrical Stimulation (IMES)

IMES

In Intramuscular Electrical Stimulation (IMES), at least two needles are inserted into the taut band and are stimulated by light TENS currents.

Superficial Dry Needling (SDN)

SDN

In SDN, the needle is inserted superficially obliquely to the skin surface, to about 3-4 mm above the trigger point or painful area. This triggers several reflex analgesic mechanisms via the spinal cord and the brain.

What is a Trigger Point?

A trigger point is a local contracture or tight band in a muscle fiber that can disrupt function, restrict range of motion, refer pain or cause local tenderness. The formation of trigger points is caused by the creation of a taut band within the muscle. This band is caused by excessive acetylcholine release from the motor endplate combined with inhibition of acetylcholine esterase and upregulation of nicotinic acetylcholine receptors.

How can Dry Needling help?

When dry needling is applied to a dysfunctional muscle or trigger point, it can decrease banding or tightness, increase blood flow, and reduce local and referred pain. The needles release tension, inflammation, chemicals, and pressure in the muscles that has caused the pain. This results in improved ROM and immediate pain relief.

How Do You Identify Trigger Points?

Trigger Points can be identified by focal tenderness to palpation along with restricted ROM when the muscle is placed on stretch. The presence of a Trigger Point is also identifiable by palpation with the presence of a local twitch response (LTR) and reproduction of predicted referred pain patterns, which matches the distribution of the subject’s pain.

Treatment Method

Treatment

She was treated using DN to the muscles mentioned before for two sessions, and no other interventions were performed in order to determine the effectiveness of DN as a primary intervention strategy without other interventions masking the effects of DN.

Results of Treatment

Clinically meaningful improvements were noted in pain and disability, as measured by the Neck Disability Index and Quadruple Visual Analog Scale. Physical examination denoted minimal to no change in cervical AROM, except for right lateral flexion, and no change in shoulder flexion/ abduction MMT.

Outcomes

Conclusion

"The patient was able to return to daily work activities without further functional limitations caused by pain. This case report shows promising outcomes for the use of DN in the treatment of non-specific cervical region strain."

What I Concluded

My Thoughts

What I concluded from this case study was that essentially, dry needling is typically just a short-term fix to treat pain so that the patient can work and/or participate their therapy activities and exercises without restricting pain. From this case study I would assume that DN is not meant to aid in treating the issue itself but to relieve the patient of pain so that they can go about their daily lives without being held back or causing secondary problems due to pain.

What are Acupuncturists arguing?

Acupuncture

Multiple acupuncturists interviewed by Healthline insist dry needling is simply acupuncture with a different name, and is not within physical therapists’ scope of practice.

“Dry needling is acupuncture and physical therapists are practicing it without a license and putting patients at risk,” Miller said. “In recent years with physical therapists doing acupuncture and calling it dry needling, we have seen a big increase in the number of unfortunate, medically negligent injuries, including pneumothorax cases. This is terrible for patients and the many years of solid safety and consumer confidence in acupuncture.”

What do PTs say?

PT

Jan Dommerholt, a physical therapist, educator, and one of the nation’s most vocal proponents of dry needling, said the procedure is not acupuncture and is just one of many tools in a physical therapist’s toolbox.

“Of course there are similarities between dry needling and acupuncture, but there are equally as many differences,” said Dommerholt, who teaches dry needling and has spoken before numerous state boards of health on the subject. “I know nothing about energy flow. That’s not what I do as a physical therapist. I come from a motion-of-movement and pain perspective."