Dry Needling vs Plantar Fasciitis

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.]