Dry Needling Often Misunderstood, Not Something to Fear

Matt Briggs - It happens to all of us. You push your body to its limits—or even beyond—and your body tells you it's had enough. The resulting pain can be intense and persistent, and if it doesn't go away with rest, it's time to see a doctor.

Fortunately, the pain treatment toolkit continues to grow. Pain that was once impossible to fight has become manageable, and in many cases, can even be cured. Some treatments, like massage, have decades of research behind them, and it's clear how they help the body speed healing. Other approaches have shown results, yet are not well understood. One such technique is dry needling – inspired by the needles in acupuncture, physical therapists use needles to stimulate the body to stop muscle pain at its source, deep below the skin.

Many patients respond well to dry needling, and while there are theories about why it works, there has not been enough careful research showing why it is effective. A few studies have looked at dry needling for healing neck pain, jaw pain and low back pain, finding some short-term benefits, but data is limited, and some areas of the body have not been studied at all.

Small spot, huge pain

In physical therapy, we see a particularly troubling condition called patellofemoral pain syndrome – you might have heard of it as “runner's knee” or “jumper's knee”. The pain centers around the kneecap on the front of the knee, and it's not necessarily from a particular injury.

Usually, it results from overuse, and it constitutes about 40 percent of all types of knee problems coming into my office. It tends to strike active people who are doing too much, too fast, too soon – and the result is inflammation, which causes muscle tightness. The body gets tired and says "that's enough and I want to relax," but the athlete tends to continue to push through, resulting in a vicious cycle that feeds on itself.

The condition can be debilitating as it affects the way people run, the way they walk, whether they can go up and down stairs – even sitting for a prolonged period can lead to pain.

My colleagues and I at The Ohio State University Wexner Medical Center are now conducting a clinical trial with 120 patients to see if dry needling can fight patellofemoral pain syndrome, as it's difficult to treat through other methods. One reason it's such a challenge is it often has no identifiable, specific source. But the theories about how dry needling works suggest it can alleviate pain at specific locations, even when the source may be hard to reach. Our study will look at muscle function before and after dry needling, and evaluate the way people move using video analyses of patients' movements.

Preliminary studies suggest the needles change the way the stimulated nerves and muscles function, and even how nerve signals reach the spinal cord and people's perception of pain within their brain. There is also evidence the needles increase blood flow where they are inserted, which helps the body's pain-fighting and healing compounds get to the areas that hurt most. But at the level of muscle fibers, where much of the pain originates and where movement is most affected, there's still a lot to learn.

The needles don't hurt

The thought of needles terrifies some people. But those getting the treatment are already in pain and dry needling is trying to help them. Usually after the first insertion, they are no longer afraid. The procedure is very safe, and the training that goes into it is extensive, requiring an understanding of anatomy, neurology, physiology, kinesiology and biomechanics.

Dry needling uses tiny, flexible, solid needles that patients sometimes don't even feel, even if the physical therapist moves the needles to stimulate the tissue. The term “dry” just means that there is no injection of medicine or other substance. The insertion of the needles will draw more blood flow to the area (and to clarify, there is no blood to see – the blood flow deep in the patient's tissues is akin to what happens from applying deep tissue massage or a heating pad, just more efficient).

Sometimes patients will say they feel a dull or weak ache when a needle is in, but it's not usually uncomfortable unless the area of pain is particularly severe. Sometimes dry needling of an area that's particularly tight may immediately cause the patient to feel a deep cramp or a muscle twitch. Physical therapists call those twitch responses, and it tells us the needle is mechanically and neurophysiologically affecting the muscle. As a result, the muscle ends up relaxing, helping with both pain and muscle movement.

Another benefit is speed. If I'm doing hands-on massage for deep tissue work, I may spend ten visits working on a muscle to try to get it to relax. With a needle, it may take me one visit, with the needle in the muscle anywhere from 30 seconds to ten minutes. It gets deeper than massage and literally pinpoints the problem areas. The procedure creates a small inflammatory response, and the body takes care of the rest, going through its natural healing process.

Moving past the knee

Through our study, we're hoping to better understand the optimal dosage for the treatment – how many times to treat, or how often or how much time in between sessions to achieve the optimal effect. Then the study will hopefully expand to include shoulder pain, lower back pain and tension headaches. I've seen some good outcomes using dry needling to treat tension headaches, where you can get the muscles in the neck, the upper shoulders and the back to relax and relieve pressure.

Ultimately, I'm hopeful that studies like ours will lead to more awareness, and acceptance of dry needling. There are many physicians who are hesitant to refer patients because they don't understand the training that goes into it, what it's doing or the expertise that physical therapists have to perform it.

The technique has been a physical therapy tool for elite athletes for many years, with many therapists using it in Australia and Europe, and it has seen a significant surge of interest in the United States in both the professional ranks and general public during the last decade – although there are still states that prohibit it. With the data to back it up, I'm hopeful that critical minds will change, giving millions of Americans access to a powerful tool for treating chronic, intense pain.

Matt Briggs, physical therapist and researcher at The Ohio State University Wexner Medical Center

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