Dry needling: a literature review with implications for clinical practice guidelines

Abstract

Background:Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs).Objectives:To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions.Major findings:According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners.Conclusions:Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, ...

Spinal and Peripheral Dry Needling Versus Peripheral Dry Needling Alone Among Individuals With a History of Lateral Ankle Sprain: A Randomized Controlled Trial

“…38,39 Despite the challenge of reliably identifying active myofascial trigger points, much previous research on the 20 Because dry needling of active trigger points results in local twitch responses on the contralateral, 40 as well as the treated side (as measured by electromyography), some authors suggest that active trigger points are centrally-maintained tissue states rather than a peripheral phenomenon. 39 Interestingly, dry needling of latent trigger points appears to result in local twitch responses on the treated side only. 40 Participants in external trunk support was provided during testing.…”

“…Dry needling is the insertion of a monofilament needle with the intent of treating a MTrP by disrupting the physiological milieu that causes the abnormal contraction, leading to restoration of proper muscular function. 10,11 While theories regarding the precise etiology and pathophysiology of MTrPs continue to evolve, three main theories have emerged to explain this phenomenon: the integrated hypothesis, expanded trigger point hypothesis, and intra-muscular stimulation (IMS). These theories originate from the research performed by Simons and Travell, Gerwin, Shah, and Dommerholt.…”

“…8,[11][12][13]15,16,19,20 Individuals with and without low back pain have demonstrated varied responses in muscle activation following a dry needling intervention to the lumbar multifidi muscles. [21][22][23] Studies investigating the physiological effects of dry needling of the lumbar multifidi muscles in individuals with 22,23 and without low back pain 21 demonstrate changes in nociceptive sensitivity, segmental mobility and motor function following the interventions.…”

Comparision of two different dry-needling techniques in the treatment of myofascial pain syndrome

“…After a total of 20 minutes the needles were taken off. [14] Peppering technique While the patient was sitting, the sterile 22 G needles 32 mm in length were inserted into the taut bands. [13] The trigger points were needled by moving the needle forward and backward 8-10 times at the same point, rotated clockwise and then by changing the inclination angle of the needle surrounding muscular tissue were also needled.…”

Treatment Preferences of Physiotherapists' for Acute Pain in Anterior Cruciate Ligament Injury

“…[41][42][43][44][45][46][47] Alternatif yaklaşımlardan kuru iğneleme ve akupunkturun ağrıyı azaltmada kullanılabileceği konusunda pek çok çalışma vardır. 48,49 Çalışmaya katılan fzt'lerin bu yöntemleri seçim yüzdeleri çok yüksek olmamakla birlikte, %12,9'u kuru iğneleme, %3,2'si akupunktur uygulamasını tercih etmiştir. Bu da kuru iğnelemenin son dönemde Türkiye'deki popülerliğine bağlanmaktadır.…”