Top 4 Benefits of dry NEEDling

I was recently asked what in my experience were the top 4 benefits of dry needling. Tough call, but when I reflect on the clients that have been assisted, it comes down to the following mix.

There are many aspects to this component. Here are three.

Firstly, It is unlikely that we are actually having a direct effect on the muscle (if that is what you are needling). In the same way, that the muscle is unlikely to be the tissue at fault. Most likely the muscle is reacting to and protecting some other irritated tissue and as a result of unaccustomed static activity became symptomatic. We know trigger points have a build up in neural sensitising metabolites and lower pH, that quickly reverse with needling, but generally returns again. My experience is that most trigger points develop from non-traumatic origins and I have explained this in much more detail here. Sure some are traumatic, but only a minority. So if we are not having an effect on the muscle, what tissue/system are we influencing? Our neural network links all tissues and I think logically it is the neural system and the trigger point is a reflection of a sensitised neural system, possibly due to an alteration in axoplasmic flow. Yup, that stuff that we know little about, but is the critical transport system in nerves and by default, provides nutrition and feedback to nerve and associated target tissues (muscle, skin, ligament). Hence the link of trigger points to a range of MSK related tissues. See here for more detail.

Secondly, from the research, it is generally acknowledged that there is little difference in effect between sham needling and verum needling - however, the effect is greater in treatment groups than no needling/control group. This difference applies also when comparing an intervention plus needling to the intervention by itself. Be this due to the placebo effect, the high impact factor of needling (like surgery) or other elements we don't definitively know yet and I don't really care. Being on the coal face of helping people, if I waited for repeated, RCTs to prove that all elements of my assessment and treatment were kosher, there wouldn't be much to do at work. A good history, backed by an understanding of anatomy and pathology, tied together with clinical reasoning and client needs, in my mind provides a good foundation on which to make sound clinical decisions.

Thirdly we know that inserting a needle has distal (and central), pain modifying effects. Putting a pin into the ECRB has been shown to reduce pain pressure thresholds in upper trapezius trigger points. These effects are non-specific, but opioid-mediated (blocked by naloxone). I have attached Hsieh's 2016 article as a recent example of this phenomena. This neurophysiological knowledge can be used to treat some pain conditions that restrict needling into the area of pain (e.g. immune compromised in that quadrant) or to increase treatment effects (e.g. layering principal of western acupuncture). Hsieh_2016_Distant_pain_relief_of_Tps.pdf.

Whether you are talking about treating miracle muscles or time efficiencies, dry needling ticks both boxes. Our services are provided in a one to one environment and as practitioners, we are generally time poor. If I can provide a neurophysiological intervention that alleviates pain and gains clients trust, that also 'creates time', then I can utilise this opportunity to provide other important interventions; education, exercise prescription, or problem-solving for example. Depending upon irritability, and the grade of needling intervention, the needles can be left in situ, while I undertake the other forms of client necessary intervention.

You can look at this in the context of both easing time pressures (and improving client service) as discussed above, or from the perspective of being a manual therapist and protecting your hands' longevity. I prefer to use and develop my hands as tools of assessment. To palpate tissue textures, joint lines and anatomical landmarks, not as blunt trauma instruments to manipulate often unwieldily tissues. I let my needling techniques do this work. Case in point is the treatment of latent trigger points in vastus lateralis. Sure you can use Graston techniques or a foam roller, but for effectiveness, and minimal discomfort for the client, dry needling in my experience is a hands down winner.

 Demand

Evidence-informed practice looks at the interaction of client's needs, known research and clinician's experience. If a client asks for dry needling because they have had success before, and from my assessment it is appropriate I will provide that service, in the knowledge I will be accessing a positive placebo. If my assessment indicates it is not appropriate (e.g. chronic condition, or client not taking responsibility) I will most likely still provide the treatment, but premise it with comments like 'this is a one-off because it only provides a short-term effect' and 'we need to add in longer-term solutions'. I don't believe we can assist clients to move along a more positive pathway unless we meet them at some mutual point first.

There are a few points falling under the acronym of NEED. Perhaps others can add points they feel appropriate for the LING bit of NEEDLING. Either here in the comments section or check out the FB conversation.

If you want to find out more about a comprehensive program of dry needling courses you can check it out here.