Dry Needling and Electrical Stimulation
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:
- 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.
- 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.
- 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.
