Dry Needling

”In this age of specialization, few clinicians are broad enough to see the whole patient and their problem” Janet G. Travell, MD (1901-1997)?


Myofascial trigger points are a common feature of nearly all pain syndromes, including fibromyalgia, and are characterized by persistent pain, loss of function and resulting movement impairments. A common characteristic of trigger points is referred pain, which may confuse those clinicians who are not familiar with common referred pain patterns. Many of our patients report that previous health care providers rarely have included the detailed and specific muscle examination that is common at Advanced Health Systems. Physical Therapists at Advanced Health Systems are certified in relevant pain sciences, the techniques of trigger point identification, effective manual techniques to inactivate trigger points, and restoration of function. Furthermore, Physical Therapists at Advanced Health Systems have advanced credentials and certification in the principles of trigger point dry needling (DN).


What is DN?

DN is an invasive procedure in which a solid filament needle is inserted into the skin and muscle directly at a myofascial trigger point. The hallmark feature of myofascial pain syndrome is a so-called “trigger point," which can be responsible for prolonged pain and dysfunction. As trigger points are easily accessible to trained hands, inactivating the trigger point is one of the most effective and fastest means to reduce pain. While Physical Therapists employ a wide range of intervention strategies to reduce pain and improve function, DN is the most precise and effective treatment method currently available to Physical Therapists to inactivate myofascial trigger points.


Is DN similar to acupuncture?



















Although there are many similarities and differences between DN and acupuncture, DN is not equivalent to acupuncture and should not be considered a form of acupuncture. Physical Therapists at Advanced Health Systems are not licensed acupuncturists and do not practice acupuncture. In contrast to most schools of acupuncture, DN is strictly based on Western medicine principles and research. Obviously, DN involves the use of needles inserted into and removed from the human body; however, that is the only similarity between DN and acupuncture. It is important to understand that these two approaches are very different and require different training for their clinical application.


How does DN work?

Inserting a needle into trigger points can bring about favorable mechanical and biochemical changes. Needling the trigger point interrupts the production and maintenance of the pain cycle, which improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.


What type of problems can be treated with DN?

DN can be used for a variety of musculoskeletal problems. Muscles are thought to be a primary contributing factor to the symptoms. Such conditions include, but are not limited to neck, back and shoulder pain, arm pain (tennis elbow, carpal tunnel, golfer’s elbow), headache to include migraines and tension-type headaches, jaw pain, buttock pain and leg pain (sciatica, hamstring strains, calf tightness/spasms). The treatment of muscles has the greatest effect on reducing pain mechanisms in the nervous system.


Is the procedure painful?

Most patients do not feel the insertion of the needle. Localizing the trigger point elicits a very brief (less than a second) painful response. Some patients describe this as a little electrical shock; others feel it more like a deep ache or a cramping sensation.


Are the needles sterile?

Yes we only use sterile disposable needles.


What side effects can I expect after the treatment?

Most patients report being sore after the procedure. The soreness is described as muscle soreness over the area treated and into the areas of referred symptoms. Typically post-needling soreness may last between a few hours and 1-2 days, but can easily be distinguished from the original pain complaint.


What should I do after having the procedure done?

Our recommendations vary depending on the amount of soreness you have and on the individual response to the treatment. The one cardinal rule for everyone following the procedure is to drink large quantities of water (1-2 gallons over a 24-hour period). Other recommendations may include applying heat or ice over the area, gentle stretches and modifications of activities.


How long does it take for the procedure to work?

Patients commonly describe an immediate reduction or elimination of the pain complaint, but it can vary from as quickly as one visit to several visits for a positive reaction to take place. Again, we are trying to cause mechanical and biochemical changes without any pharmacological means. Therefore, we are looking for a cumulative response to achieve a certain threshold after which the pain cycle is disturbed.


Where does DN  fit in the entire rehabilitation program?

Generally speaking, DN is the modality of choice when it comes to treating patients in the clinic. More frequently, DN is needed in the beginning in order to break the pain cycle. Once that is achieved, other treatment options are introduced.


Why is my doctor not familiar with DN?

Trigger points and myofascial pain are poorly recognized worldwide. Several studies have confirmed that myofascial pain is one of the most commonly ignored causes of persistent pain and dysfunction. In the US, DN  is a relatively new method for treating myofascial pain and not everyone is aware of this effective modality. Feel free to inform your doctor about this treatment option. It is upon all of us to educate others about new and innovative ways to treat pain.


Once I am feeling better, how often do I need to come back to maintain my progress?

The musculoskeletal system is under constant pressure from gravity, stress, work etc. A regular exercise program combined with good posture can prevent many problems. If the pain comes back, “tune-ups” may be recommended to treat and prevent further injury


Where Can I get more information about the procedure and people that are certified to perform DN?

As of October 2012, DN is formally within the scope of physical therapy practice in the District of Columbia and in twenty-nine states, including Alabama, Alaska, Colorado, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oregon, Rhode Island, South Dakota, South Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia, Wisconsin, and Wyoming. Visit www.myopainseminars.com. The sections Resources of Patients and Resources for Professionals on this site feature several other articles.