OK I realise needles aren’t for everyone. But even those needle-phobics must be at least curious. Even just a little? Firstly, let’s start with a quick rundown of the history of anatomy which will help to explain why dry needling is quite different to acupuncture. And then how it works (we think) and what it can help with.
Let’s go back to the start. 6000 years ago, or so the legend goes, in ancient China. The warrior inserted a sharpened stone into his first web space (that fleshy bit between your thumb and first finger) and just like that his chronic headaches suddenly improved. From here, Eastern medicine developed theories of meridians, or systems of energy flow within the body. Within these systems, organs and other deep tissue line up with superficial points on the body, and therefore can be influenced by stimulating these superficial points. And to this day, meridians continue to dominate eastern medicine.
Fast forward to the 15th century. Da Vinci’s drawings of the human body thrust western medicine toward our modern understanding of anatomy, and in turn the teaching of anatomy evolved throughout this period to routinely include dissection of cadavers.
Here we have the major divergence of eastern and western medicine – eastern theories of medicine are largely theoretical, with little or no dissection for hard evidence of these theories. In contrast, western medicine relies almost solely, and some may say too much, on evidence and proof of theory.
The term “dry needling” was coined by the American physician Janet Travell, who also pioneered studies into myofascial pain and trigger points (and was personal physician to JFK). From as early as the 1940’s Travell began interested in the idea of injecting these trigger points, or tight bands within muscles, with all different kinds of solutions – from lignocaine to saline to steroids – in order to treat muscular and chronic pain. Later on, she discovered that patients with myofascial and chronic pain improved with both wet (a solution) or dry (no solution) needling into these points.
It wasn’t until the 1990’s that an unknown genius started using thin gauge acupuncture needles instead of hypodermic needles. When practitioners realised that the effect was the same as using hypodermic needles, the practice took off. Firstly with sports medicine physios and physicians within elite sporting teams, and now to almost every physio, osteopath and myotherapist.
Travell and David Simons, another American physician, mapped out the entire human body of myofascial trigger points from their years of research into two thick volumes. And to this day Travell & SImons is still the bible for practitioners of dry needling for myofascial trigger points.
Yet this bible is also the ruin of many dry needling practitioners if they rely on hitting these plotted points, rather like acupuncture, instead of accurately assessing and diagnosing muscles that are causing pain and/or tightness, and targeting the tight bands within those muscles. The myofascial trigger points which cause pain and restriction are located within these tight bands of affected muscles. These tight bands can only be ‘felt’ with experience, and with a solid understanding of anatomy. Releasing these are the key to aid in restoring normal muscle function and reducing pain with dry needling.
The idea that dry needling is akin to acupuncture is false. Apart from using the same needles, the only similarities lie with the effects of inserting a needle into tissue – localised pain relief and systemic endorphin-like response. Acupuncture needling relies on targeting very specific points within meridians in order to influence other points in that meridian, which could like on a completely different part of the body or be internal or even habitual.
Dry needling is purely dumb western medicine at its best – see tight muscle, hit tight muscle.
There is no clear consensus on whether deep or superficial dry needling works best. Deep involves hitting trigger points and invoking a muscle twitch response and is what we find works best for the majority of people with muscle pain and tightness. The twitch response sends a signal to your spinal cord to tell it that the muscle has worked maximally, and in response a reflexive signal is sent back to relax the muscle in order not to do any damage to it. The result is a tired, worn out muscle, which may have some soreness akin to post-exercise soreness, yet with maximal relaxation. The soreness can last from 5 minutes to 2 days, with most people having little or no soreness the day after. The relaxation component lasts from between two to seven days for chronic complaints, and can be instantaneous relief for acute muscular tightness. The difference is that chronic complaints are often part of muscle patterns that are habitual, and so the muscle tightness can begin to return after a few days or a week once incorrect muscle patterns are used again. For this reason, dry needling is best done for chronic complaints in conjunction with an exercise program to help retrain these muscle patterns over at least a 6-8 week period.
Superficial dry needling is also practised for pain relieving effects, and with less post-treatment soreness. Whilst we do not find it as effective for releasing tight muscle bands, it is preferable for people who are needle-phobic or who experience significant post-treatment soreness. Many people with chronic pain syndromes tend to fall into this basket, and for these we will often begin initial dry needling sessions with gentler techniques to see how they respond before being too aggressive with deep dry needling.
Post treatment, localise heat (heat packs), stretching and gentle exercise is best. If any bleeding or bruising occurs, which is usually minimal and superficial if it does, then ice must be applied instead of heat. Some people can play football after needling, and some need to lie down! It’s best to have your first session on a day when you either have not much on, or later int he day where you can relax.
For more information or to try dry needling from the experts, feel free to make an appointment with one of our physiotherapists. Make sure you let our receptionists know that you are interested in dry needling so that we can guide you to the right physio or myotherapist to start with.