Dry needling - peripheral and central considerations (original) (raw)
Related papers
The role of a dry needling technique in pain reduction
Journal of Health Sciences
Introduction: Dry needling is a therapeutic procedure using the insertion of thin needles through the skin into myofascial trigger points (MTrPs), muscular or connective tissue with the aim to reduce pain intensity. The objective of this systematic review is to analyze the literature for the efficacy of the dry needle technique in pain reduction in conditions of musculoskeletal pain caused by MTrPs. Reference Sources: Web of Science, Scopus and EBSCOhost database were searched for studies and e-books published from January 2010 to December 2018. Studies Selection: We included randomized controlled studies, prospective and longitudinal studies, and case studies which analyzed the efficacy of dry needling for musculoskeletal pain reduction. Data Extraction Method: The studies, which satisfied criteria for inclusion were further analyzed. The primary instrument of the evaluation was pain intensity analyses. Results: Dry needling treatment is efficient in pain intensity reduction in pat...
Dry needling in the management of musculoskeletal pain
The Journal of the American Board …, 2010
Myofascial pain is a common syndrome seen by family practitioners worldwide. It can affect up to 10% of the adult population and can account for acute and chronic pain complaints. In this clinical narrative review we have attempted to introduce dry needling, a relatively new method for the management of musculoskeletal pain, to the general medical community. Different methods of dry needling, its effectiveness, and physiologic and adverse effects are discussed. Dry needling is a treatment modality that is minimally invasive, cheap, easy to learn with appropriate training, and carries a low risk. Its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews. The deep method of dry needling has been shown to be more effective than the superficial one for the treatment of pain associated with myofascial trigger points. However, over areas with potential risk of significant adverse events, such as lungs and large blood vessels, we suggest using the superficial technique, which has also been shown to be effective, albeit to a lesser extent.
2015
Objective: To determine whether dry needling of an active myofascial trigger point (MTrP) reduces pain and alters the status of the trigger point to either a nonespontaneously tender nodule or its resolution. Design: A prospective, nonrandomized, controlled, interventional clinical study. Setting: University campus. Participants: A total of 56 subjects with neck or shoulder girdle pain of more than 3 months duration and active MTrPs were recruited from a campus-wide volunteer sample. Of these, 52 completed the study (23 male and 33 female). Their mean age was 35.8 years. Interventions: Three weekly dry needling treatments of a single active MTrP. Main Outcome Measures: Primary Outcomes: Baseline and posttreatment evaluations of pain using a verbal analogue scale, the Brief Pain Inventory, and the status of the MTrP as determined by digital palpation. Trigger points were rated as active (spontaneously painful), latent (requiring palpation to reproduce the characteristic pain), or resolved (no palpable nodule). Secondary Outcomes: Profile of Mood States, Oswestry Disability Index, and Short Form 36 scores, and cervical range of motion. Results: Primary outcomes: A total of 41 subjects had a change in trigger point status from active to latent or resolved, and 11 subjects had no change (P < .001). Reduction in all pain scores was significant (P < .001). Secondary outcomes: Significant improvement in posttreatment cervical rotational asymmetry in subjects as follows: unilateral/bilateral MTrPs (P ¼ .001 and P ¼ 21, respectively); in pain pressure threshold in subjects with unilateral/bilateral MTrPs, (P ¼ .006 and P ¼ .012, respectively); improvement in the SF-36 mental health and physical functioning subscale scores (P ¼ .019 and P ¼ .03), respectively; and a decrease in the Oswestry Disability Index score (P ¼ .003). Conclusions: Dry needling reduces pain and changes MTrP status. Change in trigger point status is associated with a statistically and clinically significant reduction in pain. Reduction of pain is associated with improved mood, function, and level of disability.
Revista Fisioterapia Invasiva / Journal of Invasive Techniques in Physical Therapy
Presently, there is no clear consensus on the essential and confirmatory criteria which should govern the application of dry needling (DN) in the treatment of myofascial trigger points. The aim of this study was to generate a consensus on these criteria, via a panel discussion with DN experts which took place at the International Conference of Invasive Physical Therapy held in 2018, including the opinion of the attendees who participated in a live survey on the subject at the conference via an app. The results obtained reveal discrepancies regarding confirmatory criteria such as the elicitation of referred pain; nonetheless, consensus exists on the suitability of the application of individualized and personalized DN treatment and the combination of treatment with other intervention approaches in physical therapy, with the use of ultrasound when required to support a safer clinical practice.
Dry needling: a literature review with implications for clinical practice guidelines
Physical Therapy Reviews, 2014
Background: Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an 'intramuscular' procedure involving the isolated treatment of 'myofascial trigger points' (MTrPs). Objectives: To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. Major findings: According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. 'sensitive loci' or 'nociceptors') when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. Conclusions: Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as 'pistoning' or 'sparrow pecking'; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical 'acupuncture' literature that have used the very same 'dry needles' to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just 'TrPs'.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
Introduction: Dry-Needling (DN) induced muscle soreness is a common adverse event that takes place in almost majority of patients who received deep dry needling treatment. The effect of soreness on clinical outcomes has not been evidenced in the existing literature. Aim: To evaluate the correlation between the deep dry-needling induced muscle soreness and severity of shoulder pain in patients with myofascial pain. Materials and Methods: Seventy six participants in the age group of 30 to 60 years with Myofascial Trigger Points (MTrP) in the shoulder girdle muscles were treated with 10-12 minutes of deep dry needling. Shoulder pain severity was assessed at baseline prior to dry needling and 48 hours after dry needling using 0-10 cm Visual Analog Scale (VAS). The severity of muscle soreness was assessed immediately after dry needling, at 24 hours and 48 hours after the deep dry needling. Correlation between the shoulder pain and muscle soreness was analysed using the Spearman correlation coefficient. Result: A significant reduction of shoulder pain was observed at 48 hours (Median VAS: 7 at Baseline, 3 at 48 hours, and Median difference = 4, IQR = 2-3) after the dry needling. No significant correlation was observed between the original pain severity and needle induced muscle soreness at 24 hours (rho =-.218, p = 0.059) and 48 hours (rho =-.170, p=0.143). Conclusion: Based on the result, we conclude that there is no significant correlation between the dry-needling induced muscle soreness and shoulder pain severity among the patients who received deep dry-needling for myofascial pain. We also suggest that dry-needling induced muscle soreness has no adverse effect on the shoulder pain severity post deep trigger point dry needling.
Journal of Bodywork and Movement Therapies, 2014
Dry needling (DN) has been used recently by physical therapists as a therapy of choice for patients with myofascial trigger points (TrP). The purpose of this randomized controlled trial was to investigate the effect of DN in the treatment of TrPs in the upper trapezius (UT) muscle. A sample of convenience of 33 patients with TrP in the UT muscle participated in this study. Patients were randomly assigned to a standard (N Z 17) or experimental group (N Z 16). The treatment protocol for the standard group consisted of trigger point compression technique (TCT) on MTP, while the patients in the experimental group received DN. Pain intensity and pressure pain thresholds were assessed for both groups before and after the treatment sessions. In addition, the Disability of Arm, Hand, and Shoulder (DASH) was administered. Statistical analysis (paired t-test) revealed a significant improvement in pain, PPT and DASH scores after treatment in the experimental (DN) and standard (TCT) group compared with before treatment (P < 0.05). The ANCOVA revealed significant differences between the DN and TCT groups on the post-measurement VAS score (P Z 0.01). There was, however, no
Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points
Acupuncture in Medicine, 2016
Background Active myofascial trigger points (MTrPs) are major pain generators in myofascial pain syndrome. Dry needling (DN) is an effective method for the treatment of MTrPs. Objective To assess the immediate neurophysiological and clinical effects of DN in patients with upper trapezius MTrPs. Methods This was a prospective, clinical trial study of 20 patients with upper trapezius MTrPs and 20 healthy volunteers (matched for height, weight, body mass index and age), all of whom received one session of DN. Primary outcome measures were neuromuscular junction response (NMJR) and sympathetic skin response (SSR). Secondary outcomes were pain intensity (PI) and pressure pain threshold (PPT). Data were collected at baseline and immediately post-intervention. Results At baseline, SSR amplitude was higher in patients versus healthy volunteers (p<0.003). With respect to NMJR, a clinically abnormal increment and normal reduction was observed in patients and healthy volunteers, respectivel...
International Journal of Research in Medical Sciences, 2018
Background: The roles of physiotherapists in managing the chronic and acute pain in musculoskeletal (Msk) conditions are inevitable now days. Physiotherapists work across the time period aiding patients with their pain in medical care settings with the aim of decreasing pain, rising quality of life wherever attainable and preventing acute and sub-acute painful conditions developing into chronic pain. Dry needling, an invasive technique in the hand of Physios is a new trend in managing acute and chronic pain. Purpose of the study is to identify the immediate and delayed response of pain and presence of soreness after the dry needling in common Msk conditions which can be managed in association with other conventional physical therapy techniques. Objective was to find out the immediate and delayed effects of dry needling over pain in musculoskeletal disorders. Methods: This study was carried out in the department of physiotherapy, Malabar medical college hospital and research centre. Patient was prepared and identified the extreme tender point over the muscle affected and needle removed after 3-5 twitch response elicited. Sterility of the treatment area and needle was well maintained. Prior to the treatment again confirmed with the NPRS score and procedure was done. After few seconds of insertion of needle subjects NPRS score assessed. After removal of needling pain score was assessed after 5 mins, 30 mins, 1 hour and after one day. Results: Study showed a marked reduction in pain after dry needling at each intervals and this suggesting promoting dry needling as an adjunct to pain relief technique in physiotherapy. Conclusions: Dry needling is effective over pain in musculoskeletal disorders.