Should You Try Dry Needling?

I’ll never forget the first time I saw dry needling. I was in PT school and I saw a video of a physical therapist dry needling an elbow. “Nope, not for me.” I thought to myself. “I became a PT because I don’t want to be underneath the skin.” 

Fast forward 11 years and here I am, making dry needling a huge part of my practice. Who knew? 

This is me dry needling an Infantryman at Marine Corps Base Camp Pendleton to make sure his tennis elbow did not get in the way of grappling, shooting, typing, and writing.

My evolution came naturally. I was in the Navy and they prioritize training every physical therapist to provide the same excellent patient experience whether you’re on a ship, on the shore, or deployed overseas. I was, therefore, exposed to dry needling, trained, and mentored by the time I’d been in for a year. 

So, after dry needling, like, 27,000 servicemembers and civilians (I think I’m exaggerating, but who knows?), where have I landed on the subject? 

Dry needling is AWESOME. 

This is me dry needling an Army Green Beret in Kabul, Afghanistan to ensure his back pain did not keep him from his duties.

So what’s it all about?

Dry needling is a procedure that can provide immediate relief from pain, stiffness, and limited range of motion. If you suspect that pain is coming from a certain muscle, the results can be dramatic and rapid enough to confirm or rule out that suspicion. It is one of the few physical therapy interventions that is fast and dramatic. If your symptoms are acute (just came on) you may only require a session or two to get rid of your pain!

Can you just stretch and use a foam roller? Absolutely. And, you should! But will it get you the same results? No, it probably won’t. 

I usually describe dry needling to my patients as hitting fast forward on your recovery. It will give you the result of stretching and rolling consistently for 3-4 weeks. If you start stretching and foam rolling consistently after a dry needling treatment, results can be even more lasting and comprehensive. 

Why does it work?

Let’s get a little science-ey. When you have a muscle that is overworked, tweaked, spasmed, or strained, taut bands of tissue called trigger points can develop. Trigger points can be present in muscles that are very strong, but overused (think: upper trapezius, quadriceps, calves) or in muscles that may not be as strong, or are compensating for other areas of weakness (think: piriformis, gluteus medius, gluteus minimus).

Once these trigger points form, the body responds by sending signals to the brain the only way it knows how: pain. At first, the pain might be localized to just over the trigger point. The longer it takes your brain to resolve the issue though, the more symptoms start to radiate or refer to other locations. 

If you look at this map of the referral pattern of the gluteus minimus, you’ll see what looks exactly like sciatica. I’ve seen countless patients that come in with chronic “sciatica” and recover completely after treating this area!

This picture shows the upper trapezius and its surprising referral pattern to the head. Oftentimes patients with chronic headaches can resolve their symptoms after dry needling that taut, spasmed muscle at the top of their shoulder. 

Shoulder pain is often a result of overuse or weakness in the rotator cuff. One of the most notorious muscles for this is the posterior rotator cuff, or infraspinatus.

The infraspinatus pattern, shown here, can often mimic disc herniations in the neck due to its propensity for radiating down the arm and into the fingers. 

The most important factor in getting maximum relief from dry needling is to find the trigger point that is responsible for the symptoms in the first place. Once that’s tackled, the rest is easy!

• A tiny needle is inserted directly into the “belly of the beast” as I like to say. The needle does a couple of things:
  It interrupts the pain cycle with a different sensation, especially if we apply electric stimulation along with the needles to relax and fatigue the specific muscle fibers causing the symptoms. This helps to reduce pain from the treatment and to help the results last longer. 

• Although the needle is tiny, it is still causing microtrauma to the tissues. This creates local inflammation in tissues that may have stagnated in their healing. In this case, inflammation is good as it will re-engage the healing process.

• Trigger points are a kind of “tangling” of muscle fibers that start contracting and have a difficult time letting go. Adding the needle causes the myofibrils (tiny little muscle fibers) to attempt to pull them into the knot, but when they try to grab onto the smooth needle, they slip off and release. I think of this as someone on a trapeze that misses grabbing onto the next bar. The trigger point has no choice but to release.

But I hate needles!

I get it. I hear you. A lot of people just don’t do needles. What I can tell you is that these needles are not the same as what they use for a blood draw or other shot. They’re very thin, monofilament needles – just like what is used for acupuncture. 

These needles are so thin that they do not usually hurt to break the skin. In fact, it is pretty uncommon to experience any bleeding afterwards and I don’t remember a time I’ve ever needed so much as a band-aid for my patients.

I’m not trying to say that if you have a true phobia of needles you won’t be affected. What I am trying to say is, it may be worth facing those fears to experience the relief that dry needling can provide. 

At Elite Care Physical Therapy, it is our stance that quality matters. That includes quality of care, but it also means that we put in a real effort to make sure we’re using the best quality tools for each job. The needles we stock are the highest quality German stainless steel, engineered for precision work and to reduce pain and irritation. These needles are a little bit pricier than what you would see in a more traditional physical therapy clinic because dry needling is not typically covered by insurance. With that being said, that extra cost on our end is worth it to see a less painful procedure and an excellent result.

What conditions can it help? 

Dry needling is a fairly universal tool. It’s incredible for patients with chronic pain in the back, neck, hips, and shoulders. I really enjoy using it for tennis elbow because it can make such a quick and drastic improvement. It’s great for runners who’ve tweaked their calves or athletes with lingering achilles symptoms. I’ve used it quite a bit for pain referral, for instance dry needling the adductors (inner thigh muscles) to relieve testicular pain or menstrual cramps. It’s a pretty cool little jack-of-all-trades. Lately I’ve been having a lot of success using it to treat c-section scars and spasticity/tone in neurological conditions.

How many times will I have to have it done? 

This depends on a few things. If your symptoms are super chronic or you’re not sure what makes them appear, it may take quite a few sessions to get it under control. If you have a new injury or you understand what makes the pain come on and stopped that activity or position: it may only take 1-2 sessions!

Often I’ll get patients who do understand where their pain is coming from and cannot stop the aggravating activity. For example - someone who drives for a living and gets hip pain from the seat’s position or someone who has pain from the way that they sleep. Dry needling will help alleviate the pain, but the symptoms will return as soon as the activity is resumed so it may be a perpetual treatment modality to keep symptoms under control.

I’m already IN pain. Won’t it hurt?

The size of the monofilament needle ensures that the insertion itself of the needle is minimally uncomfortable. When the needle makes contact with a spasm or trigger point in the muscle tissue, it feels a bit like a charlie horse - an involuntary contraction that can be a bit uncomfortable depending on the location being needled and the irritability of your symptoms. 

Usually after dry needling, you can expect to feel sore for 1-2 days. Occasionally there is a bit of bruising present (typically only if you bleed during the procedure which is uncommon). There is no limit on what you can or should do as far as movement after sessions.

What you can absolutely expect is to see a drastic improvement in your symptoms.

Who shouldn’t undergo dry needling?

I think that dry needling is an incredible treatment tool. With that being said, it is just one tool in a big ol’ toolbox and it is truly not right for everyone. In order to most efficiently and effectively address your pain, it’s crucial to choose the best tool for the job. 

If you’re someone with a clotting or bleeding disorder, dry needling is probably not for you. If you’re immunocompromised, it’s pretty important to consider whether you want to open a new point of entry on your skin (even though it’s tiny and the needle is sterile). 

If your pain is due to hypermobility and not muscular trigger points, I would work more on strengthening and use needling as an adjunct for underlying pain (or not at all). 

If you have a true phobia of needles and you just can’t avoid tensing up during the procedure, the juice may not be worth the squeeze. 

If you have more specific questions about whether this treatment is right for you, schedule a discovery call or an appointment for more information!