Dry needling has gotten a lot of buzz in the last few years in the physical therapy and sports/performance world. Is it deserved? Read more to find out.
There’s a quote that gets thrown around in a lot of physical therapy continuing education courses:
“Nothing works for everyone, but everything works for someone.”
Dry needling fits well into that mantra. Some people feel nothing, and some people have found that it was an absolute game changer and helped them finally turn the corner on a chronic injury. One of my patients told me that she had been dealing with plantar fasciitis on and off for years, and though she was skeptical of dry needling’s effects, it was the difference maker that finally eliminated her symptoms for good.
What is dry needling and what does it do?
“Dry needling is the use of a filiform needle to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability.” (1)
Here is an example of what it looks like:
There are multiple theories about how and why dry needling works. I was trained in the Integrative Dry Needling model, which breaks down the mechanisms of dry needling into local and systemic effects. Put another way it works by changing the tissue where the needle is placed, which also triggers a cascade of events to create change in the body as a whole.
The theory is that when a needle is inserted into the soft tissue, it creates a “therapeutic lesion” which stimulates tissue repair and normalizes local inflammation. To understand why this is important, we need to understand how the body heals itself after an injury.
These graphics depict the normal healing process of damaged tissues. The inflammatory phase typically lasts for about 7-10 days. After which, the proliferation phase can last for about 30 days, and the remodeling/maturation phase can be variable depending on the tissue type, but can be upwards of 6 months.
The problem is that sometimes we sustain an injury and our body is not able to get to the end of the healing process. We get stuck in the inflammatory phase because we keep re-injuring the healing tissue. Then if you take ibuprofen, it interrupts the natural inflammatory process even more! After a while, you’re left with damaged tissue that doesn’t stimulate repair anymore.
That’s where dry needling can help. The stimulation of the inflammatory process can help with tissue repair. This localized response then stimulates the body to put its rebuild and repair mechanisms in motion.
How do I know if dry needling will help me?
Some people respond more strongly to dry needling than others. There are some that feel significantly better after one session, and some that don’t notice much of a difference. Here are some conditions that I find dry needling to be consistently helpful for:
Plantar fasciitis
Plantar fasciitis can nag like a bad habit. Often, tight calves and over sensitized foot muscles can contribute to continued pain. Dry needling has started to have some promising research supporting its use as an effective treatment for plantar fasciitis, possibly even more so than cortisone injections (2). In my experience, most people who are good candidates for this type of treatment are either in a rush to get better ASAP, or have been dealing with pain for a long time only because most people don’t love the idea of needles going into their feet. The bottom of the feet can be sensitive, but most people who try dry needling find that it wasn’t as bad as they thought it would be!
Tendinopathy
An area of chronic tendinopathy is often devoid of inflammatory cells (3). As explained above, dry needling can stimulate the inflammatory response that is necessary for repair of damaged tissues. The research is still emerging about how effective of a treatment this is, but so far it’s been pretty supportive, especially when combined with a progressive loading program.
Headache, Neck Pain, Jaw Pain
There are many small muscles in the neck, head, and jaw that are difficult to massage due to their location. Dry needling helps get to those hard to reach areas to provide some very targeted treatment. Things like trigeminal neuralgia (facial pain), TMD (temporomandibular disorder), and cervicogenic headache can respond very well to dry needling.
Hip Stiffness
Talk about hard to reach areas! The muscles in the hip including the psoas, and the deep external rotators are very unlikely to be “released” with massage or trigger point release. Why? Because there is between 2-3” of stuff between the skin and those muscles. You might feel some change after a manual therapy technique to “release” those muscles, but it might not be due to change in those specific muscle groups. However, a 3 inch needle can give a VERY direct stimulus to your psoas.
Summary
Dry needling can be a helpful tool for treating many different conditions. I think of dry needling like a hammer. It’s a tool, but you can’t build a house with a hammer alone. When combined with effective physical therapy treatment and good programming, dry needling can help you kick chronic pain and stiffness to the curb for good.
Interested in giving it a try?
Disclaimer: The information provided in this blog post is for general informational purposes only and is not intended as medical advice.
Sources
https://integrativedryneedling.com/
Uygur, Esat, et al. “Preliminary Report on the Role of Dry Needling versus Corticosteroid Injection, an Effective Treatment Method for Plantar Fasciitis: A Randomized Controlled Trial.” The Journal of Foot and Ankle Surgery, vol. 58, no. 2, Mar. 2019, pp. 301–305, https://doi.org/10.1053/j.jfas.2018.08.058. Accessed 16 May 2023.
Stoychev V, Finestone AS, Kalichman L. Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review. Curr Rev Musculoskelet Med. 2020;13(1):133-140. doi:10.1007/s12178-020-09608-0
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