SECTION I

Dry needling has been a popular treatment choice in the west. In dry needling filiform (solid) needles are tapped through the skin to the target tissue to bring about a therapeutic effect. Unlike injection, no medicine is delivered, hence it is ‘Dry’.

A brief History of DN

Although the needles used are similar to acupuncture, dry needling is different. Dry needling is based on physiology whereas acupuncture is explained by theories of traditional Chinese medicine.

Jan Dommerholt

“ From a physical therapy perspective, TrP-DN has no similarities with traditional acupuncture other than the tool.”- Jan Dommerholt1

Dry Needling as a treatment modality is well researched. Various studies in animal and human models have found specific physiological changes related to dry needling. There is a sea of evidence showing objective measurable changes which rule out ‘placebo only’ theories.

A number of independent research validates Dry Needling. systematic reviews3,4 including  Cochrane reviews have shown the usefulness of dry needling. However, the field is full of possibilities and there is a need for high-quality research.

Schools of Dry needling

Because dry needling originated in various geographic locations simultaneously, multiple models of needling have developed.  The trigger point model of dry needling is by far the most popular type of needling and enjoys most research support.

Chan Gunn

The radiculopathy model was proposed by Chan Gunn. In Gunn’s view, shortening of the paraspinal muscles, particularly the multifidi muscles, leads to disc compression, narrowing of the intervertebral foramina, or direct pressure on the nerve root, which subsequently would result in peripheral neuropathy.

Peter Baldry

Superficial Dry Needling (SDN) has been started by Peter Baldry in 1980’s. When Baldry was treating a trigger point in the scalenus anterior muscle, to prevent accidental damage to pleura he inserted the needle just a few millimeters into the skin. He found this to be as effective as DDN. With the success of scalanae Baldry developed a system of SDN for trigger points all over the body, even with the deep muscles.

‘Although it is certainly essential to locate each TrP accurately, experience has led me to believe that it is not necessary to employ deep needling but easier, safer and just as effective to insert the needle into the superficial tissues overlying a TrP’                                                                  -Peter Baldry

Needles

  1. Needles can be as short as12.5 mm or as long as 100 mm. the choice of needle is based on the target tissue and specific techniques used.
  2. Disposable filiform acupuncture needle with guide tube is used.
  3. Guide tube minimizes pain

Needling Procedure

  • With careful precision the structure to be needled is chosen. Then sterilized disposable needles are pierced through the skin into the target tissue.
  • Choice of needle is dependent upon depth of target tissue. The target tissue can be muscle, scar tissue, nerve endings, periosteum or other structures.
  • A clean field technique is used. As there is minimal or no bleeding, sterile field is not needed.
  • The needles are kept inserted for a span of 30 seconds to few minutes and then withdrawn and disposed properly.

Specific techniques used in Needling

Deep Dry Needling: When needle is pierced deep into the muscle/target tissue. Local Twitch Response is elicited.

Superficial Dry Needling

 Needle manipulations: movement of the needles after insertion for specific purposes.

About Clean technique

The clean technique involves strategies used for patient care to reduce the overall number of microorganisms or to prevent or reduce the risk of transmission of microorganisms from one person to another or from one place to another. This technique may also be referred to as non-sterile as the sterile technique ensures a complete absence of microorganisms and is used in more invasive procedures like surgery.

To sum up:

  • With proper judgment and precision dry needling is a powerful tool for the physiotherapist.
  • It is a quick, cost efficient treatment which when indicated produces immediate result.
  • The risks are real. Need for training and safety precautions can not be over emphasized

Dry Needling is not just about the needle through the skin. What is more important is the hands behind the needle and the head behind the hands.

References

1.Dommerholt et. al, Trigger point dry needling.

2.Baldry P. Acupuncture treatment of fibromyalgia and myofascial pain. Fibromyalgia syndrome. Elsevier, 2010:149

3.Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil2001; 82: 986–92.

4.Furlan AD, van Tulder MW, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev 2005;(1):CD001351

SECTION II

SECTION III

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Welcome to your Lecture 1 DN 360 Quiz

The term trigger point was first used by

Why dry needlers shifted from using injection needles to filiform needles?

In the radiculopathy model of Chan Gunn nerve compression is attributed to shortening of which muscles?

The superficial dry needling involves inserting the needle till

Which of the following statements are correct about a clean field?

The target tissue in dry needling can be

Disadvantages of injecting local anaesthetic in trigger point is