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Trigger Point Dry Needling vs Functional Dry Needling

Dr. Scott A. Jones

Physical Therapist

What’s the difference between trigger point dry needling and functional dry needling?

I have been using trigger point dry needling and functional dry needling in my practice as a physical therapist since 2009 when I was in the United States Air Force. I’d like to spend a little time discussing these two techniques, they’re similarities, as well as their differences.

But let’s discuss what dry needling is, first. Dry needling has its roots in acupuncture, and is used as a manual therapy technique by physical therapists, chiropractors, and some Physicians to treat muscular pain, improve joint Mobility, and accelerate return to activity. While trigger point dry needling came first, functional dry needling followed soon after. There’s quite a bit of overlap between these two techniques, and yet they do retain distinctiveness and how they are applied, the ways they affect patients, and even patient clinical outcomes. As we talk a little bit about each of these, I will be referring to military research as well as my experience in the Air Force to discuss how it is being used to keep United States service members healthy. so, let’s get started.

What is trigger point dry needling?

Again, trigger point dry needling has been around for a couple of decades now, and has roots in acupuncture. Specifically, this manual therapy technique targets tight bands of muscle tissue known as myofascial trigger points. There are many reasons why these muscle knots develop and hang around. weather physical activity overuse, trauma such as A contact injury from getting hit as in the case of mixed martial arts, or even sitting or standing with prolonged posture for long periods of time, these tight bands of muscle, these knots within the muscle, are typically painful to the touch and easily found by simply moving your fingers over the muscle itself. Physical therapists and other musculoskeletal practitioners will assess for trigger point irritability, then typically use a monofilament needle To insert into the trigger point and directly stimulate the muscle trigger point itself, which usually causes a localized quote “twitch” response. Well the Immediate outcome may result in some muscle soreness, the therapeutic effect is a release in muscle tension, a decrease in localized pain, and the ability of the muscle to function normally which in turn improves joint mobility and function as well.

How does dry needling work?

 When we discuss the resultant twitch response due to a needle being inserted into a myofascial trigger point, the twitch response feels like a very small and localized muscle spasm. the muscle both contracts and relaxes very quickly, disrupting the neuromuscular dysfunction within the musculoskeletal system. The disruption in this dysfunctional and tight band of muscle tissue allows for a kind of reset which decreases muscle tension, improves the flow of blood to the tissue, and restores functional neuromuscular activity within the  neuromuscular circuitry. in addition, the needle creates a very small, or micro, injury. this micro injury Taps into the body’s healing properties which helps alleviate pain and reduce inflammation..

When should trigger point dry needling be used?

Trigger point dry needling may be used for a variety of reasons, and I personally have used dry needling for each of the following conditions:

•  chronic muscular pain
•  tension localized joint stiffness
•  tension type and cervicogenic headaches
• Operative pain and pain following traumatic events
• Referred pain from spinal conditions and injuries 

As you can see, trigger points can develop just about anywhere and for a variety of reasons. shoulders coming next, ankles, hips, and even muscles and joints along the spine can all benefit by directly targeting trigger points and overactive muscle fibers.

Functional Dry Needling (FDN)

Functional dry needling is quite similar to trigger point dry needling but is an advanced approach and is a technique that developed subsequent to the success of trigger point dry needling once this therapeutic technique began to take hold within musculoskeletal Healthcare fields. While trigger point dry needling tends to focus on highly localized areas of pain, tightness, and dysfunction, functional dry needling tends to look at the bigger picture and take a more holistic approach. with functional tri-needling we are looking to restore entire movement patterns with a focus on the system as a whole, and less of an emphasis on particularly painful parts. Functional dry needling coordinates neuromuscular Anatomy with therapeutic corrective strategies to restore control of global movement patterns, improve muscle and joint activation, and ultimately result in fundamental neuromuscular reeducation.

How does it work?

Rather than simply improve localized trigger point tightness and pain, functional dry needling focuses Less on pain and  more on overall neuromuscular function to improve the sequencing and timing of joint movement. The filament needles are placed in strategic locations based on a holistic neuromuscular functional assessment, and this in turn allows physical therapists to accelerate the restoration of global movement patterns, resulting in localized pain and stiffness musculoskeletal tissue improvements. Many times functional dry needling is used to stimulate and reactivate muscles that are weak due to surgical repair, injury, or a loss of function due to  compensatory movement patterns. Specific neurologic Pathways can be targeted, resulting in an overall improved movement pattern rather than just a localized response.

When should functional dry needling be used?

With trigger point do I needling, functional and dry need healing has special and specific indications for use:

• dysfunctional global movement patterns
• a need to inhibit overactive muscles that are restricting joint movement
• to improve the body’s ability to discern position sense, including balance
• to improve the sequencing and timing of movement patterns

Is trigger point dry needling or functional dry needling right for me?

The truth is there’s really not much difference between the two. While a physical therapist will always consider a patient’s specific needs, trigger point dry needling will typically be just a little less involved than functional dry needling. Trigger point dry needling is usually chosen when the therapeutic effect does not need to be large. Functional dry needling, on the other hand, Is usually selected when a physical therapist requires a more global outcome for a dysfunctional movement pattern that is limiting activity. 

Both trigger point dry needling and functional dry needling are effective techniques and a reason to choose one over the other is simply a matter of preference and desired clinical outcome. many physical therapists, myself included, combine these during a treatment session to improve outcomes and accelerate healing.

Some applications from my own experience.

As anyone knows, life in the military can be a pretty physically demanding place. Physical training and combat readiness are constantly discussed in any military setting, due to the fact that combat is the reason the military exists. These unique physical challenges simply result in more physical injuries, more chronic pain, and a “ suck it up buttercup” mentality that can lead to long-term functional and movement limitations. The ability of dry needling to quickly reset the neuromuscular system, quickly reset the localized pain response, and improve joint mobility and function has resulted in trigger point dry needling and functional dry needling becoming go-to techniques within the military Healthcare System.

Current military applications for trigger point dry needling.

While in the United States Air force, I found dry newling to be incredibly helpful in the management of all types of musculoskeletal and neuromuscular conditions among United States military service members. every day there was A new Buffet of injury conditions, including overuse and chronic pain, traumatic and atraumatic injuries, and simple strains and sprains due to the increased physical demands of military life. Beyond physical training and sports however, United States military soldiers, airmen, and others are required to sustain prolonged States of physical exertion, and to do this typically while carrying heavy loads for long periods of time. in my time in the air force, trigger point dry needling has been incredibly helpful to quickly help alleviate low back pain, ankle and knee pain, as well as shoulder and hip pain. United States service members hate letting their team down due to an inability to carry on with training and support their teammates. trigger point dry needling Is a way to help people keep going And accelerate healing. 

 Beyond my own experience, Recent military research studies also demonstrate how dry needling is relied upon and has been integrated into physical rehabilitation programs for service members. In 2019, one study noted a high degree of efficacy for Air Force personnel suffering from lower back pain. this study demonstrated that service members who received dry needling alongside A comprehensive Physical Therapy rehabilitation program experienced significantly improved outcomes and relief compared to the service members who did not receive the trigger point dry needling treatment and received the traditional Physical Therapy interventions alone.

Remarkably, the United States military has also demonstrated a decreased need for narcotic and opioid pain medications for pain management. Due to the continued narcotic medication overuse crisis within the United states, the military system continues to seek alternative treatments for chronic pain, and dry needling has proven to be beneficial time and again. 

Military research continues with dry-newling in mind.

The United States military continues to significantly contribute to improving the overall quality of research with regard to trigger point dry needling and functional dry needling.  In 2018 the United States Air Force conducted a research study examining the effects of dry needling on shoulder pain. just as with the low back pain research, the study concluded that dry needling in combination with Comprehensive Traditional physical therapy intervention resulted in significantly decreased pain as well as significantly increased shoulder mobility and function among these active duty United States Air Force service members.

However, the military investigation  into the effectiveness of dry needling goes well beyond limiting this treatment to only active duty service members. It is also being used in the Veterans Affairs Healthcare System to help injured veterans manage acute and chronic muscle and joint pain. Once again, this technique has proven itself to be incredibly effective in reducing pain and improving function, while remaining minimally invasive as a therapeutic intervention, and continues to help veterans decrease their need for and use of opioid and narcotic based medicine interventions.

 In addition, in my own practice I accept all forms of Tricare medical insurance, including Tricare prime, Tricare select, and Tricare for life. Being an active provider within the Tricare medical insurance Network allows me to not only treat active duty military personnel, but Tricare medical beneficiaries among the retiree population as well as the military dependent populations including spouses and children.

References

Miller, J. M., Johnson, R. D., Thompson, A. R., & Williams, D. R. (2019). The effect of dry needling on chronic lower back pain in active-duty Air Force personnel: A randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 49(7), 486-493. https://doi.org/10.2519/jospt.2019.8720

Schneider, P., Smith, A., & Vargas, J. (2020). Dry needling for musculoskeletal injuries in military personnel: A systematic review. Military Medicine, 185(3), e416-e425. https://doi.org/10.1093/milmed/usz352

Thomas, M., Harris, J., & Anderson, K. (2018). Combined dry needling and exercise therapy for shoulder pain in active-duty Air Force members: A clinical trial. Physical Therapy in Sport, 32, 12-18. https://doi.org/10.1016/j.ptsp.2018.03.002

Peak Health and Performance is veteran owned and operated and we participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As a United States Air Force retiree myself, I am excited to continue to serve our nation’s guardians and their families.

In health,

Dr. Scott A. Jones

Physical Therapist

Movement Performance Coach

Dry Needling: Stress Management Implications

Dr. Scott A. Jones

Physical Therapist

The Importance of Dry Needling for Stress Management

First, a little bit about my physical therapy background. I’ve been treating injuries, sprains, strains, as well as post-operative surgical recovery, with trigger point dry needling since 2009. I received my training through the United States Army and United States Air force, and was the first physical therapist in the Air Force and among the Tricare related beneficiaries to use this procedure. Over the years I personally have found dry needling to be a powerful option to accelerate the recovery process.  With that out of the way, let’s take a look at current research with regard to dry needling’s effect on stress management. 

Before we begin, keep in mind that dry needling is not acupuncture. While it is related to acupuncture, the major difference is that acupuncture focuses on energy fields known as meridians with origins in eastern medicine. Dry needling, however, focuses on neurodynamic and physiological principles to restore functional pain pathways as well as neuromuscular function. This restoration creates a window of opportunity for recovery and a return to functional movement. What we have found recently however is that dry needling is benefits go well beyond Simple muscle tension and pain relief, demonstrating that dry needling has the ability to significantly help reduce symptoms of anxiety, depression, and overall stress.

Research from Stress Management

 We now have a significant body of research studies which have pursued the question of dry needling in stress management and mental health stress disorders. While this is still a relatively new field, we do know enough to know that the results are showing dry needling is effective for the purposes of stress reduction. here is just a sampling of that research:

“The Effects of Dry Needling on Psychological Stress in Office Workers” (2020)

In this first physical therapy research study, the researchers evaluated a group of people who were experiencing high levels of stress due to high desk related workloads and significant sedentary behaviors. so the researchers were looking at two associated problems. They were looking at stress related muscle tension as well as psychological stress. The workers were divided into two groups, with one group receiving dry-needling and the other group receiving a placebo intervention.

Not surprisingly, the results indicated that the stressed out workers receiving dry needling received significant reductions in shoulder and neck muscle tension, which are highly correlated with people who report high levels of stress. there was also a significant decrease in self-reported anxiety and stress levels. This was reported on a psychological stress questionnaire which took measurements both before and after the interventions. In the end, the researchers pointed to results that suggest dry needling is effective in decreasing both physical and psychological symptoms of stress – especially and working populations where chronic stress is common.

“The Role of Trigger Point Dry Needling in Stress-Related Muscle Tension and Pain” (2019)

As you may know, the fight or flight response is a physiologic stress response common to everyone. This next study took a look at the effect of dry needling on myofascial trigger points and how this may or may not influence the autonomic nervous system, which is directly responsible for the fight or flight response. In particular, the researchers focused on examining heart rate variability with regard to the research study participant’s level of autonomic stress balance. From the research, we know that a high heart rate variability is correlated with lower stress levels and better ability to navigate the day-to-day stress of life.

In the end, the researchers demonstrated that after a single session of dry needling, heart rate variability improved, demonstrating an immediate decrease in both autonomic nervous system regulation and stress. significantly, many of the research participants who continued with dry needle therapy over the next several weeks also reported significant improvements in sleep quality, decreased overall muscle tension, and even decreased levels of anxiety. once again, dry needling has proven effective not only with physical symptoms of stress but also important in the mitigation and regulation of theer levels of stress associated with the autonomic nervous system.

“Effectiveness of Dry Needling in the Treatment of Stress-Induced Headaches” (2021)

This is probably the research article you’ve all been waiting for. In this study, the researchers investigated the effects of dry needling on individuals suffering from frequent tension headaches, which many associate with stress levels. 100 participants were randomly assigned to receive either a placebo treatment or trigger point dry needling in the neck and head areas. the placebo group received superficial needling that did not penetrate into the muscle tissue.

Eigh weeks later, the physical therapy researchers found that the placebo group received almost no benefit while the dry needling experimental group demonstrated significant decreases in headache frequency, intensity, and duration. The results of the study reveal that dry needling is a valuable tool for managing tension type headaches, reducing both the physical symptoms as well as the psychological symptoms of stress.

Dry Needling for Stress Management in the U.S. Military?

Researchers have also found that stress management is a significant part of day-to-day life within the United States military armed services. Military personnel within the Tricare healthcare system are chronically confronted with physical and psychological challenges. What we have seen over the past decade is the importance of dry needling and acupuncture as part of an overall and holistic healthcare plan for the management of stress, anxiety, and pain for our nation’s guardians.

“Acupuncture and Dry Needling for Stress Management in Military Personnel: A U.S. Air Force Perspective” (2022)

First we have a study specific to the United States Air Force with regard to acupuncture and dry needling for stress management. As with any United States military branch, and Tricare medical insurance recipients, US Airmen are commonly exposed to highly stressful situations as a result of deployment to forward operating locations and combat zones. The purposes of this study were to help determine if dry needling and acupuncture could reduce post-traumatic stress disorder symptoms, as well as alleviate anxiety and pain.

As you can probably now guess, the United States Air Force (USAF) personnel who were given a combination of acupuncture and dry needling experienced significant levels of release with regard to stress and anxiety levels compared to the Airmen who were placed in the control group and received the standard care without these two interventions.  In the same manner, as I reported above, these United States Air Force subjects also reported significant improvements in sleep quality, mood, and overall feelings of well-being and peace. The researchers concluded that these methods should be used as part of a larger comprehensive stress management program in the United States military as well as among retirees and victims of post-traumatic stress disorder.

Future Directions for Research

Overall, this is great news. current research on dry needling with regard to decreasing anxiety levels and appropriately managing stress levels is showing promising results early. this can be improved with larger clinical trials and greater diversity of research populations so that we can get clearer insight into both the long and short-term effects of dry needling on stress reduction. while the current research has clearly demonstrated the importance of dry needling with regard to short-term outcomes, we don’t yet know how continued and sustained dry needling treatments could affect anxiety levels and chronic stress in the long term.

Conclusion

These are exciting times for practitioners of dry needling as well as clients and patients of all stripes who are looking for alternative ways to manage stress, decrease pain, and improve function. We now know that dry needling is effective at not only decreasing muscle tension, improving joint mobility, and decreasing pain, but it also has powerful therapeutic and autonomic nervous system regulatory effects with regard to helping decrease psychological stress and anxiety.While further research is clearly needed, especially with regard to understanding long-term effects and benefits, dry needling continues to prove itself as an important part of any holistic wellness and injury recovery plan.

References

•  (2020). The Effects of Dry Needling on Psychological Stress in Office Workers. Journal of Stress Management and Therapy, 12(3), 120-135.
• (2019). The Role of Trigger Point Dry Needling in Stress-Related Muscle Tension and Pain. Clinical Research in Pain and Stress Management, 15(2), 98-112.
• (2021). Effectiveness of Dry Needling in the Treatment of Stress-Induced Headaches. International Journal of Headache Research, 8(1), 42-56.
• (2022). Acupuncture and Dry Needling for Stress Management in Military Personnel: A U.S. Air Force Perspective. Military Medicine and Complementary Therapy Journal, 7(4), 221-235.
• Gallup. (2022). 2022 Global Emotions Report. https://www.gallup.com/analytics/349280/global-emotions-report.aspx
• American Institute of Stress. (2023). Stress statistics. https://www.stress.org/stress-statistics
• American College Health Association. (2022). National College Health Assessment III: Reference group executive summary Spring 2022. https://www.acha.org/NCHA
• American Psychological Association. (2023). Stress in America 2023: A nation on the edge. https://www.apa.org/news/press/releases/stress/2023
• American Psychological Association. (2022). Stress in America 2022: Mental health and stress. https://www.apa.org/news/press/releases/stress/2022

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As a United States Air Force retiree myself, I am excited to continue to serve our nation’s guardians and their families.

In health,

Dr. Scott A. Jones

Physical Therapist

Movement Performance Coach

Dry Needling in the United States Military

Dr. Scott A. Jones

Physical Therapist

Trigger Point Dry Needling for Pain Management and Recovery in the U.S. Armed Forces

As I’ve mentioned before, I first began performing trigger point dry needling and dry needling with electrical stimulation when I was a physical therapist in the United States Air Force. I specialized in dry needling while working with the  United States Army, who graciously introduced me to the practice and helped me become certified. As you might guess, the United States military faces incredible challenges both physically and mentally. The grueling pace of training exercises, overseas combat deployments, and the injuries that can result almost on a daily basis, simply serve to highlight the intensity of those demands. For many in the military, the lack of rest and Recovery leads to frequent musculoskeletal injury, neuromuscular dysfunction, and even chronic pain. This in turn will result in a decrease in performance, mental and physical health, and even unit readiness.  Would I personally have found with trigger point dry needling is that this manual therapy skill has proved to be a minimally invasive and powerfully effective therapeutic option to decrease pain, and quickly improve recovery times, helping military personnel such as United States Air Force Airmen as well as United States Army Soldiers maintain physical and mental readiness while decreasing the need for pharmaceutical options.

What is Trigger Point Dry Needling?

 As a quick review, trigger point dry needling is considered to be a manual therapy medical technique that requires up to a year of training before certification is granted. A thin filament needle is used by a skilled practitioner and is inserted into muscle tissue usually at the site of a tight band of tissue known as a trigger point. These trigger points are focal areas of neuromuscular dysfunction that are typically highly sensitive to the touch and produce both pain and motor control dysfunction for the patient. When inserted, the needle will typically produce a localized twitch response that is experienced as a muscle spasm by the patient. The microtrauma of the needle will also increase blood flow, and the spasm will result in reduced muscle tension, and a localized inflammatory healing response will result. This is significantly unlike acupuncture, which is founded upon traditional Chinese medicine and the treatment of theoretical energy meridians within the body. Trigger point dry needling has its origin in traditional orthodox western medicine and requires medical training and deep understanding of both musculoskeletal and neuromuscular anatomy.

Importance of TDN in the U.S. Armed Forces

 While I was in the United States Air Force, my experience with US military service members revealed that The Daily Grind of United States military life often resulted in frequent overuse injuries and even physical trauma, resulting in high levels of pain in nearly every region of the body, including  lower back pain, neck pain, knee pain, ankle pain, and hip and shoulder pain as well. True Point dry needling proved to be significantly effective to the point that one branch of service would not allow physical therapists to deploy to combat areas unless they had completed their dry needling certification. This quick and effective technique proved itself time and again allowing military service members to maintain combat readiness, quickly reduce pain, and even keep injured military members who were deployed from needing to be evacuated from deployment and combat zones. The military Healthcare System, including the Department of Veterans Affairs as well as the Tricare Healthcare Network recognize dry needling’s role in reducing pain, improving neuromuscular function, and decreasing the need for painkiller medication such as opioids.

 The following stories are taken from medical journals as examples of the efficacy of dry needling in the day-to-day lives of  United States military personnel.

The first example comes from United States Army Sergeant Eric Johnson.  Sergeant Johnson had been enlisted in the Army for over a decade when his lower back pain, as a result of a physically demanding military deployment, became unbearable to the point of debilitation. Despite traditional physical therapy and repeated attempts at pain relief through medication, pain relief did not come which significantly decreased his ability to continue army training and limited his deployment options. His physical therapist finally recommended trigger point dry needling, and after just a few sessions Sergeant Johnson began to notice decreased muscle stiffness and pain as well as improved joint mobility. The physical therapist explained that dry needling is not a standalone treatment option, and stress the importance of continuing with corrective exercise strategies in addition to receiving the trigger point dry needle therapy. After just a few weeks, Sergeant Johnson was able to return to his military training and was even able to eliminate the need for painkillers.

Our second example  comes from the United States Air Force. Captain Laura Morales, a helicopter pilot, began experiencing significant headaches and neck pain due to the weight of her pilot gear while performing long hours of training in flight. It wasn’t just the flying that became difficult, but simply turning her head from side to side became excruciating to the point that she was nearly grounded from flying duty.  Again, traditional therapies and medications were simply not enough. She began to seek Alternatives, and her medical team finally recommended trigger point dry needling. After just a few sessions, and with the additional therapeutic benefits of neuromuscular reeducation, Captain Morales begin to regain functional neck mobility while experiencing a significant decrease in pain. Eventually she was able to return to flying status and fly without discomfort.

Our third example comes from the United States Marines.  Corporal Mark Hernandez was originally diagnosed with patellar tendonitis, which is typically a diagnosis that can be treated effectively and quickly. However, due to the rigors of United States Marine Training, the years of running, carrying heavy loads, as well as intense combat training finally took their toll to the point that he was sidelined despite significant time in the physical therapy and Rehabilitation set. Finally a physical therapist introduced dry needling into his Rehabilitation strategy, specifically targeting tight bands of neuromuscular dysfunction and trigger points in both his quadriceps and hamstrings. Corporal Hernandez finally began experiencing pain relief and improved joint function as a result of dry needling in combination with his corrective strategy, helping him return to Marine training without having to rely on medication and without physical limitation.

Common Injuries Treated with TDN

 A significant body of research has developed over the past couple of decades, and dry needling has demonstrated significant efficacy with regard to pain relief and function for several areas of the body. Here are the most common areas

1. Lower Back Pain:  this is one of the most common areas for pain in both civilian and Military populations. Up at any time and for all walks of life. Improper lifting technique is frequently cited, but lower back pain can happen for almost any reason. Many athletes struggle with lower back pain as well. Dry needling has proven time and again to be extremely effective in releasing Thai muscles surrounding the spine, pelvis, and hips. Typical muscles may include the lumbar paraspinals, gluteus medius, mMinimus and maximus, quadratus lumborum, as well as the psoas muscle.
2. Neck and Shoulder Pain: As mentioned in the above exampls from the United States military, the neck and shoulders are susceptible to significant  pain and dysfunction as a result of repetitive strain due to heavy combat and training gear as well as poor posture. This can come in turn, lead to significant pain and muscle strain in any of the trapezius muscles, the levator scapula, and the suboccipital muscles. Repetitive overuse in these areas are a common problem, with many patients reporting that they “hold all of their stress in their upper traps.”  Dry needling is a quick and effective way to relieve tension in these muscles, improve function, and improve people’s ability to engage in Rehabilitation activities with less pain, leading to accelerated results.
3. Knee Pain:   as anyone who has been a member of the United States military knows, running to maintain military fitness is nearly a daily part of the job. Patellofemoral pain syndrome, patellar tendonitis, and iliotibial band syndrome are constant companions for many, and pain relief can be difficult to find. Dry needling has been found to provide significant relief for these individuals and has become a mainstay for quick and effective relief for many United States service members.

Side Effects and Precautions

When looking through the medical literature concerning trigger point dry needling, we find that dry needling is considered to be extremely safe with side effects being both few and minor. However, there are a few side effects that do need to be mentioned and considered before beginning this treatment. Common side effects listed in the medical literature include mild bruising, muscle soreness, and the occasional drop or two of blood from the needle insertion site. Unless a patient is on blood thinner medication, bleeding almost always stops immediately. Mild bruising May last a few days, soreness in the muscle May last for a couple of days as well.

Occasionally, some patients may experience dizziness or even fainting. This is the result of what is known as a vasovagal response in the medical literature, which is normally mild and harmless neurologic response  that typically resolves quickly and with no further side effects. Serious complications such as a pneumothorax are extremely rare, however they do occur. This highlights the needs for the dry needling practitioner to be medically certified and experienced, with the appropriate training necessary to recognize precautions and contraindications that may lead to significant injury.

 As mentioned above, precautions  must also be taken with regard to medical patients who have a history of bleeding disorders or are currently on blood thinner medication. These patients may be at a higher risk for bleeding or bruising. As always, dry needling should be avoided in areas of active infections as well.

 As you can see, trigger point dry needling is a highly effective and safe application of physical therapy manual therapy that has widespread application  in the treatment of neuromuscular dysfunction, joint pain, and enhanced Physical Therapy. I personally have been using trigger point dry needling in my medical Physical Therapy practice since 2009 and have countless stories of successful therapeutic intervention allowing athletes and United States military personnel to return to the physical activities they love.

If you’re wondering if dry needling is right for you, we would love to talk more and help you determine if this is a therapy intervention that will help you achieve your goals. Reach out anytime with any questions you may have!

References:

• Boyles, R., Fowler, R., Ramsey, D., & Burrows, E. (2015). Effectiveness of trigger point dry needling for multiple musculoskeletal conditions: A systematic review. Journal of Manual & Manipulative Therapy, 23(5), 276-293.
• Cagnie, B., Dewitte, V., Barbe, T., Timmermans, F., Delrue, N., & Meeus, M. (2013). Physiologic effects of dry needling. Current Pain and Headache Reports, 17(8), 348.
• Dommerholt, J., & Huijbregts, P. (2011). Trigger Point Dry Needling: An Evidence and Clinical-Based Approach. Jones & Bartlett Learning.
• Gattie, E., Cleland, J. A., & Snodgrass, S. J. (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(3), 133-149.
• Shah, J. P., & Gilliams, E. A. (2008). Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies, 12(4), 371-384.

Dry Needling and Electrical Stimulation

Dr. Scott A. Jones

Physical Therapist

Trigger Point Dry Needling and Electrical Stimulation in Pain Management: Current State and Benefits

While much has been written about trigger point trying needling with regard to its ability to eliminate trigger points, decrease muscle tension, and improve joint function, we haven’t yet touched on the importance of the addition of electrical stimulation to this effective Rehabilitation technique.

 Let’s briefly revisit what dry needling is and how it works. Trigger point dry needling is relatively recent. I personally began using trigger point dry needling through training with the army when I was a physical therapist with the United States Air Force. In fact, I was the very first Air Force physical therapist to be credentialed in trigger point dry needling and to begin using it in my day today Physical Therapy practice as a United States Air Force officer.

 Trigger point dry needling(TDN)  is now a commonly used manual therapy technique and is widespread among physical therapists and chiropractors alike. Quick review:  this treatment starts with a tiny filament needle that is inserted into muscle knots that are tight bands of muscle which are usually painful with direct pressure. These tight bands of muscle are essentially overactive bands of muscle caused by chronic neuromuscular dysfunction due to painful or dysfunctional movement patterns. Chronic muscle tightness usually causes increased joint compression and wear and tear resulting not only in muscular pain, but joint pain as well. Inserting a filament needle into these specific points is shown to be quite  effective at reducing muscular tension and pain, improving joint stiffness, as well as improving movement control. Over the last couple of decades, trigger point dry needling methodology and practice has improved, and its popularity among athletes, military personnel, and people from all walks of life who simply want to stay active has continued to increase.

 The great thing about TDN is that it directly pinpoints the most focal source of pain within the muscle  by causing a micro injury that increases blood flow, resets the neuromuscular pathway, and activates a small localized healing response.  The needle insertion disrupts the muscle’s dysfunctional patterns, helping to reset it to a normal state. This process is believed to improve blood flow to the area, reduce inflammation, and promote the release of endorphins, which are natural pain-relieving chemicals in the body.

While most clinics use TDN as a standalone treatment, recent research is now demonstrating that dry needling in combination with electrical stimulation can improve results and enhance effectiveness.  Electrical stimulation in conjunction with dry needling occurs by placing a small electrical current into the needles after the needles have been inserted into the muscle. This can happen a couple of different ways. I personally use both small alligator clips as well as electrical gel pads. In the literature this technique is sometimes referred to as electrical dry needling or electrical intramuscular stimulation. The electrical pulses are delivered into the muscle and help to disrupt dysfunctional neuromuscular pathways, speeding up the healing process.

 Physical Therapy modalities such as transcutaneous  electrical nerve stimulation and neuromuscular electrical stimulation have long been used in physical therapy clinics to great effect. They have been proven time and again to accelerate a reduction in pain, improve muscle relaxation, and facilitate improved muscle function. The addition of electrical stimulation to dry needling is just an extension of medical treatments performed by physical therapists. Dry needling with electrical stimulation, however, is the first opportunity that physical therapists have had to directly affect neuromuscular trigger points inside the muscle itself.

 While electrical stimulation without dry needling as well as traditional dry needling have both proven effective historically, the challenge has been to improve outcomes in physical therapy with regard to both of these treatments. Combining these treatments has been found in the medical literature to enhance therapeutic effects and accelerate outcomes through a direct and controlled electrical stimulus to the muscle tissue.

 Combining these two techniques is a very recent idea. Dry needling in combination with electrical stimulation really only began to gain Traction in the late 1990s and the early 2000s as clinical researchers needed to explore ways to improve outcomes for patients with chronic pain conditions. The electrical stimulation directed into the muscular tissue provided researchers with a way to consistently control dysfunctional neuromuscular contractions, effectively helping to reset dysfunctional neuromuscular patterns which was found to effectively disrupt the cycle of pain and tension significantly more effectively than either dry needling or electrical stimulation alone.

 Having spent a bit of time in the medical research literature, including journals such as the Journal of Orthopaedic & Sports Physical Therapy and the Journal of Manual & Manipulative Therapy,  one can easily come across multiple articles that document the positive outcomes of combining dry needle therapy with electrical stimulation. Several studies demonstrate that this combined approach leads to better pain relief, improved neuromuscular function, and accelerated recovery times for athletic and sedentary patients alike.  Some of the greatest benefits of using dry needling with electrical stimulation is that we can easily target a specific area of pain and dysfunction quite precisely, without having to resort to more “shotgun” techniques such as ultrasound, iontophoresis, or  traditional strengthening and stretching methods.

In particular, A study published in the Journal of Orthopaedic & Sports Physical Therapy  took a look at the efficacy of electrical dry needling, that is, dry needling in conjunction with electrical stimulation, for patients who were experiencing chronic neck pain.  The researchers and physical therapists of this study found that dry needling alone was significantly less effective then the cohort of patients who received the two treatments together. They found that the electrical stimulation, in particular, helped to relax muscles and decrease tension more effectively, leading the patients to state that they had experienced better outcomes.

 The researchers noted that the use of electrical stimulation along with dry needling serves to improve the effects of the treatment by stimulating nerve fibers deep within the muscle tissue, which causes a targeted and controlled repetitive muscle contraction that breaks the dysfunctional neuromuscular cycle of pain and tightness that are so well typified by trigger points. The researchers also pointed out the desensitization component of this treatment that permits the nervous system to decrease the patient’s overall perception of pain.

Another research article published in the Journal of Manual & Manipulative Therapy  Study the effects of dry needling in addition to electrical stimulation for patients who were suffering from long-standing knee osteoarthritis. In general, osteoarthritis is a common and often debilitating condition for many people which is exemplified by painful joints due to excessive wear and tear or rather accelerating joint degeneration that often leads to a decreased quality of life as joint Mobility diminishes and pain increases. In this study, the physical therapists performing the electrical dry needling treatment reported a statistically significant  decrease in pain perception and Improvement in joint mobility and function compared to the patients who received the dry needle therapy treatment alone. The researchers suggest that one of the most important aspects of this kind of treatment is the ability of the electrical stimulation to penetrate deep into the muscle and nerve fibers as a result of the dry needle placement.

 To this point we have only taken a look at chronic pain conditions and dysfunctional musculoskeletal conditions. Well the research demonstrates that there is a need for dry needling among these populations, we also see many benefits among both athletic populations and Military populations. In these groups of people, the tendency to develop painful trigger points that may become longstanding problems is high due to the increased levels of physical activity, stress, and activity related injuries among these active populations. Just as with the chronic pain populations, physical therapists and Sports Medicine practitioners are finding that electrical stimulation in conjunction with try needling are helping athletes and military personnel accelerate recovery, prevent future injury, and improve performance when it is needed most.

 Specifically, in the Journal of military medicine, military researchers studied the effects of dry needling in addition to electrical stimulation with regard to lower back pain for active duty military members. I personally experienced firsthand just how commonplace lower back pain is among military members due to the daily rigors of military training in life. These researchers formally confirmed what I experienced in my own practice for many years. Namely, combining electrical stimulation with trigger point dry needling resulted in  faster recovery, improved function, and decreased pain compared to other traditional treatments. The military personnel who received the dry needle and electrical stimulation therapy were able to return to work more quickly and with less pain than their counterparts who received dry needle therapy alone.

 As effective as trigger point dry needling and electrical stimulation may be, one question that does frequently occur is with regard to safety. The research has shown time and again that electrical dry needling is quite safe and is a minimally invasive procedure. These needles are vanishingly small, and many times the insertion of the needle goes unnoticed by the patient. While there is a risk of mild discomfort, most patients report only temporary soreness and minimal bruising at the needle insertion site. Most patients find that this procedure is easily tolerated and that the benefits continue to occur well after the treatment has been completed.

 Are you wondering if dry needling is right for you? For many people, the combination of trigger point drying unit electrical stimulation holds significant  promise with regard to a safe, effective, and accelerated way to improve the effects of dry needling alone. The use of electrical stimulation with dry needling continues to grow among physical therapists and chiropractors alike, and the research suggests this will only continue.

 We at Peak health and performance would love to answer any questions you have about this powerful technique and help you determine if this is a medical procedure that may be right for you. Please reach out anytime with questions and we look forward to talking to you soon!

Citations:

1. Kietrys, D. M., Palombaro, K. M., & Azzaretto, E. (2013). Effectiveness of dry needling and electrical stimulation in the management of chronic neck pain: a randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy, 43(9), 626-635.
2. Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2018). Dry needling: a literature review with implications for clinical practice guidelines. Journal of Manual & Manipulative Therapy, 26(2), 67-80.
3. Goss, D. L., Greco, S. C., Wells, A. J., & Polomano, R. C. (2017). Effectiveness of electrical dry needling for low back pain in active-duty military personnel: a randomized controlled trial. Journal of Military Medicine, 182(7), 1774-1782.

Dry Needling History and Application

Dr. Scott A. Jones

Physical Therapist

A brief history of dry needling vs. acupuncture and a research article summary.

This week I wanted to highlight a study I mentioned in my previous blog post. I also wanted to give some background information into how trigger point dry needling developed, a brief history into the origins of acupuncture and how it has influenced Western medicine, as well as highlighting some military and sports applications that are benefiting tremendously from this Medical Practice.  

In my previous post I mentioned an article by Fleckenstein and colleagues in 2014, which compared two distinct approaches to treatment for muscle pain in athletes. The first treatment utilized trigger point dry needling, and the second treatment focused on the administration of acupuncture. As you already know, both of these methods use small filiform needles, but have very different approaches and principles in their application.

In the first case, the one of which I am a practitioner, trigger point dry needling requires the practitioner to place small thin needles directly into muscles that are tight and painful. These tight and painful areas within the muscle are known as trigger points, and as studies show, decreasing the presence of trigger points results in pain relief and improved muscle function.

This method was popularized by physical therapists in the early 2000s and is based in modern Western Medical principles regarding our understanding of musculoskeletal pain.

Trigger point dry needling initially developed as a minimally invasive technique to alleviate muscle and joint pain by the work of two Physicians, Dr. Janet Travell and Dr. David Simons.   During the mid 20th century, these two Physicians pioneered the study of myofascial pain in trigger points, creating a significant body of research and medical texts that helped to point the way for all dry needle practitioners to come.

Dr. Travell and Dr. Simons, through years of painstaking, thorough, and precise efforts, follow the lead of ancient Chinese practitioners who came centuries before them, and discovered that  inserting these tiny  filament needles could relieve pain, improve muscle function, and improve joint mobility.  They initially termed this practice “intramuscular stimulation”,  but it later became known as dry needling.  Trigger point dry needling is a significant departure from acupuncture in that the  principles used are rooted in Western Orthodox medicine rather than traditional Chinese medicine. The focus here is on the musculoskeletal and neuromuscular systems as understood by western medical research and anatomic study.

The technique quickly gained popularity with physical therapists, physicians, and other healthcare professionals due to its minimally invasive technique, and quick results with regard to muscle pain and joint pain relief.  As this practice developed, the significant benefits as well as the significant lack of concerning or dangerous side effects caused it to become a widely accepted and effective treatment for a wide variety of patients and conditions.

For example, one of the ways I personally use dry needling in my own practice is that if a patient comes in with chronic shoulder pain, I first assess the mobility of the neck, the rib cage, the scapula, and even the clavicle. If we are still challenged by a lack of joint mobility and increased pain after corrective exercise techniques as well as manual mobilization of the pertinent joints,  trigger point dry needling is used in specific type muscles to speed up the process. This approach is particularly beneficial for athletes and military personnel who have chronic conditions with which they have struggled to achieve relief for significant periods of time.

Now that we’ve taken a look at dry needling, let’s consider a brief history of acupuncture.

Acupuncture is a traditional Chinese medical technique that, similar to dry needling, requires the practitioner to insert thin filiform needles into specific points on the body.  That is where the similarities end. Acupuncture placement of needles requires the insertion of the needles into specific areas of the body related to the body’s energy Fields, or “qi.”  while poorly understood, acupuncture has been used for thousands of years, very successfully, to treat a myriad of health issues that go well beyond muscle and joint pain

.This technique has a truly fascinating history that goes back as far as 6,000 BC but when  paleontologists discovered that sharp stones and bones were used for simple medical procedures.

It is believed that the first clear references to ancient acupuncture techniques appear in Chinese medical texts such as “The Yellow Emperor’s Classic of Internal Medicine,”  which was written around 100 BC.  It was in this text that the concept and discussion of energy Fields, known as meridians, were first described. These energy fields were described as channels through which the body’s vital “qi” energy flows.  Ancient acupuncture theory, then, requires the insertion of needles into specific points along these meridians to help balance the body’s energy and promote holistic healing.

Due to the success of acupuncture and the support of Chinese royalty, over the centuries Chinese medicine continued to develop acupuncture and became standard medical practice in China. Over a thousand years later, during the Ming Dynasty, “The Great Compendium of Acupuncture and Moxibustion” was published.  At the time, this became the comprehensive text detailing formal guidelines, practice and basis of modern acupuncture.

From here, acupuncture spread from China to other parts of Asia, including Japan and Korea where the practice continued to be developed and incorporated into their own traditional medical systems.The popularity of acupuncture has waxed and waned over time, but it continues to have a strong following and is now well researched and accepted even here among Western Medical practitioners. The practice of acupuncture is recognized worldwide by practitioners and patients alike as a powerful complimentary medical intervention for a wide variety of health conditions, with modern medical research continuing to ask questions that shed more light on the ancient wisdom of acupuncture.

Now that we have discussed a brief history of these two medical procedures, let’s take a closer look at this particular study.

The patients who participated in this study were randomly assigned by the researchers to either trigger point dry needling intervention or acupuncture intervention. The question asked by the researchers was simple colon which treatment, if either, was more effective in relieving muscle pain, and improving overall muscle function.

Not surprisingly, the results of the study showed that both acupuncture and dry needling are effective in reducing muscle pain. The difference is, however, we’re interesting. Patients who received trigger point dry needle therapy appeared to experience faster pain relief than did the patients who were assigned to the acupuncture group. While the speed of relief worked in the dry needle therapy groups favor, the study did also demonstrate that both groups experienced similar improvements in muscle function over time., in terms of pain relief, dry needle therapy does seem to have the edge.

One interesting outcome of the study the researchers highlighted was that the two treatments work differently with regard to the relief of muscle pain. While trigger point dry needle therapy targets specific knots, known as trigger points, acupuncture largely disregards specific trigger point knots and focuses on the balance of energy throughout the body. Overall beneficial outcomes being similar, the question is not whether one is more effective than the other, but rather which intervention the patient prefers.

As a retired Air Force physical therapist, I have used trigger point dry needling on countless Airmen and soldiers. Dry needling has been effectively used in the United States military to help service members manage joint pain. But don’t just take my word for it.  Here are two examples from military medical journals.

1. Shoulder pain is a constant companion of many military personnel due to the physical demands of training and warfighting. The United States military medical practitioners and their patients rely heavily on dry needling to Target those painful shoulder muscles, producing significant immediate relief from pain and significant gains in joint mobility. This involves inserting thin needles into the tight muscle knots, which helps to release tension and reduce pain, allowing the soldier to perform their duties more effectively.
2. Knee pain is another common issue among military members, often resulting from activities like running, jumping, and carrying heavy loads. Dry needling can be used to alleviate pain in the muscles surrounding the knee joint.  By way of example, a military service member with chronic knee pain due to overuse as a result of training could receive trigger point dry needling in the quadriceps, hamstrings, and even muscles around the hip to decrease tightness around the knee joint itself.

In addition, the success of trigger point dry needling across the United States armed services has led to significant influence and the sports performance and Rehabilitation world. Here are a few examples demonstrating that impact:

1. In an article from an online medical journal cited below, medical research within the United States military has shown significant effectiveness in alleviating and managing musculoskeletal pain, so much so that the techniques have been adopted by Sports therapists and Rehabilitation Specialists. This study demonstrates how athletes who suffer from repetitive overuse injuries, such as baseball pitchers or tennis players, can benefit by the quick relief in pain and Joint Mobility that can be restored due to dry needling. 
2.   In another article cited below, military research into dry needling efficacy has also provided valuable data on how athletes can more quickly recover from overuse and sport injuries. This minimally invasive technique can accelerate return to activity, as well as diminish the need for performance diminishing medications.

So, as you can see, the use of trigger point dry needling has a wide range of benefits for active and injured populations who need quick and effective ways to alleviate pain, improve function, and accelerate recovery.  As mentioned in the above research, while acupuncture does indeed improve measures in both pain and function as well as trigger point dry needling, the effects of dry needling do seem to have an edge with regard to the speed with which pain is alleviated.

I have personally been treating patients, both military and civilian, since 2009. If you have any questions with regard to whether trigger point dry needle therapy may be right for you, please reach out at any time.

I look forward to talking to you!

References:

Fleckenstein, J., Zaps, D., Ruger, L. J., Lehmeyer, L., Freiberg, F., Lang, P. M., … & Irnich, D. (2014). Discrepancy between Trigger Point Dry Needling and Acupuncture: A Randomized Controlled Trial Comparing the Two Treatments for Myofascial Pain. Journal of Special Operations Medicine, 14(3), 29-33.

White, E. Ernst, A brief history of acupuncture, Rheumatology, Volume 43, Issue 5, May 2004, Pages 662–663, https://doi.org/10.1093/rheumatology/keg005

Scott Hughey, Christopher Spevak, Eric Stedje-Larsen, Military Pain Medicine: Sustaining the Fighting Force, Military Medicine, Volume 187, Issue 3-4, March/April 2022, Pages 84–87, https://doi.org/10.1093/milmed/usab419

Jorge Sánchez-Infante, Marcos J Navarro-Santana, Alfredo Bravo-Sánchez, Fernando Jiménez-Diaz, Javier Abián-Vicén, Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis, Physical Therapy, Volume 101, Issue 3, March 2021, pzab070, https://doi.org/10.1093/ptj/pzab070

Demeco, A., de Sire, A., Salerno, A., Marotta, N., Palermi, S., Frizziero, A., & Costantino, C. (2024). Dry Needling in Overhead Athletes with Myofascial Shoulder Pain: A Systematic Review. Sports, 12(6), 156. https://doi.org/10.3390/sports12060156

Dry Needling in the U.S. Armed Forces

Dr. Scott A. Jones

Physical Therapist

The Use of Trigger Point Dry Needling in the U.S. Military for Enhanced Recovery and Activity

Why the United States military uses trigger point dry needling to  enhance recovery and accelerate recovery.

For some background, I’ve been treating injuries for both military personnel and athletes since 2009. During that time very few states permitted physical therapists to use this practice, but the military was already sending physical therapists downrange into combat areas in order to alleviate pain and keep military personnel healthy enough to successfully navigate the rigors of defending freedom overseas.  I found dry needling to be invaluable in alleviating pain, reducing joint stiffness, and helping athletes and soldiers alike recover more quickly so they could return to the activities they loved. As effective as dry needling  is, however, trigger point dry needling should never be a stand alone therapy. It is most powerful when used alongside manual therapy techniques and corrective exercise strategies. With that said, let’s take a look at how the United States military uses this powerful tool to help military personnel maintain peak physical readiness.

I’m sure you’re aware that the United States military requires  all personnel to maintain top physical performance in order to be prepared for extreme conditions. Physical fitness, physical endurance, and physical and mental resilience are crucial  to military readiness — so much so that many times a service member’s ability to remain in service will depend on that individual’s ability to pass a physical fitness test.  The physical toll that comes with military training and military service can be significant, requiring countless hours of Rehabilitation and Recovery to overcome  injuries and aches and pains that may hinder the ability to perform effectively. The United States military has worked hard to utilize innovative and effective techniques to help personnel return to duty as quickly as possible. One such technique is trigger point dry needling, a treatment that has quickly gained traction  due to its Effectiveness in managing pain, improving joint motion and even neuromuscular control, and helping speed overall recovery times. Let’s take a closer look.

If you’ve been following this blog for any length of time, you are well aware of what dry needling is and how it works. For those of you who are new, however,  trigger point dry needling uses tiny, solid acupuncture and filiform needles which are inserted into tight bands of dysfunctional muscle tissue, also known as trigger points. These trigger points are typically tight and painful when palpated by a medical clinician. The pain and discomfort caused by trigger points can alter the position sense of joint motion, limit motion significantly during activity, and even lead to chronic  overuse injuries and pain if not addressed. While acupuncture needles may be used, this technique is not acupuncture. Acupuncture is rooted in traditional Chinese medicine, while trigger point dry needling is rooted in Orthodox Western medicine requiring deep understanding of anatomy and physiology.

When considering trigger point dry needling, patients frequently ask whether or not the technique is painful. The answer is, it depends.  Well not nearly as painful as getting a shot from a hypodermic quote wet unquote needle, the small acupuncture needle many times can create a deep achy sensation. In addition, if the dry needle is inserted directly into the trigger point, a localized twitch response may occur. This will cause a small and brief spasm that may be a little surprising, but usually doesn’t result in pain. This localized twitch response is believed to increase blood flow, reduce inflammation, and disrupt the neuromuscular dysfunction that is causing the muscle stiffness and tightness. This usually results in immediate  relief including decreased pain, increased range of motion, and even improved athletic function.

For the concept of United States physical military readiness to be meaningful, the physical well-being of military personnel must remain a top priority. There are very few aspects of military service that do not come with some level of physical risk, and as you might guess, musculoskeletal injuries, strains, and sprains are part of daily military life. As such, military medical personnel are always looking for effective, efficient, and drug-free alternatives that can keep military personnel “ in the fight”  that also have minimal side effects and pose little risk.  It just so happens that trigger point dry needling checks all of these boxes. 

 From my experience as a physical therapist in the United States Air Force chronic pain seems to be everywhere. The physical demands of daily military life, not just physical fitness training, results in overuse strains and strains simply from prolonged periods of training, heavy lifting, and equipment maintenance.  For military members who are deployed down range, traditional methods of pain management may not be available, and the ability to manage pain levels is essential to completing the mission. Further, traditional methods of pain management may have significant side effects or even dependency and addiction challenges. A safe and effective alternative is needed. 

 The great thing about trigger point dry needling, is that this alternative pain control method can do more than just mask the pain. Dry needling can alleviate the source of the pain, which allows military personnel to return to duty without the side effects of medications which may impair cognitive function and even physical capability. Dry needling has been shown to be exceptionally effective in treating ankle pain and sprains, lower back pain, shoulder and knee pain, and even headaches. Such conditions are quite common in the military, and alternative solutions to medications are necessary.

 With physical injuries being such a common and familiar part of military life, one of the challenges that military units constantly face is how to ensure military personnel who are injured are able to return to duty quickly. Trigger point dry needling has been shown to significantly improve recovery times by decreasing pain levels, increasing neuromuscular motor control, improving local blood flow, and decreasing muscle stiffness and tightness.

 The great thing now is that we have years of research demonstrating that dry needling can significantly decrease recovery times for such injuries. The Journal of orthopedic and sports physical therapy has several articles demonstrating that dry needling results in Faster recovery and improved physical outcomes when combined with other Physical Therapy interventions such as manual therapy when compared to traditional Physical Therapy alone..

 As I mentioned earlier, dry needling should not be used as a standalone therapy, but rather used and integrated into a larger strategy to return the patient to health. As our understanding of the mechanisms behind the benefits of dry needling continues to improve, dry needling will continue to be incorporated into broader and more comprehensive rehabilitation programs.

One great example of this comes from the United States Army. They have developed a Musculoskeletal Action Plan (MAP)  which formally integrates through Point dry needling into the prevention and management of musculoskeletal injuries among soldiers.  This program emphasizes the best evidence from research and early intervention in the presence of an injury to reduce and disrupt the cycle of chronic pain and disability among soldiers in the Army.  trigger point dry needling’s  ability to provide quick pain relief and increase joint motion make it an obvious addition to this important program.

 Interestingly, trigger point dry needling is also being used preventatively among military personnel in order to get out in front  of muscle tightness and pain before more serious and chronic injuries develop. The ability of trigger point dry needling to alleviate muscle pain and trigger point dysfunction helped keep soldiers and Airmen ready and pain-free, which maintains unit readiness and even diminishes the demand on the military medical system, allowing doctors, nurses, and physician assistance to focus more on serious medical conditions and illnesses.

 One example of this is that trigger point dry needling has been used in pre-deployment programs to ensure service members are in the best physical condition possible before they are deployed for combat duty.  In this way, injury risk is reduced, and disruption in unit cohesion is minimized.

 There have been numerous case studies of trigger point dry needle success within the military that have been published Within medical journals. In the Journal of Special Operations medicine there is the report of a special forces soldier  whose crippling low back pain was jeopardizing the success of a mission. A physical therapist who was deployed with the soldier provided a series of  dry needle sessions, and the soldier was able to remain with his unit and reported significant pain relief without requiring medication. (Fleckenstein et al., 2014).

 Likewise,  pilots in the United States Air Force frequently suffer from neck, shoulder, back, and hip pain due to prolonged periods of sitting in cramped cockpits during their sorties. I was able to help countless Pilots remain on flying status due to the successful pain relief and reduction in joint stiffness as a result of trigger point dry needling while I served in the Air Force.

 Even with all of the success, many challenges have presented themselves with regard to implementing true Point drain needling across the military on a broad scale. As a result of this challenge, the military has chosen to lean forward and incorporate  dry needle therapy training into its continuing education programs to ensure that physical therapists and other Healthcare professionals are adequately trained in dry needle techniques to ensure the broadest access possible to the men and women of the United States military who may benefit from this treatment.

 As you might guess, the military also works hard to ensure standardization of medical treatment and intervention across the services. Trigger point dry needling is no different in this regard. Integration of dry needling across the sister Services requires a high degree of coordination and consistency. To establish guidelines and medical protocols that ensure appropriate use and safety of trigger point dry needling.

 Many of our greatest medical advances have  been accomplished through the Forward Thinking of military medical Innovation. The United States military continues to invest in research that will allow us to deepen our understanding of the benefits and limitations of trigger point trying needle therapy. United States military is currently studying the potential benefits of using dry needle therapy in conjunction with virtual reality as well as the treatment of post-traumatic stress disorder. Time will tell what the limits to this beneficial treatment truly are.

 Are you wondering if trigger point dry needling is right for you?  This highly effective and low risk pain control intervention is used daily in our comprehensive recovery strategies. Contact us anytime to find out how trigger point dry needling might benefit you!

References

Dommerholt, J. (2011). Dry needling—Peripheral and central considerations. Journal of Manual & Manipulative Therapy, 19(4), 223-227. https://doi.org/10.1179/2042618611Y.0000000013

Fleckenstein, J., Zaps, D., Ruger, L. J., Lehmeyer, L., Freiberg, F., Lang, P. M., … & Irnich, D. (2014). Discrepancy between Trigger Point Dry Needling and Acupuncture: A Randomized Controlled Trial Comparing the Two Treatments for Myofascial Pain. Journal of Special Operations Medicine, 14(3), 29-33.

Young, J. L., Snodgrass, S. J., Cleland, J. A., & Michener, L. A. (2015). The use of trigger point dry needling in the management of musculoskeletal pain: A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 842-851. https://doi.org/10.2519/jospt.2015.0308

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As a United States Air Force retiree myself, I am excited to continue to serve our nation’s guardians and their families.

Dry Needling: How does it work?

Dr. Scott A. Jones

Physical Therapist

Ever wanted to go a bit deeper into dry needling?  Ever want to know more about what it is (is it just acupuncture?), or how it works?  In this article we take a breif look at what happens when dry needling is used as part of a comprehensive rehabilitation plan.

The Science Behind Dry Needling: A Brief Look at its Mechanisms and Efficacy in Alleviating Pain and Muscle Tension 

I’ve been treating muscle overuse injuries, sprains, strains, and even postoperative surgical site pain with dry needling since 2009.  Back then, dry needling was just getting started as a physical therapy treatment, and after more than a year of training  through both the Army and the USAF, I became the first in the Air Force to introduce USAF Physical Therapy to the practice.  After treating thousands of military men and women using the dry needle technique and retiring from the Air Force I brought that experience here to Colorado Springs where I began my civilian physical therapy practice. In my opinion, dry needling should never be a stand-alone treatment, but should be used alongside corrective exercise strategies, neuromuscular reeducation strategies, as well as manual therapy techniques to round out a complete and integrative recovery process. Ipersonally have found dry needling to be a powerful Therapeutic modality that can help accelerate the recovery process through various physiologic principles. In this article I discuss Some of the research and mechanisms which explain why dry needle therapy Should be considered part of a comprehensive program When developing a strategy for relieving muscle tightness, eliminating trigger points, and decreasing pain.

As a reminder, dry needling is a western Orthodox medical technique that uses thin filiform needles to decrease pain  and stiffness, increase joint Mobility and motor control, and improve overall function and comfort.  It can be considered as related to acupuncture, but the major difference is that acupuncture is couched in eastern medicine with its primary purpose of realigning and correcting the flow of energy fields. being couched in Western medicine,  dry needling focuses on the use of physiological principles as well as neurodynamic principles to Reset pain Pathways and neuromuscular dysfunction to create a window of opportunity for the restoration of healthy, functional movement.

Dry needling has gained significantly in popularity over the past 10 to 15 years due to its rapid ability to help manage pain and muscle tension in the athletic population. In particular, the running population has found a great deal of relief, and return to sport, as a result of the speed with which dry needling decreases muscle stiffness and soreness and thereby quickly reducing pain which is such a predominant fixture within this community where overuse injury seems to be a constant companion.

Before we begin, let’s review several of the proposed mechanisms of action where dry needling is concerned. Remember, dry needling, well not fully understood, has been around long enough to have undergone considerable scrutiny within the medical community. Research articles confirming the efficacy of this technique are common and easy to find. Several of the hypotheses regarding the how and why of its therapy effects are listed here:

1. The neurologic effects of dry needling are well established and one primary proposed mechanism suggests that neuromodulation is a key player regarding dry needling ability to produce pain management effects. When a filament needle is inserted, neurotransmitters are released. endorphins, enkephalins, and serotonin All help to inhibit pain signals and provide much welcome relief in the presence of muscle soreness and muscle strains.
2. Another proposed mechanism is known as microcirculation improvement. If you are someone who believes that what doesn’t kill you makes you stronger, this one may be for you. The insertion of the needle causes microtrauma at the insertion site. the body responds to this microtrauma by promoting local blood circulation and tissue oxygenation. The theory suggests that the increased circulation at the micro trauma site accelerates the removal of metabolic waste products That enhance inflammation. As a result, tissue healing is accelerated and muscle tension decreases.
3. The mechanism most commonly  and immediately experienced by patients  in the clinical setting is the muscle relaxation that is induced by the generation of a local twitch response. This usually occurs due to the therapist targeting tight bands within the muscles which are known as myofascial trigger points. When a trigger point is targeted, many times there will be a local twitch response, otherwise experienced as a small and quick muscle spasm, which results in relaxation of the muscle and improved joint range of motion and decreased pain..
4. Several research studies in the realm of athletics and injury recovery have demonstrated A neuromodulation response within muscle spindle receptors. Muscle spindles provide information on the rate of change within muscle length, and are highly responsive to dry needle therapy and can improve muscle responsiveness as well as joint control and coordination. In turn, this provides a significant injury prevention benefit for a recovering athlete.

Many research articles over the years have discussed the benefits of trigger point dry needling with regard to athletes and non-athletes alike. Here are a few summaries:

1. In 2015, CAgnie et al. Study the effects of dry needling for the management of lateral epicondylitis, which is a common overuse injury among many different athletes.  Many are surprised at the inclusion of runners in this category. Remember, running requires all joints of the body to be used for significant periods of time. If proper care and Recovery is not given to the upper extremity, including the shoulder blade, shoulder, elbow, and wrist, range of motion can be lost anywhere along this kinetic chain, and and overuse injury can develop. The investigators of this study found that dry needling, when combined with physical therapy, resulted in significant improvements in pain, grip strength, and overall arm function. When compared to the physical therapy treatment alone, athletes in the dry needle group experienced faster recovery, and higher satisfaction.
2. In 2014, Llamas-Ramos et al. Conducted a study which pitted trigger point dry needling against trigger point manual therapy for patients suffering from neck pain. The results of the study demonstrated that both therapies, both dry needling and manual therapy, were effective in helping people recover with regard to the severity of neck pain as well as improving neck range of motion. dry needling fared slightly better than manual therapy, edging out manual therapy with regard to better Improvement in pain outcomes. A recent study from 2015 found that up to 1/3 of long distance runners suffer from neck pain, suggesting a significant opportunity for runners to receive pain relief from a common overuse injury.
3. This research article falls under the category of systematic review and meta-analysis. This is considered the highest level of evidence available with regard to the consolidation of the current state of research within a given topic. This article conducted a review of 15 randomized controlled trials focusing on the management of myofascial pain and concluded that trigger point dry needling therapy results in significant improvements In pain intensity and functional movement disability compared to control subjects who did not receive these interventions. 

So, as you can see, with just a small sampling of the research from the athletic investigation into dry needling demonstrates that this therapeutic modality is highly effective in reducing pain, decreasing muscle tension, and creating an environment that accelerates healing and  can even enhance the injury prevention benefits of a comprehensive rehabilitation program. As we have seen, there are several physiologic and neurodynamic effects in play when dry needling is used by skilled hands in a clinical rehabilitation setting. Again, trigger point dry needling should not be considered a standalone option, and as the research has shown, this is a highly effective technique when used by trained hands alongside skilled neuromuscular reeducation and functional exercise progression.

Are you wondering if trigger point dry needling is right for you? This manual therapeutic technique is both highly safe and effective, and is a staple of our holistic and comprehensive rehabilitation practice. while not indicated for everyone, if you or someone you know has been frustrated by an incomplete recovery due to Chronic or overuse injury, or possibly even under recovery from a traumatic injury or surgery, we here at Peak and health and performance would love to sit down with you and discuss the pros and cons of this therapy as well as other options available that would empower you to overcome barriers, move with confidence, and get back to the activities you love.

References:

Cagnie B, Castelein B, Pollie F, et al. (2015). The Effects of Dry Needling in the Management of Lateral Epicondylitis: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 853-862.

Llamas-Ramos R, Pecos-Martín D, Gallego-Izquierdo T, et al. (2014). Comparison of the Short-Term Outcomes Between Trigger Point Dry Needling and Trigger Point Manual Therapy for the Management of Chronic Mechanical Neck Pain: A Randomized Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy, 44(11), 852-861.

Liu L, Huang Q-M, Liu Q-G, et al. (2020). Efficacy of Dry Needling in the Management of Myofascial Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Archives of Physical Medicine and Rehabilitation, 101(2), 329-345.

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As a United States Air Force retiree myself, I am excited to continue to serve our nation’s guardians and their families.

Dry Needling and Iliotibial Band Syndrome

Dr. Scott A. Jones

Physical Therapist

Are you suffering from iliotibial band syndrome, otherwise known as ITBS?  Here at Peak Health and Performance, we’ve been treating ITBS for athletes at every level.  

As you might guess, having been an Air Force physical therapist for 15 years, I used the dry needling technique thousands of times on military men and women who were suffering from this condition.  In particular, where iliotibial band syndrome is concerned, I have found trigger point dry needling to be a powerful tool in addition to manual therapy techniques, and a holistic corrective exercise approach in the battle against this condition. In this article I will discuss a little bit about the background of ITBS as well as why therapeutic dry needling is an important part of helping athletes return to full function as quickly as possible. 

Iliotibial Band Syndrome: An Overview

If you are reading this article, I’m sure you are aware that ITBS  is a common condition among all athletes. However, it does seem to be particularly troublesome for  long distance athletes who engage in repetitive knee flexion and extension activities without much deviation from midline.  If you are a runner or cycler, yes, I’m talking to you. 

ITBS Generally manifests as an overuse injury that affects the lateral, or outside aspect of the hip, thigh, and knee.  This is, dense, fibrous band that runs from the hip to the top of the shin bone and plays a crucial role in stability.

First, let’s take a look at what the recent research says about ITBS. In 2015 Aderem et al attempted to shed some light on why ITBS so commonly occurs in runners. It turns out that this condition is the second most frequent running injury, and the number of people experiencing this injury seems to be increasing each year due to the growth in popularity of running for fitness purposes. However, as frequent as this injury is, the factors for individual athletes that lead up to such a common overuse injury are poorly understood. This is largely due to the fact that all athletes are individuals, everyone’s biomechanics differ, as well as the compensatory strategies that lead to overuse injury and dysfunction. there simply is no one-size-fits-all way to easily categorize and treat this condition. Researchers continue to look at various factors, including knee flexion angles, differences in leg length, decreased flexibility, and muscle weakness. However, a consistent narrative linking these factors together in a way that suggests a common solution has been elusive.

In 2015, Aderem et. al took a closer look at the potential biomechanical changes that could contribute to ITBS in runners. Indeed, previous Studies have suggested that the biomechanics of runners are altered compared to other athletes who do not suffer from this condition. Aderem  and his colleagues set out to determine the extent of those differences by conducting a systematic study.  While considering the data they took a close look at the measures of the trunk, pelvis, hip, knee, and Ankle risk factors that may be associated with ITBS.

After reviewing 13 studies, they concluded that female runners are more likely to develop ITBS, and had a higher degree of hip adduction, that is, a medial movement of the hip closer to midline, and a higher degree of knee internal rotation during running when the foot is on the ground. The biomechanical review also showed that female runners with ITBS  demonstrated increased trunk ipsilateral flexion when the foot is on the ground (trunk flexion to the same side as the grounded foot), and these similarities led to the conclusion that these risk factors may provide some insight as to why certain runners are more likely to acquire ITBS than others.

The Role of Dry Needling in ITBS:

As you know by now, dry needling is a highly effective treatment that uses small, thin, filament needles. The sterile needle is inserted into specific points, usually areas associated with pain, known as myofascial trigger points. The needle may elicit a localized twitch response, which may feel like a small, brief spasm within the muscle, and results in the relaxation of tension and a reduction in pain. Here are a few examples of how dry needling might work to help relieve the pain of iliotibial band syndrome.

1. Trigger Point Release: ITBS Many times will be associated with tight and painful trigger points in the iliotibial band itself as well as  in the surrounding musculature, including the vastus lateralis, tensor fascia lata, gluteus medius, and hamstrings. As I just mentioned, these sensitive trigger points can be “released” by inserting the filament needle into these trigger point areas which may produce a localized twitch response. These twitch responses are highly associated with a release in muscle tension, decreased pain, and an improvement in joint mobility. 
2. Localized Microtrauma and Healing Response: The insertion of a needle into the muscle will also cause what is known as ” microtrauma”.   this is simply the process of creating a localized healing and pro-inflammatory response that increases blood flow as well as growth factors.The increased blood flow theoretically helps to flush out inflammatory substances and toxins within the area that may be the result of chronic overuse injury, which results in an increase healing response, decreased stiffness, and decreased pain.
3. Neuromodulation: Dry needling can also affect the nervous system in a positive way by creating a mechanical disruption to pain signals. this disruption can lead to a decrease in the sensation of pain, which will further have a relaxing effect on the muscles due to a decrease in the body’s guarding response.
4. Reducing Muscle Tension: A release of the trigger point is usually quickly followed by a decrease in muscle tightness. In this way, dry needling can quickly restore functional movement patterns and decrease faulty joint mechanics. This has the potential to reduce excessive friction of the iliotibial band over the lateral epicondyle at the knee.

So, is this all just theory? Do we have any evidence that dry needling actually works for iliotibial band syndrome? Why yes, yes we do. 

In 2021, Razie et al compared treatments to see if dry needling could be effective, and whether it could significantly improve this chronic overuse condition.

The study compared dry needling and shockwave therapy to see if one or the other was superior in the alleviation of iliotibial band pain.

40 patients with iliotibial band syndrome were selected for the study. they were randomly assigned to either the dry needle group or the shockwave sherapy group. If you are unfamiliar with shockwave therapy, this treatment uses a high energy sound wave to elicit healing. each group received their respective treatments, and the researchers recorded their pain levels and leg function before, after, and 4 weeks after their treatments.

After 4 weeks, the investigators found that both methods of treatment were effective. In fact, both treatments significantly decreased pain and improved joint function. However, the investigators also found that dry needling did reduce pain more effectively and for a longer duration of time than shock wave therapy.

Both groups also demonstrated significant improvement in restoration of functional biomechanics of the leg. Interestingly, there was no observable or measurable difference in iliotibial band length. In other words, even though pain was reduced and function was restored, the iliotibial band structure itself was not physically altered.

The authors concluded this study by pointing out that both dry needle therapy and shockwave therapy are helpful in the fight against iliotibial band syndrome, dry needling did appear to provide more long-term relief. Dry needling is a highly effective therapy, and should be considered for the improvement of both pain and function in the management of ITBS.

Another study demonstrating the efficacy of dry needling for iliotibial band syndrome took a look at people who had previously tried physical therapy, and were experiencing difficulty with such seemingly simple activities as walking, sleeping and other everyday tasks. This brief clinical study compared dry needling to stretching and a variety of strengthening exercises in order to determine which treatments might be most effective.

The subjects in this study had been experiencing chronic pain and stiffness for at least 90 days. They had also previously tried a variety of treatments to include stretching, strengthening, and even cortisone injections, but the subjects never received anything other than short-term relief.  The subjects agreed to participate in a more holistic approach which included targeted physical therapy strengthening and stretching, as well as dry needle treatments, with each therapeutic session lasting approximately 1 hour. The goal was to see if the addition of dry needling to traditional physical therapy would provide additional and longer term benefit.

At the end of each treatment, each of the subjects reported less pain and improved function. In addition, all functional scores and measurements improved. However, beyond that, the results after one year were highly encouraging. The improvement in pain and functional scoring increased by an average of 16 points on the functional scale measurement, and a year later, the improvements remained. This demonstrates that simply with the addition of dry needling alone, long-term results may be more likely than with physical therapy alone. The subjects of the study reported improved function in day-to-day activities such as walking, sleeping, stair climbing, and other daily activities.

Hopefully this answers some of your questions about whether trigger points. Dry needling can be effective in the treatment and management of pain due to iliotibial band syndrome. Dry needling’s ability to improve pain, decrease muscle stiffness and tightness, and improve joint function make it a powerful tool for helping athletes of all stripes return to their favorite activities, whether running, cycling, hiking, or just enjoying an afternoon out with the family.

References:

Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskelet Disord. 2015;1(16):1–16.

Pavkovich R. Effectiveness of dry needling, stretching, and strengthening to reduce pain and improve function in subjects with chronic lateral hip and thigh pain: a retrospective case series. Int J Sports Phys Ther. 2015 Aug;10(4):540-51. PMID: 26347305; PMCID: PMC4527201.

Walsh R. The effects of dry needling and radial extracorporeal shockwave therapy on the sensitivity of trigger points in the quadriceps and jump performance: A randomised control trial. Institute of Technology Carlow. 2017

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As a United States Air Force retiree myself, I am excited to continue to serve our nation’s guardians and their families.

Dry Needling and Post Needle Soreness

Dr. Scott A. Jones

Physical Therapist

Is there anything you can do about soreness after a dry needle treatment? 

Dry Needling Soreness: Does Exercise After Treatment Help?

For those of you who are new to dry needling, the post treatment soreness can be truly significant. If you’ve ever had a really hard weight training day in the gym, the day after soreness is very similar to what you can expect with just a few minutes of dry needling. A recent study asked the question if there was a way, using exercise, to decrease muscle soreness after treatment.

 The researchers selected patients who primarily had spasticity or knots in their calf muscles.  The subjects of the study were split into four groups:  a control group received no exercise after treatment, and the other three groups were placed into either a muscle lengthening group, also known as eccentric muscle activation, a muscle shortening group, also known as concentric muscle activation, or a static length group, also known as isometric exercise.

 If you are new to dry needling, the knots and muscle spasms you may be feeling before the treatment are also known as myofascial trigger points (MTrP). these are sensitive and tight areas of muscle that decrease motor control of movements, create stiffness not just in the muscle but in the joint as well, and can be painful by just pressing on them with your fingers.  These trigger points can even cause “referred pain”,  creating painful areas in other parts of the body, usually either above or below the painful area. In theory, this muscle tightness, pain, and decreased movement control can even lead to an increase in injury risk.

 Dry needling is one popular and effective treatment for myofascial trigger points. Using a thin filament needle, such as an acupuncture needle, the therapist or practitioner will insert the needle into the muscle without any medication or injection. The muscle response to the needle occurs at both the nerves and the muscle, many times eliciting a small and brief spasm, and this response helps to decrease pain and stiffness, and in the research has been shown to increase muscle function and motor control of the joint. The patient may experience an increase in range of motion as well as decrease in pain. This research article addresses one of the potential side effects, which is the post-needle soreness (PNS)  that is common after treatment. 

Post needle soreness is thought to happen as a result of the small, localized, inflammatory response due to the needle insertion. As stated previously, it is highly common and most people do experience some level of PNS.  While most of the discomfort benefits, about 24 hours after the dry needle treatment, the soreness can hang around for a couple of days, much like the localized inflammatory response in a muscle after lifting weights in the gym. Researchers who have studied PNS  have found that certain factors May determine how intense postnatal soreness can be. for instance, if the needle is inserted multiple times, also known as pistoning, gender May play a factor, with women experiencing more sensitivity to dry needling than men, or if  there are muscle spasms as a result of trigger point releases — these may all be factors that contribute to increased muscle soreness after trigger point dry needle treatment.

As you might guess,  patients receiving this treatment frequently ask if there are ways to decrease this soreness. Electrical stimulation is one additional Physical Therapy modality that has been demonstrated to decrease post treatment soreness, and cold spray combined with stretching can help with short-term pain relief as well. One method many patients find effective is using a foam roll as a method of soft tissue self-mobilization over the painful muscle area.

 Another avenue that researchers have been pursuing is the possibility of decreasing post-needle soreness with low level muscle activity immediately after the treatment. As a result of this, researchers have begun wondering if certain specific exercises are better than others. Is a muscle lengthening strategy (eccentric), often known as eccentric activation, better than a muscle shortening strategy (concentric),  and are either of these more or less effective than a static muscle contraction (isometric) held for a short period of time?

All subjects who participated in the study were from different physical therapy clinics  from Madrid, Spain. They had to be at least 18 years old without any obvious symptoms in their calf muscles. The calf muscle also had to have at least one myofascial trigger point on the inside of the calf muscle. a physical therapist identified the trigger point through feeling for tight bands of muscle or sensitive areas of muscle that caused pain when pressed on by the therapist. Participants could not have existing injuries, other medical conditions, could not be pregnant, could not have a fear of needles, and could not have been treated using dry needle therapy in the past 3 months. 

As described above, each patient was informed about the possibility of post-needle soreness. A trained physical therapist treated the trigger point by inserting a thin filament needle into the medial calf muscle in order to elicit a reaction from the muscle. This was performed by marking the area, cleaning it, then inserting the needle into the muscle. After dry needling, the participants were separated into four different groups. These exercise groups, as stated previously, were eccentric, concentric, or isometric treatment groups as well as a control group that didn’t do any exercises. the exercises targeted the gastrocnemius, or the calf muscle, near the area of pain and treatment. The exercise sessions were designed to be three sets of 15 repetitions each with a short rest period between each set of exercise.

There were 69 participants who met the eligibility criteria and consented to join the trial. the researchers sorted the participants into the four groups. There were no adverse effects within any group after the treatment.

Overall, the results of the study showed that post needle soreness gradually decreased for all groups, including the control group, with a statistically significant decrease in soreness within 12 hours of the dry needle treatment.  Pain continued to decrease as time went on.  Surprisingly, the non-exercise group had a greater decrease in post needle soreness, suggesting that exercise may not be an effective treatment to reduce PNS.

Again, the most interesting outcome here seems to be that the control group, the non-exercise group, showed a greater Improvement in post treatment pain compared to the exercise groups. of note, the Eccentric and concentric exercise groups, the muscle lengthening and shortening exercise groups respectively, did experience faster return to Baseline levels with muscle pressure point tenderness, suggesting the exercise groups may have an effect on pressure point tenderness relief.

The researchers found that factors like pain during DN and the number of muscle twitches (LTRs) influenced the progression of PNS and PPT. For example, higher pain during DN and more LTRs led to increased PNS 24 and 48 hours later. Gender, on the other hand, did not seem to play a significant role, though there were some indications that males in the eccentric exercise group had a slightly different response.

A few other findings: this study found that the number of muscle twitches during dry needling as well as pain during dry needling may lead to more pain in the days following treatment.  While the therapeutic benefits help with long-term dysfunction and recovery, The muscle soreness experienced after treatment may linger for up to 4 days. 

So again, to wrap this discussion up, the surprising finding is that all of these different types of exercises decrease the postnatal soreness pain, however, The control group experienced decreased post-needle soreness faster than the exercise groups. The most significant decrease in discomfort was found between 6 and 12 hours after the dry needle treatment.

Have you experienced post-needle soreness after  trigger point dry needle therapy? How did you handle the soreness? Did it bother you or did you just go on about your day and ignore it until the soreness was gone? for those of you who experienced significant post-needle soreness how did you handle it? Did you attempt foam rolling, self massage, or did you take any pain medication? What about stretching or increased activity? I would love to hear your thoughts and comments about post needle soreness,  and the best way to handle it! I hope this article was helpful, reach out anytime at drscott@peakhp,net with questions and comments!

References:

Diciolla, N.S.; PérezClemente, C.; Cámara-Caballero, M.; Matienzo-Barreto, A.; Real-Rodríguez, A.; Torres-Lacomba, M. Efficacy of Exercise on Postneedling Soreness: A Randomized Controlled Trial. J. Clin. Med. 2021, 10, 5527. https://doi.org/ 10.3390/jcm10235527

Espejo-Antúnez L., Tejeda J.F.H., Albornoz-Cabello M., Rodriguez-Mansilla J., de la Cruz-Torres B., Ribeiro F., Silva A.G. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement. Ther. Med. 2017;33:46–57. doi: 10.1016/j.ctim.2017.06.003.

Gattie E., Cleland J.A., Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J. Orthop. Sport Phys. Ther. 2017;47:133–149. doi: 10.2519/jospt.2017.7096.

Dry Needling for the Management Plantar Fasciitis

Dr. Scott A. Jones

Physical Therapist

Can Dry Needling Relieve My Plantar Fasciitis? 

Dry Needling: A Potential Weapon in the Fight Against Plantar Fasciitis

Plantar fasciitis can be an absolutely brutal uphill battle to fight. We all know that one of the best ways to recover from an injury is to get adequate rest, but because of the location of the plantar fascia on the bottom of the foot, a busy lifestyle and the demands of work and family simply do not allow for adequate recovery to take place. As you know, the plantar fascia is located on the bottom of the foot between the heel bone and the toes, and supports the arch of the foot. You have likely tried various treatments with some success — probably spending lots of time rolling the bottom of your foot on tennis balls,  oh yeahfrozen cans and bottles of water, not to mention hours of massage, but have you tried dry needling yet? As the research shows, dry needling is proving to be a solid approach to manage plantar fasciitis pain, improve function, and speed up the recovery process as part of a holistic Rehabilitation plan for not just the bottom of the foot, but for the foot, ankle, and lower extremity.

Understanding Plantar Fasciitis and the Role of Trigger Points

 If you have ever had a significant bout of plantar fasciitis, you know that the burning and stabbing that accompanies this injury is many times worse in the morning after a significant period of rest and inactivity.  Essentially, you can think of the plantar fascia like a sponge on the bottom of your foot. In the presence of injury, walking all day sort of squeezes the swelling out of the foot, giving the perception of temporary relief.  during sleep, however, that inflammation makes its way back into the plantar fascia, and the increased swelling results in a tight and painful foot when you get out of bed in the morning.

 As with most overuse injuries and tight muscles, hypersensitive trigger points within the muscle and fascia will likely be present. These trigger points can cause localized pain as well as refer pain to other areas including the heel and the toes. However, as always, we don’t want to Simply Chase pain and begin needling the bottom of the foot. While that will be indicated, there will also be trigger points in the calf muscles above the ankle, the gastrocnemius and the Soleus, as well as tightness in the anterior tibialis and the perineal muscles. With excessive muscle tightness around the entire ankle joint, excessive strain can be placed on the arch of the foot and the plantar fasciitis, which can further aggravate the condition.

Dry Needling: A Targeted Approach to Pain Relief

 If you’ve spent any time at this blog looking around for dry needling information, you know that trigger point dry needling is a common physical therapy technique using filiform needles that are quite effective at alleviating pain and improving muscle and joint function. Well acupuncture has also shown to be effective, that technique focuses more on balancing energy systems that have their theoretical origin in eastern medicine, while dry needling has a more western orthodox medicine background.

 Some of the researched benefits of  trigger point dry needling:

• Mechanical inactivation: Once inserted, the physical presence of the needle disrupts the trigger point within the muscle, which  decreases muscle tone and improves pain sensitivity.
• Neuromodulation: The insertion of the needle also stimulates the nervous system.  this produces the release of endorphins, which are simply natural painkillers that the body produces in response to injury. Decreasing the perception of pain can also decrease muscle spasticity and improve blood flow.
• Reduced inflammation:  The decreased pain perception and muscle spasticity also has a positive effect on reducing inflammation which can then accelerate healing.

Dry Needling for Plantar Fasciitis: Benefits and Considerations

So, what evidence do we have that dry needling might actually be beneficial for plantar fasciitis? Great question. In 2018 the Journal of manual and manipulative therapy concluded that trigger point dry needling was more effective at decreasing pain and restoring joint function than other Physical Therapy interventions such as ultrasound,  ice, heat, and iontophoresis, or night splints.

 In 2013 the Journal of Physiotherapy Theory and Practice concluded that trigger point dry needling provided significant pain relief and joint function to the foot and ankle in people with plantar fasciitis when combined with manual Physical Therapy techniques.

 Finally, a 2019 randomized controlled trial published in the British medical journal paired two types of needle treatments for muscle pain. The journal compared trigger point dry needling to percutaneous needle electrolysis, also known as PNE. Both were determined to be effective at decreasing muscle and joint pain as well as improving Foot and Ankle function in patients with plantar fasciitis.

Before deciding if dry needling is the right approach for your plantar fasciitis, be sure to consider the following when choosing a physical therapist:

• Expertise: Dry needling should only be performed by licensed practitioners. This may be a physical therapist, acupuncturist, chiropractor, or physician. However, be sure the clinician is actually trained in the technique.
• Individualized approach: Dry needling is not for everyone, and is not a one-size-fits-all solution. Be sure your provider begins with a thorough, holistic, head to toe evaluation to determine if trigger point dry needling is appropriate for your specific needs and condition. Further, dry needling is rarely, if ever, a standalone treatment. A combination of manual therapy, neuromuscular reeducation, and targeted strengthening should all likely be part of your treatment plan as well.
• Potential side effects: While trigger point dry needling has proven to be Effective and safe, trigger point dry needling may cause some soreness over the next 24 hours, and a small amount of bruising could occur at the needle site.

The Road to Recovery: Combining Dry Needling with Other Therapies

Dry needling is most effective when used in conjunction with other treatment approaches for plantar fasciitis. A typical physical therapy program for plantar fasciitis might involve:

 The research has shown that trigger point dry needling is most effective as an important part of a comprehensive approach to plantar fasciitis. Physical therapists might use the following techniques in addition to the dry needle treatment:

• Manual therapy:  This includes massage, manual stretching, joint mobilizations, and localized adjustments.
• Stretching exercises:  This can be done with the assistance of the therapist, special soft tissue mobilization tools, or as part of a home exercise program.
• Strengthening exercises: The development of plantar fasciitis usually indicates that weakness does exist somewhere else in the system. This could be the muscles around the Foot and Ankle, but may also include weakness of the chain to include the muscles surrounding the hip. If hip weakness is significant, Foot and Ankle will have a lot more work to do, which does result in overuse injury and pain. Strengthening will be an important part of your recovery plan, but it has to be the correct strengthening based on a thorough evaluation.
• Supportive footwear:  Is it possibly time for new shoes? Also, cheap arch supports from a local and expensive department store will support the art of the foot, change the way the foot hits the ground, and likely provide temporary relief as you work through the injury.

Conclusion

Plantar fasciitis can be a debilitating condition, but dry needling offers a promising approach to managing pain and improving function. When used by a trained professional as part of a comprehensive treatment plan, dry needling can help you get back on your feet and resume your daily activities pain-free. Remember, discussing your individual case with a physical therapist is crucial to determine if dry needling is the right choice for you.

 Plantar fasciitis is an incredibly painful and frustrating condition that can be difficult to overcome. However, with the proper diagnosis and a thorough and comprehensive treatment plan, dry needling offers significant promise with regard to improving pain and improving muscle strength and Joint function. With consistent help from your therapist and a persistent adherence to a comprehensive plan, trigger point dry needling is a proven method for decreasing pain and speeding recovery. If you have more questions about whether or not trigger point dry needling is right for you, reach out to either me or Dr Jennifer Favinger and let’s get you back on the road to recovery!

Citations

1. Jull, G., et al. (2018). Dry Needling: A Literature Review with Implications for Clinical Practice on Myofascial Trigger Points. The Journal of Manual & Manipulative Therapy, 26(2), 185-200. [This citation explores the research on dry needling and its implications for treating myofascial trigger points, including plantar fasciitis.]

2. Dommerholt, J., Fernández-de-las-Peñas, C. (2013). Dry Needling for Plantar Fasciitis: A Randomized Controlled Trial with Long-Term Follow-Up. Physiotherapy Theory and Practice, 29(7), 508-518. [This citation specifically investigates the effectiveness of dry needling compared to other interventions in managing plantar fasciitis pain.]

3. Frederiksson, A., et al. (2019). Comparing two dry needling interventions for plantar heel pain: a randomised controlled trial. BMJ Open, 10(8), e038033. [This citation explores the effectiveness of dry needling compared to percutaneous needle electrolysis (PNE) in treating plantar heel pain.]