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What is Dry Needling?
Dry needling is an innovative therapeutic technique that involves inserting a small, thin, monofilament needle into a muscle(s) to create a local twitch response, release shortened bands of muscles, and decrease trigger point activity. It is called dry needling as it does not use medicine or inject any solution into the muscle. This technique has been shown to improve and normalize the biochemical, mechanical, and electrical components of the muscles with myofascial dysfunction. The normalization of those components helps with decreasing pain, decreasing muscle tension, improving range of motion, promoting healing, and restoring function. Dry needling is combined with other physical therapy techniques and exercises as part of your treatment plan.
What are Trigger Points?
A trigger point is a taut band of muscle located within a larger muscle group. Trigger points can be tender to the touch and/or refer pain to other parts of the body. When an injury occurs from repetitive use, poor posture, or acute trauma; injury or damage occurs to the muscles. The muscles will then go into a protective state of contraction and create taut bands to help prevent further damage to the tissue. The contracture increases inflammation in the area limiting blood flow and oxygen further contributing to the injury. This leads to fibrosis and scarring which limits the muscle’s ability to function by limiting the lengthening and shortening of the muscle. This limited function contributes to pain in the area, referred pain, or nerve compression.
What conditions can be treated by Dry Needling?
A large variety of musculoskeletal issues can be treated with dry needling. When paired with physical therapy treatments of manual therapy and exercise, dry needling can speed up recovery time and allow you to return to your normal daily activities.
Acute and chronic pain
Neck and back pain
Shoulder, hip, and knee pain
Decreased range of motion
How does Dry Needling differ from Acupuncture?
Acupuncture is based on ancient theories and traditional Chinese medicine that focuses on the flow of Qi or energy along meridians for treatment of conditions.
Dry needling is based on western medicine and the scientific study of the musculoskeletal system and neuroanatomy. Dry needling penetrates the skin and is inserted into the muscle to elicit a local twitch response, where acupuncture does not.
Is Dry Needling Painful?
While many patients experience minimal discomfort during dry needling treatments, it's important to note that the sensation can vary, particularly when treating acute injuries, tendinitis, or chronic problem areas. In these cases, you may experience a brief moment of heightened discomfort as the needle is inserted to trigger a spontaneous twitch response in the muscle. This sensation is often likened to a muscle cramp or a localized ache.
However, any discomfort is typically short-lived, subsiding quickly after the procedure. The benefits, on the other hand, are substantial and long-lasting. Following the treatment, it's common to feel muscle soreness akin to what you might experience after an intense workout. This is a normal part of the muscle's healing process and usually resolves within 24-28 hours as muscle function is restored.
For post-treatment soreness, at-home remedies such as applying heat or ice and staying well-hydrated can be effective in alleviating discomfort. Overall, the temporary nature of any pain experienced is often outweighed by the significant and enduring benefits of dry needling, making it a worthwhile consideration for many patients.
What is the History of Dry Needling?
The development of modern dry needling reflects the great tradition of empirical science, which carries some truth, and certainly some of the defects of empiricism. All new developments are built on the previous achievements of the leaders that came before.
We describe here the development of dry needling chronologically and hence define the generations of modern dry needling. It does not at all mean one modality is superior, as we all know that all modalities have certain benefits and limitations. Of course, any modality works best when in well-trained and experienced hands.
The history of dry needling dates back to the 1940’s with Dr. Janet Travell and arguably others before her. Dr. Travell identified the muscular trigger points and referral patterns that were elicited with “wet needling”, later she discovered that “dry needling” offered the same results. This was certainly groundbreaking work and hence she created the term dry needling. She and Dr. David G. Simon carefully identified most of the trigger points located in the human body. Thus, the first generation of modern dry needling was established.
In the late 1970’s Dr. C. Gunn developed the concept and technique of Intramuscular Stimulation (IMS). IMS is a technique for the treatment of myofascial pain syndrome based on a comprehensive diagnostic and therapeutic model that identifies the etiology of myofascial pain as neuropathic i.e. due to disease or dysfunction in the nervous system. It specifically identifies the nerve root as the generator of the pathology, so it is referred to as a radiculo-neuropathic model. Chronologically the IMS or Gunn approach can be considered the second generation of modern dry needling, even though it was developed without referring to Travell’s trigger point approach.
In late 1970’s, Dr. H.C. Dung, a professor of anatomy, in San Antonio, Texas, discovered the homeostatic points. Dr. Janet Travell recognized and was impressed by Dr. Dung’s discovery (personal communication). In 1999, Dr. H.C. Dung and Dr. Yun-Tao Ma co-authored the book Scientific Acupuncture for Healthcare Professionals published in China. This was the first modern needling textbook published in China. Later they co-authored the second book , Pain Measurement of the Human body also published in China to further explain the clinical application of the system.
Dr. Yun-tao Ma’s experience with needling dates back to 1968 in China where he was interested in pain science. This led to Dr. Ma being trained as neuroscientist at the National Institute of Health (NIH) and as a pain researcher in the Department of Physical Therapy at the University of Iowa. Dr. Ma continued Dr. Dung’s work to explore the physiology of the homeostatic point system and their clinical application. Dr. Ma discovered a relationship between homeostatic points and human biomechanical homeostasis. Dr. Ma also found that all modern dry needling modalities with seemingly different theories and clinical techniques, in fact, share the same physiology and are not in conflict with each other. (The Laws of Dry Needling taught in our courses)
The work of Dr. Ma and Dr. Dung can be considered the third generation of modern dry needling. The integration of treating conditions at a symptomatic, segmental, and at a systemic level, allows the practitioner to view and treat the human body as an inter-related organism, yet allowing the clinical freedom to adapt the treatment for each patient. As a result Integrative Dry Needling (IDN) provides the framework upon which to address all types of neuromuscular dysfunction.
The fourth generation of modern dry needling (DN) is currently being written. Medical and allied health professionals are incorporating DN with their current modalites, techniques and treatment concepts. Today’s modern DN is part of a multi-modal treatment plan, not a stand alone modality. Practitioners continue to find new ways to integrate and expand the use of DN to improve clinical results at a pace not previously achieved. The future of DN is exciting and filled with the potential to help more patients manage an expanding list of conditions. You can be confident that the Integrative Dry Needling Institute (IDN), with it’s adaptive Neurologic Dry Needling treatment model, will continue to be leading the charge!
(Dr. Frank Gargano DPT Founder, Integrative Dry Needling Institute, LLC https://integrativedryneedling.com/history-of-dry-needling/)
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