Dry needling — peripheral and central considerations

Abstract

Dry needling is a common treatment technique in orthopedic manual physical therapy. Although various dry needling approaches exist, the more common and best supported approach targets myofascial trigger points. This article aims to place trigger point dry needling within the context of pain sciences. From a pain science perspective, trigger points are constant sources of peripheral nociceptive input leading to peripheral and central sensitization. Dry needling cannot only reverse some aspects of central sensitization, it reduces local and referred pain, improves range of motion and muscle activation pattern, and alters the chemical environment of trigger points. Trigger point dry needling should be based on a thorough understanding of the scientific background of trigger points, the differences and similarities between active and latent trigger points, motor adaptation, and central sensitize application. Several outcome studies are included, as well as comments on dry needling and acupuncture.

Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists

“…It should be noted that there are many different schools of acupuncture with different treatment points and techniques. 5 The manipulation of the needle with…”

“…3 Superficial dry needling (SDN) involves inserting the needle into the skin, fascia, and muscle overlying a TrP, 4 whereas, with deep dry needling (DDN) the needle is inserted into the TrP with the aim of eliciting Local Twitch Responses (LTRs). 5 Essential for obtaining therapeutic benefit with TrP-DN, LTRs are reflex spinal cord contractions of the muscle fibers in a taut band. [6][7][8] Eliciting LTRs can reduce concentrations of nociceptive chemicals, such as substance P and calcitonin gene-related peptide, found in the immediate vicinity of active TrPs.…”

“…Furthermore, the education of acupuncturists and physiotherapists using TrP-DN is considerably different. 5 A specific study of AEs following TrP-DN was, therefore, deemed necessary. The aim of this study was to determine the incidence of AEs associated with the use of TrP-DN as practiced by a sample of physiotherapists with David G Simons Academy (DGSA) training in Ireland.…”

Cadaveric and Ultrasonographic Validation of Needling Placement in the Cervical Multifidus Muscle

“…In such scenarios, dry needling has been proposed as a specific intervention aimed to activate the cervical multifidus muscle. 21 This hypothesis is further supported by the results from a recent study in which patients with low back pain who positively responded to dry needling in the lumbar multifidus muscle exhibited an increased contracted thickness of the muscle, suggesting that dry needling was able to facilitate muscle contraction. 13 This study would support clinical observation that multifidus dry needling may be applied before starting any therapeutic exercise program to more fully remedy impaired muscle contraction.…”

Dry Needling and its Use in Health Care A Treatment Modality and Adjunct for Pain Management

“…[22] The addition of dry needling of the multifidus muscle of the low back in the treatment of low back pain has been shown to increase multifidus muscle contraction and decrease sensitivity to pain in patients who responded to treatment. [23] The use of dry needling has been postulated to be a mechanism for the attainment of early pain relief in order to facilitate a manual therapy technique and a quicker return to function. [24] Other modalities used as an intervention for pain relief Dry needling and other modalities are available to aide in the delivery of pain management.…”