Dry needling enables practitioners not only to defuse pain, but to help heal. Dry needling uses monofilament needles, which are also used in acupuncture. “Any similarity between acupuncture and dry needling is on the surface”, says Dr. David Fishkin, DC, MPH, founder of the Dry Needling Institute in Rockville, MD.
How different are acupuncture and dry needling?
Dr. David Fishkin says dry needling (DN) is “a physiologic therapeutic technique and procedure. Its purpose is to neutralize soft tissue and to restore and improve muscle and fascial function. This treatment mechanically disrupts physiologically locked tissue. It consists of insertion of a monofilament, sterile, thin-gauge needle, a needle that also happens to be used by acupuncturists. Dry needling is not to be confused with acupuncture. Acupuncture is an Asian complete system of healing. Its theories focus on the use of specific points, meridians, and the concept of chi, or life-force.
The dry needling procedure, however, works with myofascial trigger points and tender points. It is based on Western concepts of anatomy, physiology, neurology, and biomechanics. The only common element is the choice of tool.”
What are the physiological and neurological mechanisms behind dry needling?
“Tissue becomes locked, fixated. We also use this term in chiropractic—when joints become fixated.” But that, says Dr. Fishkin, refers to bones. “With soft tissue, the muscle-fascial system is also in a locked or fixated state. The needle has to mechanically disrupt the area in a way similar to chiropractic manipulation to restore motion.” Dr. Fishkin says that with trigger points, too, the provider wants to allow fixation to dissipate. “I believe what’s happening is that dry needling improves lymphatic and blood circulation. pH levels improve. Interstitial swelling, which is associated with this process, recedes, and neuronoxious chemicals are flushed out. Whether it’s osseous manipulation or mobilization or massage, they all cause a response in the central system, meaning in the brain, as well. Needling will send signals to the spinal cord and up pathways to the brain, which appear to elicit a strong response from the hypothalamus, which then influences the pituitary and subsequent endocrine functions.
Is there always a spinal cord component to dry needling?
“In treatment, yes. But you can have a purely peripheral presentation. You can treat peripherally and it can result in complete resolution of the problem. So it’s not necessary to treat both. You can treat just peripherally.” But, Dr. Fishkin says, it’s often important to needle both a particular trigger point and the related paraspinals. “We may not be sure where the irritation started — centrally or peripherally. As we know, the communication goes both ways. Therefore, when there is a question, absolutely treat both. But there are times when someone will have a very localized area and you can just treat the spot and be done with it.”
“The important thing to me is that the patient has a minimally painful experience. Some other techniques are very uncomfortable for the patient. I’ve adapted and changed the approach to make it both as comfortable and as effective as possible.”
1. Lewit, K. The needle effect in the relief of myofascial pain. Pain 1979;6(1):83-90.
2. Simons DG, Travell JG. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Lippincott, Williams & Wilkins. 1999.
3. Simons DG, Mense S. Diagnosis and therapy of myofascial trigger points. Schmerz. December 2003; 17(6):419-24.
4. Langevin HM. Connective tissue: a body-wide signaling network? Med Hypotheses. 2006; 66(6):1074-7.
5. Langevin HM. Connective Tissue Mechanotransduction Responses to Stretch and Acupuncture: From Ex Vivo Fibroblast Cytoskeletal Morphology to In Vivo Ultrasound Elasticity Imaging. National Center for Complementary and Alternative Medicine. Lecture.
6. Shah JP. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. Journal Appl Physiol 2005;99:1977-1984.
7. Brendstrup P. Morphological and chemical connective tissue changes in fibrotic muscles. Annals of Rheumatic Diseases 1957;16:438-40.
8. Baldry P. Myofascial Pain and Fibromyalgia Syndromes. Edinburgh, UK: Churchill Livingstone. 2001
9. Baldry P. Superficial Versus Deep Dry Needling. Acupuncture in Medicine 2002; 20(2-3):78-81.
10. Gunn CC. Electrical twitch-obtaining intramuscular stimulation in lower-back pain: a pilot study. Am J Phys Medicine & Rehab 2006;85(12):1015-1016.
11. Gunn CC. Tenderness at motor points. a diagnostic and prognostic aid for low-back injury. J of Bone & Joint Surgery 1976;58(6):815-25.
12. Gunn CC, The Gunn Approach to the Treatment of Chronic Pain. Churchill Livingstone. 1996.
13. Garcia-Franco M. A comparative study of two myofascial infiltration techniques in trigger points: dry needling and local anaesthetic injections. Rehabilitacion 2006;40(4):188-92.
14. Ay, S. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2010 Jan;29(1):19-23.
Brendstrup P. Morphological and chemical connective tissue changes in fibrotic muscles. Annals of Rheumatic Diseases 1957;16:438-40.
Gerwin RD. An expansion of Simons’ integrated hypothesis of trigger point formation. Current Pain and Headache Reports 2004 8: 468-75.
Kimura Y. Evaluation of sympathetic vasoconstrictor response following nociceptive stimulation of latent myofascial trigger points in humans. Acta Physiol (Oxf). 2009; Feb 4. [Epub ahead of print] Shah JP. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. Journal Appl Physiol 2005;99:1977-1984.
Takaguchi S. Relationship between a chronically painful trapezius muscle and its metabolic state analyzed with PET/CT. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jul;110(1):54-61.
Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. J Bodywork Movement Ther. 2008;12:371–84.
JOURNAL OF THE AMERICAN CHIROPRACTIC ASSOCIATION – JULY 2011 7 Lund N. Muscle tissue oxygen pressure in primary fibromylagia. Scandanavian Journal of Rheumatology 1986;15(2):165-173.