Dry Needling history and application.

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