Dry Needling in our U.S. Armed Forces?
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.
