Procedure - Dry Needling

What is it?

Dry needling is a form of therapy where fine needles are inserted into myofascial trigger points (painful knots in muscles), tendons, ligaments, or near nerves in order to stimulate a healing response in painful musculoskeletal conditions.

Dry needling is not acupuncture; it does not have the purpose of altering the flow of energy (“Qi”) in traditional Chinese meridians for the treatment of diseases. Dry needling is a modern, science-based intervention for the treatment of pain and dysfunction in musculoskeletal conditions such as neck pain, shoulder impingement, tennis elbow, carpal tunnel syndrome, headaches/ migraines, knee pain, knee arthritis, shin splints, plantar fasciitis, low back pain, etc. Research shows three main ways dry needling works:

• Inducing natural inflammatory response, that helps with chronic pain and injuries
• Resetting neuromuscular junctions. When needles are placed in trigger points it resets muscles leading to restored resting length
• Promotes production of endogenous opioids by releasing fibroblasts, which helps with pain and healing effect

Is it safe?

Drowsiness, tiredness or dizziness occurs after treatment in a small number of patients (1-3%) and, if affected, you are advised not to drive. Minor bleeding or bruising occurs after dry needling in 15-20% of treatments and is considered normal. Temporary pain during dry needling occurs in 60- 70% of treatments. Existing symptoms can get worse after treatment (less than 3% of patients); however, serious side effects can occur in less than 1 per 10,000 treatments (less than 0.01%).

The most common serious side effect from dry needling when doing protocols near the lungs is pneumothorax (lung collapse due to air inside the chest wall). The symptoms of dry needling induced pneumothorax commonly do not occur until after the treatment session, sometimes taking several hours to develop. The signs and symptoms of a pneumothorax may include shortness of breath on exertion, increased breathing rate, chest pain, dry cough, bluish discoloration of the skin or excessive sweating. If such signs and/or symptoms occur, you should immediately contact your physical therapist or physician and go to the emergency department.

Nerves or blood vessels may be damaged from dry needling which can result in pain, numbness, or tingling; however, this is a very rare event and is usually temporary. Damage to internal organs has been reported in the medical literature following needling; however, these are extremely rare events (1 in 200,000).

What to expect after and what to do

• Temporary pain may occur after dry needling or existing symptoms could worsen
• Light use for the first 24-36 hours after dry needling, advancing your activity as tolerated
• Continue exercises and stretches at home as appropriate
• Avoid NSAIDS such as Ibuprofen, Motrin, Advil, etc. as this reverses the effects of dry needling. If you are in pain you can take Acetaminophen (Tylenol)
• Avoid ice as this reverses the effects of dry needling, you can use heat if you need to
• Eat a balanced diet and stay hydrated before and after needling
• If you experience any symptoms such as shortness of breath with exertion, increased breathing rate, chest pain, dry cough, bluish discoloration of the skin or excessive sweating notify the provider who did your dry needling, call 911 or go to the Emergency Department immediately
• Dry needling can be done up to 2x a week as tolerated