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Dry Needling- It could be the answer to your pain

 

Lately I’ve been receiving a number of referrals from other practitioners (MD’s, PT’s and other Chiropractors) for a technique I learned about 20 years ago called Dry Needling.

Dry needling is a procedure in which a filiform needle is inserted into the skin and muscle directly at  myofascial trigger points.

Myofascial trigger points consist of contraction knots, which are related to the production and maintenance of the pain cycle (see prior posts).

 

Dry needling was introduced by a Czech physician Karel Lewit in 1979.

Lewit noticed that the success of injections into trigger points for relieving pain was unconnected to the analgesic used and could be achieved using a dry needle.

Chan Gunn, who introduced me to this procedure, developed a type of dry needling called intramuscular stimulation (IMS) in the 1980s.

Gunn believed that the peripheral muscle spasm was not the origin of pain, but instead, tight paraspinal muscles were causing spinal nerve compression (radiculopathy), and nerve damage running peripherally.

This spinal nerve damage eventually reached the associated muscle, causing shortening and trigger points.

Gunn recommended a needle be placed in the paraspinal muscles in addition to the distally affected muscle.

Later, Peter Baldry developed a version called superficial dry needling in 2005, in which the needle is inserted about 5–10 mm into the tissue above the trigger point.

Baldry practiced deep dry needling until he had a patient in the early 1980s with a trigger point in his anterior scalene muscle. Baldry decided to only penetrate the skin for fear of puncturing a lung.

Baldry has such success with this technique that he applied it throughout the body by simply puncturing the skin superficially over a trigger point without actually reaching it.

How does Acupuncture differ from Dry Needling?

 

 

 

The answer to this question depends upon who you ask.

An acupuncturist would say that dry needling is the same as treating “Ashi” or tender point acupuncture.

Someone trained in dry needling would argue that while the tool (i.e. the needle) is the same, the decision as to where to place the needle is different.

Having been trained in both traditional acupuncture and by Dr. Gunn in IMS style dry needling, my answer falls in line with the dry needle interpretation.

In tender point acupuncture, there is a TCM (Traditional Chinese Medical) Assessment that evaluates meridians and energy by looking at the tongue and feeling pulses. Points are chosen in order to balance energy in the dysfunctional meridians.

 

While some of the points chosen by a TCM trained acupuncturist may be similar to those used in dry needling, to be effective, there is a more to it than just treating symptomatic tender points.

In dry needling (at least the way I practice), the assessment includes:

  1. A movement screen
  2. Range of motion evaluation
  3. Strength testing
  4. Palpation

The needling is usually only part of the treatment which also includes:

  1. Manual therapy
  2. Stretching
  3. Corrective exercise
  4. Nutritional support

 

 

 

 

 

 

Is one form of therapy better than the other?

In my opinion, the dry needling approach is more effective for musculo-skeletal conditions, injuries and performance enhancement, whereas TCM acupuncture excels at internal medical conditions.

The following is a typical example of how acupuncture or dry needling would approach a problem:

A patient complains of pain.

The acupuncture approach includes a tongue and pulse diagnosis along with a series of questions.

The patient is then categorized as being in excess or deficient.

This leads to a TCM or constitutional diagnosis.

The patient would be treated with local points and constitutional points to balance meridians and Qi. They are also generally prescribed herbal formulas.

The dry needling approach would involve a medical history and an examination to include:
1. A movement screen

2. Range of motion evaluation

3. Strength testing

4. Palpation

Needles would then be used mechanically to deactivate trigger points in both the over active (tight) and underactive (weak) muscles as well as the involved paraspinal muscles.

These muscles would then be stretched or activated accordingly, to either lengthen of strengthen the involved muscles.

Lastly, home corrective exercises would be prescribed to reinforce the treatment.

The examination and treatment might include the joints above and below depending upon what shows up in the movement assessment.

Whereas acupuncture points are generally stationary, the points used in dry needling are specific to the individual’s dysfunction and can vary accordingly.

Physical therapist, chiropractors and naturopathic physicians are all starting to embrace dry needling, but are limited to practicing it in certain states (not currently in  Washington).

To my knowledge there are few if any other practitioners trained in both TCM style acupuncture and dry needling, which would be the only legal way to receive this procedure in Washington state other than from medical or Osteopathic doctors who has been trained.

For more articles on this style of needling, please visit my website:

www.old.drgeofflecovin.com

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin

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