Dry Needling: The Future of Physical Therapy

Time passes and so, our knowledge grows.

Physical Therapy has come a long way as a profession; it’s amazing how differently we practice now compared to even just 10 years ago!

The more we learn, the more impactful & efficient our treatments become – as they should!

To that point, many PTs have slowly begun to implement Dry Needling into their practices as the research & results continue to pile in!

Dry Needling may be the current latest & greatest in available treatment strategies, but how much do we really know about this unique procedure?

What is Dry Needling?

The future of Physical Therapy!

I jest, but it definitely is the most powerful modality we’ve been able to add to our toolkit yet!

Dry Needling, at a surface level, is actually pretty straight-forward; your PT uses a fine, non-injecting, monofilament needle to penetrate the skin and stimulate your underlying tissues, in order to produce some sort of musculoskeletal or neuromuscular benefit.

It is specifically not acupuncture, though there is plenty of overlap in the approach & the potential outcomes.

What is the Difference Between Dry Needling & Acupuncture?

Based on our definition, one could easily argue that acupuncture is a form of Dry Needling!

While modern Dry Needling has more of a clinical, evidence-based origin, acupuncture originates from early traditional Chinese medicine!

Acupuncturists claim to be dealing with the flow of “life force”: chi, qi, yin & yang. Not exactly scientific!

Through these mysterious life forces, acupuncturists claim to be able to treat not only pain, but also chronic fatigue, GI distress, fertility issues, anxiety, depression, & trouble sleeping!

Unfortunately, there’s currently no evidence to support these bold claims!

Acupuncture is just fundamentally different from modern Dry Needling in practice.

The goal of Dry Needling is to interact with muscles, specifically muscle spindles, to produce a motor response. To reach the muscular level, Dry Needling requires longer needles than acupuncturists would typically use.

Acupuncture involves using needles to interact with “meridians” at a more superficial level. Meridians are essentially all over – or at least that’s what they say – and they aren’t known to be deep. There generally won’t be any muscular interactions & thus there’s no expectation of a motor response.

The flow of chi can’t be seen by the naked eye!

So, How Does Dry Needling Work?

It’s difficult to pinpoint an exact physiological mechanism for the effects of Dry Needling, but we do get a clearer picture of the science each day!

Essentially every rationale presented to this point is very evidence-based & logically sound !

Proponents of the Myofascial-Trigger Point Theory speak to muscle fiber shortening, altered homeostasis & increased tissue irritability following a muscular strain or injury. They advocate for needling directly into that “trigger point” & producing a twitch response, relaxing the shortened fibers & returning the unit to homeostasis.

The Radiculopathic Theory points to fiber shortening as a result of nerve root compression at the spinal level. Advocates of the Radiculopathic Theory point to the benefit & importance of needling the motor points of the segmental multifidi to produce myotomal effects.

Contemporary Models highlight the needle’s interaction with the muscle spindle, activating the muscle’s stretch reflex and through that reflex loop facilitating both central & peripheral nervous system changes.

It’s very possible that the effects of Dry Needling could be explained by some combination of all of the above!

When it comes to actual practice, it’s most likely that a skilled clinician is pulling from each one of the available rationales!

What Can Dry Needling Really Do?

Well, let’s run down a list of the generally accepted potential benefits of Dry Needling:

1. Reducing Chronic & Acute Pain

There is a growing body of work outlining the effectiveness of manual Dry Needling, as well as Dry Needling with e-stim, in reducing both Chronic & Acute musculoskeletal pain. These effects have been shown to take effect immediately post-treatment & to remain at follow up [1,2].

2. Promoting Improved Motor Recruitment & Force Output

There are multiple studies highlighting that following a Dry Needling session, patients present with significantly increased force production & motor recruitment, as well as reduced contraction time [3, 4]. Researchers have also outlined the potential of intramuscular e-stim to promote activation of muscles that patients have lost voluntary control over [5]!

3. Remapping the Somatosensory Cortex

In a 2005 fMRI study, researchers were able to highlight improved blood flow & activation of the portion of the somatosensory cortex representing the leg, in response to dry needling with e-stim applied to the Anterior Tibialis musculature [6].

4. Increasing Blood Flow

When assessing the body’s hemodynamic response to needling, researchers have shown that blood flow and oxygen saturation increased significantly after a single dry needling session, and that the results lasted well after the intervention [7].

5. Improving Resting & Contractile Tone & Reducing Spasticity

Neuromuscular changes are some of the most generally accepted effects of dry needling. Multiple studies have suggested that dry needling may produce an instant benefit in the treatment of varying degrees of muscle spasticity [8-10]. It has also been shown to immediately improve both resting & contracted tone, further lending to its beneficial nature [11].

So we’ve got evidence suggesting that Dry Needling leads to healthier, stronger, less stressed, more responsive muscles while also reducing resting tone & pain! With those type of results, it’s no wonder we’re seeing PTs take up Dry Needling en masse!

Dry Needling is an extremely powerful modality & it’s in every Physical Therapist’s best interest to master it!

The more we continue to learn & grow, the stronger our profession becomes!

Better treatments means better outcomes & happier, healthier patients!

Works Cited & Further Reading

1. Chys, M., De Meulemeester, K., De Greef, I., Murillo, C., Kindt, W., Kouzouz, Y., Lescroart, B., & Cagnie, B. (2023). Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review. Journal of clinical medicine, 12(3), 1205. https://doi.org/10.3390/jcm12031205
2. de Sire A, Ammendolia A, Lippi L, Farì G, Cisari C, Invernizzi M. Percutaneous Electrical Nerve Stimulation (PENS) as a Rehabilitation Approach for Reducing Mixed Chronic Pain in Patients with Musculoskeletal Disorders. Applied Sciences. 2021; 11(9):4257. https://doi.org/10.3390/app11094257
3. Sánchez-Infante, J., Bravo-Sánchez, A., Jiménez, F., & Abián-Vicén, J. (2021). Effects of dry needling on mechanical and contractile properties of the upper trapezius with latent myofascial trigger points: A randomized controlled trial. Musculoskeletal science & practice, 56, 102456. https://doi.org/10.1016/j.msksp.2021.102456
4. Schneider, E., Moore, E. S., Stanborough, R., & Slaven, E. (2022). Effects of Trigger Point Dry Needling on Strength Measurements and Activation Levels of the Gluteus Medius: A Quasi-Experimental Randomized Control Study. International journal of sports physical therapy, 17(7), 1404–1416. https://doi.org/10.26603/001c.55536
5. Hollis, S., & McClure, P. (2017). Intramuscular Electrical Stimulation for Muscle Activation of the Tibialis Anterior After Surgical Repair: A Case Report. The Journal of orthopaedic and sports physical therapy, 47(12), 965–969. https://doi.org/10.2519/jospt.2017.7368
6. Napadow, V., Makris, N., Liu, J., Kettner, N. W., Kwong, K. K., & Hui, K. K. (2005). Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI. Human brain mapping, 24(3), 193–205. https://doi.org/10.1002/hbm.20081
7. Cagnie, B., Barbe, T., De Ridder, E., Van Oosterwijck, J., Cools, A., & Danneels, L. (2012). The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. Journal of manipulative and physiological therapeutics, 35(9), 685–691. https://doi.org/10.1016/j.jmpt.2012.10.005
8. Fernández-de-Las-Pe?as, C., Pérez-Bellmunt, A., Llurda-Almuzara, L., Plaza-Manzano, G., De-la-Llave-Rincón, A. I., & Navarro-Santana, M. J. (2021). Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis. Pain medicine (Malden, Mass.), 22(1), 131–141. https://doi.org/10.1093/pm/pnaa392
9. Zhang, Z., Wang, W., Song, Y., Zhai, T., Zhu, Y., Jiang, L., Li, Q., Jin, L., Li, K., & Feng, W. (2021). Immediate Effect of Dry Needling at Myofascial Trigger Point on Hand Spasticity in Chronic Post-stroke Patients: A Multicenter Randomized Controlled Trial. Frontiers in neurology, 12, 745618. https://doi.org/10.3389/fneur.2021.745618
10. Ansari, N. N., Naghdi, S., Fakhari, Z., Radinmehr, H., & Hasson, S. (2015). Dry needling for the treatment of poststroke muscle spasticity: a prospective case report. NeuroRehabilitation, 36(1), 61–65. https://doi.org/10.3233/NRE-141192
11. Cross, K. M., & McMurray, M. (2017). DRY NEEDLING INCREASES MUSCLE THICKNESS IN A SUBJECT WITH PERSISTENT MUSCLE DYSFUNCTION: A CASE REPORT. International journal of sports physical therapy, 12(3), 468–475.