Dry needling is a commonly used treatment by physical therapists and other healthcare providers. It can be used for a wide variety of ailments, injuries, and dysfunctions. It’s use has been increasing in popularity in the US and around the world, and many people claim excellent results from Dry Needling treatment. At Iron Standard, we also commonly use dry needling to treat a wide variety of problems, and we get tons of questions about what it actually does, if it’s the same as acupuncture, or if it really does work at all. We wanted to take this chance to do a deeper dive to fully answer some of these questions, and to highlight some of the current research behind the effectiveness of dry needling, as well as some aspects of dry needling that we don’t yet fully understand.
Is Dry Needling The Same As Acupuncture?
One of the first questions we get about dry needling is this one. When we perform dry needling, we are often using the very same needles that acupuncturists use… but that is pretty much where the similarities stop. I’m not an acupuncture expert, but from my research on the topic, acupuncture is based around treating various points along energy meridians in the body. The proposed purpose of acupuncture is to balance energy, life-force, or qi in the body. It’s been around for thousands of years, and is a staple of Eastern medicine.
Functional dry needling as we use it at Iron Standard, is primarily used to target dysfunctional (weak, painful, tight, etc.) muscles. Placement of needles is based off of a thorough evaluation of the neuromuscular system, and the goal of treatment using functional dry needling is to restore function, aka get you back to doing what you love!
What Does Dry Needling Actually Do?
The physiology behind dry needling can be a little complicated, and to be honest, there are some aspects that aren’t completely clear in the literature, but we want to do our best to simplify what we do know.
On a basic physiological level, there are several things that have been observed as responses to dry needling. The primary ones that we’ll focus on in this article are – improved blood flow, reduced spontaneous electrical activity, decreased inflammatory markers in the area, and increased strength and endurance in muscles. Let’s take a closer look at each of those.
One therapeutic response that we see with dry needling is an increase in blood flow to the area that has been stimulated with the needle. Cagnie et al in 2012 found that both blood flow and tissue oxygenation were significantly increased after performing dry needling in the upper trapezius muscle. The reason this is important is because we often see a decrease in blood flow in areas of a muscle that are especially tender/painful. Improving blood flow is just one way to help address this area.
Another physiological response that we see with dry needling is a reduction in nerve activity in the painful area, referred to in the literature as “Spontaneous Electrical Activity.” Along with the decreased blood flow discussed above, another characteristic that we see in these tender/painful areas of muscle is an increase in this spontaneous electrical activity. The exact cause of this isn’t really clear, but it behaves as if the nerve is communicating to the muscle that it needs to stay in a contracted state. This could be a big part of why you feel “knots” in your muscle in these tender areas. Dry needling essentially works as a “reset” to significantly reduce this nerve activity, in turn helping the muscle to relax. (Chen, 2012)
The next major impact on a physiological level that we see with dry needling is a significant decrease in several biochemicals that are associated with pain, inflammation, and hypoxia. This one can get pretty complicated, but here’s the quick summary. Substance P is a neurotransmitter with several different roles, but for our purposes, it’s most important role is in the communication of pain signals. Typically when we see a higher level of substance P, we see more pain. In a couple studies by Hsieh et al in 2012, and 2014, it was found that substance P was significantly decreased after dry needling. Interestingly, it seemed to decrease more with more dry needling sessions. And get this – they even found that dry needling could have effects in areas other than where the needle was actually placed – specifically going “up” the neuromuscular chain. This could be a whole article in itself, but we’ll leave it at that!
So these three factors really focus on physiological effects that just help reduce pain, but there is also some evidence that dry needling can improve muscular performance. Haser et al in 2017 found that dry needling treatment combined with water pressure massage was associated with improved strength and endurance in elite soccer players, as well as a reduced injury incidence compared to the control group.
This got a little dense, so to sum it up in a sentence – Dry needling acts as a “reset button” for a muscle that results in restored blood flow, normalization of nerve activity, reduced inflammatory markers, and improved muscle function.
Can Dry Needling Help Me?
We made some pretty bold claims above, but you may be wondering if dry needling is right for your specific condition. In the past several years, there has been emerging research on the use of dry needling in the management of a wide variety of conditions. We’ll do a very quick and brief overview of several of these here:
- Hip Osteoarthritis – after 4 dry needling treatments, participants saw a decrease in pain, and improvement in hip muscle strength and physical function.
- Cervicogenic headaches – patients who received spinal manipulation combined with dry needling had significant reductions in headache frequency and intensity compared to a group that received spinal mobilization and exercise. These benefits were still seen at 3 month follow up, and a greater number of people in the needling group were able to come off of their headache medication. (Dunning 2021)
- Low back pain – a 2018 review of dry needling research by Funk et al demonstrated that dry needling has been shown to be beneficial for a wide variety of conditions in the lumbar spine. This includes people who have chronic low back pain, as well as radicular pain associated with the lumbosacral region.
- Shoulder Pain – Koppenhaver 2016 found that individuals with shoulder pain had decreased pain and increased shoulder ROM after just one dry needling treatment. Another study by Saylor-Pavkovich in 2016 found that patients with chronic rotator cuff tendinopathy experienced reduced pain and disability following 8 weeks of dry needling treatment combined with strengthening exercises.
- Tendinopathy – Stoychev et al in 2020 demonstrated benefits of dry needling on tendinopathy in numerous locations – achilles, patella, rotator cuff, tennis elbow, etc.
- Acute Soft Tissue Injuries – multiple case reports have demonstrated benefits of dry needling in recovery from acute muscle strains
- TMD – check out last week’s blog if you want more information on how dry needling can help TMD or jaw pain.
This is by no means an exhaustive list, rather just some of the more common problems that we treat with dry needling.
Is Dry Needling Safe?
Finally, and probably most importantly, you may be wondering about the safety of dry needling. Safety is absolutely our first priority with our patients, so we are always sure to perform proper screening and assessment before we ever consider the use of dry needling. We have received advanced education in the proper technique and application of functional dry needling, which included extensive education on proper safety protocols. Beyond our own caution and adherence to protocol, the current research on this topic demonstrates that dry needling is an extremely safe treatment. In a study by Boyce et al in 2020, 20,494 needling sessions were included in the study, and major adverse events were reported in only 20 sessions, or 0.1% of all needling sessions. In another study by Brady et al in 2014, no significant adverse events were reported in over 7000 dry needling sessions.
Hopefully this article helps to explain some details about what is happening when we perform dry needling. If you think you could benefit from dry needling, please reach out! We would love to help!
If you are interested in a dry needling session, click on the button to the left to get in touch with us!
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Cagnie, Barbara, et al. “Physiologic Effects of Dry Needling.” Current Pain and Headache Reports, vol. 17, no. 8, 2013, doi:10.1007/s11916-013-0348-5.
Cagnie, Barbara, et al. “The Influence of Dry Needling of the Trapezius Muscle on Muscle Blood Flow and Oxygenation.” Journal of Manipulative and Physiological Therapeutics, vol. 35, no. 9, 2012, pp. 685–691., doi:10.1016/j.jmpt.2012.10.005.
Chen, Jo-Tong, et al. “Inhibitory Effect of Dry Needling on the Spontaneous Electrical Activity Recorded from Myofascial Trigger Spots of Rabbit Skeletal Muscle.” American Journal of Physical Medicine & Rehabilitation, vol. 80, no. 10, 2001, pp. 729–735., doi:10.1097/00002060-200110000-00004.
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Koppenhaver, Shane, et al. “Effects of Dry Needling to the Symptomatic versus Control Shoulder in Patients with Unilateral Subacromial Pain Syndrome.” Manual Therapy, vol. 26, 2016, pp. 62–69., doi:10.1016/j.math.2016.07.009.
Mayoral, Orlando, et al. “Efficacy of Myofascial Trigger Point Dry Needling in the Prevention of Pain after Total Knee Arthroplasty: A Randomized, Double-Blinded, Placebo-Controlled Trial.” Evidence-Based Complementary and Alternative Medicine, vol. 2013, 2013, pp. 1–8., doi:10.1155/2013/694941.
Rainey CE. The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report. Int J Sports Phys Ther. 2013;8(2):145-161.
Stoychev, Vladimir, et al. “Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review.” Current Reviews in Musculoskeletal Medicine, vol. 13, no. 1, 2020, pp. 133–140., doi:10.1007/s12178-020-09608-0.
Saylor-Pavkovich E. STRENGTH EXERCISES COMBINED WITH DRY NEEDLING WITH ELECTRICAL STIMULATION IMPROVE PAIN AND FUNCTION IN PATIENTS WITH CHRONIC ROTATOR CUFF TENDINOPATHY: A RETROSPECTIVE CASE SERIES. Int J Sports Phys Ther. 2016 Jun;11(3):409-22. PMID: 27274427; PMCID: PMC4886809.
Velázquez-Saornil, Jorge, et al. “Efficacy of Quadriceps Vastus Medialis Dry Needling in a Rehabilitation Protocol after Surgical Reconstruction of Complete Anterior Cruciate Ligament Rupture.” Medicine, vol. 96, no. 17, 2017, doi:10.1097/md.0000000000006726.