The Evolution of Dry Needling
The Evolution of Dry Needling
Dr. Scott A. Jones
Physical Therapist
We have spent a lot of time in the past several weeks discussing trigger point dry needling, and today I would like to shine a little bit of a light on functional dry needling.
For those of you who are new to this blog, I am a United States Air Force trained physical therapist. I retired from the Air Force in 2016, but have been dry needling as a result of that military training since 2009. I’ve been treating trigger points, overuse injuries, sprains, strains, neurologic disorders such as radiculopathy, loss of balance issues, as well as postoperative surgical site pain since that initial training. Back then, trigger point dry needling as a manual therapy intervention for physical therapists was just getting started. I had been invited to field training as an Air Force participant among Army colleagues, and after more than a year of training I helped introduce dry needling to the United States Air Force medical system as the first practitioner of trigger point dry needling in the air force. Since that time I have treated thousands of United States military service members as well as dependents and retirees who are beneficiaries of Tricare Medical insurance.
Functional Dry Needling – How did it begin?
Here in the west, dry needling is considered a manual therapy technique utilized by physical therapists and chiropractors involving the use of small, solid needles into joints and muscles in order to decrease pain, improve functional mobility of joints, and accelerate healing. Sometimes confused with acupuncture, dry needling is firmly couched in Western medicine and physical therapy, but of course it’s Roots do lie with acupuncture in the east.
Message, we do pay homage to acupuncture, the origin of dry needling, which dates back to over 2,000 years of traditional Chinese medicine. while many physical therapists do use acupuncture needles, in acupuncture the insertion of the needles takes place at specific points on the body, called meridians, as the practitioner Works to balance energy fields which in turn promotes healing. Western dry needling, however, took its cue from a western biomedical approach which is heavily rooted in musculoskeletal anatomy and physiology. As far back as the early 1900s, European neurologists began to ask questions as to whether using these small filiform needles at specific myofascial trigger points, otherwise known as muscle knots, could decrease pain and accelerate healing. These European neurologists actually coined the phrase and developed the concept of trigger points, which came to be known as painful areas of muscle that could be easily palpated through a manual assessment, and these painful bands could even refer pain to other parts of the body.
As commonplace as dry needling is now, its acceptance as a consistently beneficial therapeutic intervention only began to come to prominence in the late 20th century. More and more practitioners have experienced the improved outcomes for patients by focusing on the neuromuscular reset that results from inserting these small filament needles into painful trigger points. Whereas dry needling focuses on connective tissue and muscle dysfunction, acupuncture is more rooted in Eastern Energy theory.
Dry Needling’s Evolution – The Past 20 Years
As I mentioned earlier, I’ve been practicing dry noodling since 2009. Back then, with the exception of the United States army, there were very few dry needle practitioners across the United states. In fact, most of the states within the Union did not permit physical therapists to practice or perform dry needle trigger point therapy. Going back about 20 years, dry needling was used by almost no physical therapists, and has slowly gained traction from Simply being a niche intervention to its current status as a widely used and highly commonplace therapeutic modality. The Beneficial effects of trigger point dry needling, through the efforts of diligent and tireless researchers, has continued to grow in the medical areas of pain science, neurophysiology, and neuromuscular biomechanics. As the body of evidence continues to pile up, our current understanding of dry needling has grown by leaps and bounds.
Originally, as far back as the early 2000s, myofascial pain and musculoskeletal trigger points were the main focus of dry needling. several different Healthcare practitioners begin this practice, including physical therapist, chiropractors, and osteopaths. in these early days it was often considered an alternative approach and was typically relegated to temporary relief of muscle tightness and localized pain, however it has increasingly become a Mainstay part of the western Healthcare System and is typically included in most musculoskeletal Rehabilitation programs.
Functional dry needling typically goes beyond a simple alleviation of pain and stiffness, and usually emphasizes restoration of functional movement, a more holistic and Global approach to rehabilitation, and Western biomechanical principles. In just the past 10 years functional dry needling has grown immensely, and its practitioners continue to relieve trigger points but also focus on Regional interdependence and Global movement patterns that inhibit compensatory behaviors and restore neuromuscular balance.
In the late 2000s and the early 2010s, I personally witnessed the rise and spread of trigger point and functional dry needling across the United states. Physical Therapy practice acts had to be updated state by state to explicitly state that physical therapists were legally allowed to perform dry needling.
Dry needling applications
Dry needling is now used across the musculoskeletal Rehabilitation spectrum. here are just a few of the applications currently in use by physical therapists and dry needle practitioners.
- Myofascial Pain Syndrome
- Muscle Tightness and Spasms
- Joint Pain and Dysfunction
- Chronic Pain Conditions
- Tension Headaches and Migraines
- Postoperative Rehabilitation
- New and Emerging Applications of Dry Needling
Through further research efforts, here are some new and emerging applications of dry needling:
- Neurological Conditions: There are encouraging preliminary results in such areas as pursuing dry needling as an alternative intervention for patients with neurologic disorders such as stroke, multiple sclerosis, Parkinson’s disease, cerebral palsy, and others. dry needling is demonstrating that it can Target spasticity and abnormal muscle activation, providing patients with decreased muscle hypertonicity and decreased pain
- Chronic Tendinopathy: Achilles tendonitis, tennis elbow, and a host of other tendon overuse injury conditions are now being regularly treated with dry needling. the research suggests dry needling May activate collagen production, accelerating tissue repair.
- Visceral Pain and Dysfunction: Researchers are currently exploring dry needling as an option for decreasing and managing pain for patients experiencing dysfunction related to their internal organs.Emerging research suggests that dry needling may have a role in managing pain and dysfunction related to internal organs.
- Complex Regional Pain Syndrome (CRPS): Dry needling has also been demonstrated to help modulate abnormal pain responses in conditionsthat have been historically difficult to treat.
How Dry Needling is Used by the United States Military
As has been the case for some time now, and as I experienced in the United States Air force, the United States military as a whole has largely embraced dry needling as an effective alternative within pain management to decrease use of and Reliance on opioids and narcotics. Whether training or actively participating in combat operations, United States military service members experience frequent injuries due to overuse, and the physical demands of day-to-day work.
As my time in the United States Air Force demonstrated, dry needling is now being sought and utilized early in the rehabilitation and musculoskeletal treatment process. Dry needling is used in both acute and chronic injury management situations, and is particularly useful to help relieve muscle pain, improve joint range of motion, and accelerate the recovery process as a whole. to be sure, dry needling is not, however, a standalone treatment. Military physical therapists use dry needling alongside other, more traditional Physical Therapy Rehabilitation techniques. Whether participating in training exercises, simply showing up and doing the job every day, or service members returning from deployment to combat zones suffering from chronic pain and musculoskeletal injuries, dry needling has proven itself time and again and has become a go-to intervention That has improved outcomes and accelerated pain relief.
Finally, the United States military’s commitment to and focus on medical research and advancements has contributed to significant improvements in treating complex pain syndromes experienced by military veterans. such examples include post traumatic stress disorder, complex regional pain syndrome as mentioned above, and pain management for amputees.
As you can see, the evolution of dry needling over the past two decades has been extensive and continues to gain steam. dry-needling has become a versatile and valuable tool in modern pain management and Rehabilitation and is quickly becoming one of the most powerful manual therapy tools available in the management of chronic and acute pain conditions. We are now seeing the rise and dry needling across many patient populations and medical conditions that have traditionally been considered too complex. The research efforts continue both on the military side and the civilian side and dry needlings continued development with regard to Medical intervention and application will clearly only continue to grow in the foreseeable future.
References:
Baldry, P. E. (2005). Myofascial pain and fibromyalgia syndromes: A clinical guide to diagnosis and management. Elsevier Health Sciences.
Dommerholt, J., & Huijbregts, P. A. (Eds.). (2011). Myofascial trigger points: Pathophysiology and evidence-informed diagnosis and management. Jones & Bartlett Publishers.
Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). Dry needling for patients with tendinopathy: A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 47(7), 488–496. https://doi.org/10.2519/jospt.2017.7317
Kalichman, L., & Vulfsons, S. (2010). Dry needling in the management of myofascial trigger points. Journal of Bodywork and Movement Therapies, 14(3), 273-278. https://doi.org/10.1016/j.jbmt.2010.01.002
Liu, L., Huang, Q.-M., Liu, Q.-G., Ye, G., Bo, C.-Z., Chen, M.-J., & Li, P. (2018). Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 99(1), 144-152. https://doi.org/10.1016/j.apmr.2017.06.006
Mejuto-Bogarín, D., Salom-Moreno, J., Ortega-Santiago, R., Truyols-Domínguez, S., & Fernández-de-las-Peñas, C. (2014). Short-term changes in neck pain and active range of motion after a single cervical spine manipulation or mobilization in patients with acute mechanical neck pain: A randomized controlled trial. Journal of Manipulative and Physiological Therapeutics, 37(8), 559-567. https://doi.org/10.1016/j.jmpt.2014.06.007
Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Myofascial pain and dysfunction: The trigger point manual (Vol. 1). Williams & Wilkins.
Shah, J. P., & Gilliams, E. A. (2008). Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies, 12(4), 371-384. https://doi.org/10.1016/j.jbmt.2008.06.006
Peak Health and Performance is veteran owned and operated and we 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.
In health,
Dr. Scott A. Jones
Physical Therapist
Movement Performance Coach
