Dry needling (DN) is a skilled technique performed by a physical therapist using thin filiform needles to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability. (Federation of State Boards of Physical Therapy, May 2015; fsbpt)
Functional Dry Needling (FDN) incorporates assessment including myotomes and referred pain patterns to determine sites for DN which will provide optimal relief.
Manual soft tissue mobilization, therapeutic exercise, neuromuscular re-education, and functional retraining should be used in combination with DN interventions. The patient should be educated in appropriate self-care techniques post DN treatment, which may include specific stretches of the involved muscles, thermo applications, or gentle trigger point pressure. DN is rarely a stand-alone procedure and should be part of a broader physical therapy approach. DN should result in a more efficient progression to corrective exercises to improve activity limitations and participation restrictions.
To provide dry needling services, physical therapists in Nebraska are required to obtain additional hours in DN. Our therapists at Midwest Physical Therapy Services have undergone this training and are able to provide DN services in the state of Nebraska.
SEE BELOW FOR MORE INFORMATION FOR HEALTH CARE PRACTITIONERS:
The physiological basis for DN depends upon the targeted tissue and treatment objectives. The treatment of myofascial trigger points (referred to as TrPs) has a different physiological basis than treatment of excessive muscle tension, scar tissue, fascia, and connective tissues. TrPs are hyperirritable spots within a taut band of contracture skeletal muscle fibers that produce local and/or referred pain when stimulated. TrPs are physiological contractures characterized by local ischemia and hypoxia, significantly lowered pH (active TRPs only), chemically altered milieu (active TRPs only), local and referred pain, and altered muscle activation patterns. TrPs are associated with dysfunctional motor endplates, endplate noise, and an increased release of acetylcholine. TrPs activate muscle nociceptors and are peripheral sources of persistent nociceptive input, thus contributing to the development of peripheral and central sensitization. Stimulation of TrPs activates the periaqueductal grey and anterior Cingular cortex in the brain, and enkaphalinergic, serotonergic, and noradrenergic inhibitory systems associated with A-δ (A delta) fibers through segmental inhibition.
The physiological basis for DN treatment of excessive muscle tension, scar tissue, fascia, and connective tissues is not as well described in the literature, but the available research shows that there may be several benefits. Muscle tension is determined by a combination of the basic viscoelastic properties of a muscle and its surrounding fascia, and the degree of activation of the contractile apparatus of the muscle. There is some evidence that excessive muscle tension, as seen for example in spasticity, can be alleviated with DN. Scar tissue has been linked to myofascial pain and fibroblasts. Fibroblasts are specialized contractile cells within the fascia that are of particular interest, as they synthesize, organize, and remodel collagen, dependent upon the tension between the extracellular matrix and the cell. DN, especially when used in combination with rotation of the needle, can place fibroblasts in a high tension matrix, at which point the fibroblast changes shape and assumes a lamellar shape, and increases its collagen synthesis and cell proliferation. DN has been shown to directly activate fibroblasts through mechanical manipulation of the needle, which in turn activates the release of cytokines and other pro-inflammatory mediators. DN can play a substantial role in the process of mechanotransduction, which is described as the process by which the body converts mechanical loading into cellular responses. Fibroblast activation with a solid filament has been shown to result in pain neuromodulation.
