Dry Needling: Update to the "Hurts So Good" treatment for pain.

March 30, 2017

The technique is called "dry" because there is no medication involved.

No liquids.

 

Dry what?

Needling. Yes, that's right. This is a discussion about using needles to reduce pain AND improve function. The technique is called "dry" because there is no medication involved. No liquids. The sterile, thin, solid needle serves to disrupt the painful cycle. I have been using this technique on a regular basis since my formal dry needling education in 2013. I have been achieving excellent results ever since I first practiced for hours on my lovely and understanding wife, Katie.

 

What follows is in response to a 2017 Dry Needling literature review article I read last week. It was written by one of the foremost authorities on the subject, James Dunning, DPT, MSc, FAAOMPT.  But first, a little background.

 

Muscles Tight as Ropes.
I am quite sure everyone has felt the tight ropes in parts of their muscles. Some are so tight they could replace the strings on your guitar. Within these ropes are sometimes painful nodules or "knots." Nearly all of us know how painful those can be! These "knots" are known as myofascial trigger points (MTrPs.) Now these MTrPs are real buggers. They can spontaneously cause both local and distal pain, called referral. They can alter the way our nervous system functions and responds to the stresses of movement. These guys can even linger in the muscle without our knowledge until they are activated somehow. This usually occurs due to a sudden increase in force such as catching oneself in a fall, a harder than usual workout, or a whiplash type injury. Whether they are activated or not, they always alter the function of the muscle changing how the related joints are controlled. This can lead to other issues at the joint or tendon. There are many ways in which we can treat MTrPs including but not limited to various massage techniques including barrier release/NMT, tissue rolling, and DN. The remainder of this blog will focus on the latter.  

 

My results were amazing. Although

short lived, the post treatment

pain was higher than I wanted.

 

Hurts so good! - "You're gonna do what with that needle?"
This is the typical expression I see on the faces of my clients when I begin the conversation about Dry Needling. I have been performing Dry Needling technique in my clinic for 4 years. From the start it was known to be "worth it." For those of you who have not experienced dry needling technique, it is very difficult to describe. It feels like a deep ache in the muscle and is sometimes accompanied by a strong twitch, similar to getting your knee reflex checked. 

 

 I was trained by Myopain Seminars, one of the premier schools on myofascial pain treatment (pain in muscles and fascia.) Based on research at the time, we were instructed to go after a "local twitch response" or LTR. Several studies suggest DN works because of the mechanical disruption of these MTrPs by the needle, liquid medication NOT required. So after the training, I set out looking for the all powerful LTR. I would explain to my clients that there would be a strong twitch followed by a deep ache. It would be quite sore for 3-5 hours and then slowly get better over the next 24-72 hours. It would feel similar to a hard workout. I went along this way for some time. My results were amazing. Although short lived, the post treatment pain was higher than I wanted. 

 

As one would expect, my technique

and application has progressed

and transformed over the years.  

 

Now I have not always been open to new ideas. But over the last 7-8 years, I have fully opened myself to new thoughts and ways to treat. Through trade sessions with other PTs and ongoing education, I found a new way to perform DN. It involves being much more gentle and not necessarily going after the LTR. My new primary mode is to let the needle sit in the tissue and "cook" for awhile. I tell my clients that I am going to let the needle, "do their magic" as chemical feedback loops cause reduced pain and improved anti inflammatory response. Instead of a strong twitch, which still occur at times, I am generally looking for a sometimes strong deep ache. As the deep ache begins to subside, I perform gentle twisting and pulling motions. This pulls and tensions the deepest tissues given them a good deep stretch and changing how the nervous system interacts with the tissue. The discomfort is only to tolerance of the client. It is a much slower and gentler approach. As it turns out, I starting getting even better results with LESS pain afterwards! Eureka!

 

 

Less pain is a good thing. However, looking over this review of the current needling research led to more revelation: the local twitch response that I was previously looking to create, might actually be harming the tissue more than helping. It can damage the motor endplate, the area where the nerve enters the muscle. The LTR can even lower native opioid levels - the stuff that helps us not feel pain - which may actually reduce pain management.  On the other hand, slow needling with manual stimulation such as twisting and gentle tugging - my new technique as a result of my treatment transformation - is apparently better at increasing local and spinal opioid levels. 

 

The painful LTR during DN appears

unnecessary and may not be required

for management of Myofascial pain.

 

The skinny

DN is wonderful for the treatment of Myofascial Pain Syndrome. Techniques that include slow, gentle needling with manual twisting and pulling of the needle are well supported to be effective. The firing of LTR is actually correlated with increased post needling pain and may actually cause more damage to the tissues.  Obtaining one or multiple LTR does not have support for short term positive outcomes in neck, shoulder, and back pain. Long term outcomes have not been studied. The painful LTR during DN appears unnecessary and may not be required for management of Myofascial pain.

 

 

So, if you or someone you know have some new or old pains that just won't go away, even with your favorite method of tissue work, Contact Us. Dry Needling might be right for you. 

 

 

 

 

Dr Jim Wittekind is a licensed physical therapist. His main goal is assisting people in learning how to shutdown the system and relax so they can recover and enjoy life. He combines the science of the Postural Restoration Institute with the wisdom of meditation and mindful movement practices to turn down the crazy and enjoy life.
 

 

 

 

 

 

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