Dry needling is a controversial and unproven technique for treating Myofascial Pain. It involves the insertion of fine, (but usually) solid needles through the skin into muscle tissue with a view to releasing tight areas or “knots” within the muscle, commonly referred to as Mysofascial Trigger Points. It is known as ‘dry’ needling as no liquid is injected.
The technique is not the same as acupuncture. It is not rooted in Chinese medicine and whereas in acupuncture practitioners talk about redirecting the body’s energy flow by placing needles at certain points in the body, in dry needling needles are placed directly into the affected muscles.
What is Myofascial Pain Syndrome?
Myofascial Pain Syndrome (MPS) is a chronic pain condition affecting either a single muscle or group of muscles and is caused by injury or damage to the fascia, the layers of connective tissue that surround and protect our muscles.
The condition is characterised by the presence of trigger points which can often be felt or even seen beneath the skin. These trigger points are tender to touch and cause pain. Pain can often be felt in other parts of the body, which is called ‘referred pain’. The level of pain can vary considerably from modest discomfort to totally unbearable.
What are the conventional treatments for Myofascial Pain Syndrome?
Whilst there is no ‘cure’ as such for MPS, physiotherapy and massage are common initial treatment recommendations. A trigger point release technique is often used. This involves applying pressure to the trigger point and then gradually increasing that pressure until the trigger point releases. This can only provide relief in the short term, but it can then enable the treatment provider to take advantage of the temporary respite in the pain to work with the patient on MPS stretching exercises. These can help to strengthen the muscles for long term benefit.
If less invasive therapy is unsuccessful, trigger point injections may be considered. A trigger point injection is an injection of local anaesthetic and steroid into the painful ‘knot’. Pain relief may become apparent within a few hours. This is the effect of the local anaesthetic. The steroid itself may take a couple of weeks to start having an effect and, if successful, can help provide relief for perhaps two or three months. As with the trigger point release, this respite in the pain can provide a window of opportunity for the physical therapist to work on muscle strengthening.
Alternative therapy techniques
Some sufferers do find benefit in alternative forms of therapy. These include dry needling as well as relaxation techniques such as the Feldenkrais Method or the Bowen Technique.
What is the theory behind dry needling?
There remains considerable uncertainty as to what processes, if any, come into play as a result of dry needling.
One theory is that the needles cause tight muscles to twitch and then relax, relieving tension and therefore pain. Another is that the needles may increase blood flow or trigger nerve responses which alter the perception of pain.
Risks
Certain jurisdictions prohibit dry needling, including a number of states in the US. As this remains an alternative technique which is generally carried out by a variety of different practitioners, concern is often expressed at the level of training provided to practitioners.
The most common side effects are bruising and bleeding but there have occasionally been cases reported of nerve damage.
Has there been any research?
A host of papers have been published on dry needling, although some of these have come in for criticism for their poor quality.
One systematic review studied the results of 23 “randomized, controlled trials in which some form of needling therapy was used to treat myofascial pain.” This review examined trials of all needle therapies for MPS – injections as well as dry needling. In a surprise for proponents of myofascial trigger point injections, it was found that “trials that compared dry needling with injection found no difference in effect.”
In conclusion, the authors stated that “direct needling of myofascial trigger points appears to be an effective treatment, but the hypothesis that needling therapies have efficacy beyond placebo is neither supported nor refuted by the evidence from clinical trials. Any effect of these therapies is likely because of the needle or placebo rather than the injection of either saline or active drug. Controlled trials are needed to investigate whether needling has an effect beyond placebo on myofascial trigger point pain.”
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