Dry Needling and Post Needle Soreness
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.
