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  • Northeast Wisconsin
  • August 2018
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Dry needling revisited

Five years ago, I wrote of a relatively new technique that was available to physical therapists called dry needling. Now that time has passed, let us take a look at this tool and how it has affected the treatment of patients with musculoskeletal pain.

Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues for the management of neuromuscular pain, and movement impairments.

Myofascial trigger points, also known as trigger points, are described as hyperirritable spots in a taut band of a skeletal muscle that is painful on compression, stretch, overload or contraction of the tissue, which usually responds with a referred pain that is perceived distant from the spot.

A very thin filiform dry needle (without medication) is inserted into a trigger point with the goal of creating a twitch response. When this occurs, it releases the trigger point and relaxes the taut muscle band. This will alleviate the pain and symptoms that the trigger point has caused. The technique itself can vary widely. The term dry needling is not trademarked. Using the internet to search for this term can bring up pages and pages of various techniques, definitions and applications.

When I took the course nine years ago — the first offered in Wisconsin — coursework consisted of five 3-day sessions, the last course cumulating in a written and practical examination to gain certification with this technique. The leader of teaching dry needling has been Myopain Seminars, a company situated in Bethesda, Maryland. The owners of the company learned and trained with Janet Travell, MD, the person most known with regard to the study of trigger points and the referral pain patterns they produce.

Since 2009, Wisconsin physical therapists have had written guidelines in the state Physical Therapy Practice Act allowing the utilization of the dry needling technique. Wisconsin was one of the first 15 states (currently 44 states allow therapists to do dry needling) in the union to permit dry needling by physical therapists.

There are distractors in the physical therapy community, as well as other disciplines, that wonder why a therapist is inserting a dry needle into a patient. However, with all the courses that I have taken dealing with soft tissue involvement, no technique has had the positive impact on improving a patient’s condition faster and more effectively than dry needling — if the condition calls for it. Therein lies the key: having competent practitioners who understand the technique, current literature and when indicated for use.

While most of our patients who come to us have not heard of this technique, word of dry needling is spreading. Many patients have been referred from family, friends, even physicians to see us for possible dry needling treatment. For those who have interest, do check with your therapist to ensure that they have undergone extensive coursework, testing and are certified in this technique. Many of the companies that are teaching this technique do not go through the demands of current literature review, training and testing. I feel this is an error not only of the participants taking such coursework, but also the course itself.

Each of our therapists have numerous cases of success for headaches, TMJ, shoulder, back, hip, and other body region pain. Dry needling is not a treatment by itself. It is a “tool in the toolbox” of techniques that a physical therapist has to offer patients to restore the musculoskeletal system to optimal health. 

Steve Barnett

I love talking about this subject, and can be reached at [email protected] As always, if you have not exercised in some time, please consult with your physician before you begin.

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