Dr. Rebecca Van Heuklon, DPT, FAFS, FMR
What is this dry needling treatment everyone is talking about? Is it the same as acupuncture? Does it really work? Will it hurt? Is it right for me? Does my insurance cover it? These are all questions rumbling around about this treatment available through physical therapy and the goal of this article is to help clear up some of these questions.
What is it? (and what isn’t it?)
Dry needling is a treatment that can be performed by physical therapists that undergo post-graduate continuing education for advanced, face-to-face, hands-on training. It builds on the strong foundation of anatomy, physiology, and biomechanics already taught in PT school. After a thorough evaluation is performed, dry needling is a tool that can be used to compliment a comprehensive physical therapy treatment plan, which may also include manual therapy, therapeutic exercise, education, and other modalities as needed. Dry needling is not the same as traditional Chinese Medicine Acupuncture even though both procedures are performed using a needle. Dry needling is a modern clinical technique practiced by health care professionals to address musculoskeletal pain and movement dysfunction, while acupuncture is part of ancient Chinese medicine used to treat human diseases. Each involves different treatment principles, training/schooling, and licensing.
How does it work?
Dry needling uses a very fine needle to penetrate the skin and underlying soft tissue to create a cut or lesion, which activates remodeling of the tissue in and around the needling site. The lesion stimulates the body to respond by increasing circulation, normalizing inflammation, decreasing tissue tension, providing pain relief, and replacing injured tissue with new tissue, all with the goal of promoting self-healing in areas of acute or chronic injuries. Only sterile, single use, disposable needles are used for the treatment. The needles can be inserted in different areas of the body, including trigger points (hyperirritable contracted bands within a muscle that can cause local or referred pain), local/symptomatic soft tissues, paravertebral points along the spine, and along peripheral nerve pathways.
What can it help and when is it not appropriate?
Dry needling can be used to address pain, inflammation, trigger points, excessive muscle tension, scar tissue, fascial adhesions, and muscle contractures/cramping. It is rarely performed as a stand-alone procedure but can be used in conjunction with other physical therapy treatments to treat neck, back, shoulder, arm, buttock, and leg pain, headache (including migraine and tension-type headaches), sprains, strains, and muscle spasms.
Dry needling is not appropriate for people who have:
- Phobia of needles
- Cognitive impairment
- Local skin lesion
- Local or systemic infection
- Uncontrolled bleeding or anticoagulant therapy
- Compromised immune system
- Vascular disease/varicose veins
- Recent surgical procedure where the joint capsule has been opened
- Women in their first trimester of pregnancy.
What should I expect?
The success of dry needling varies from person to person and improves when the body has a high potential for self-healing. The majority of patients have at least partial symptom relief, while less than 10% have little to no response. Some people feel pain relief immediately, while some take several sessions to notice a change in their symptoms. Others may feel achy immediately after the needing, with symptom relief later that evening or the next day. Rarely does the needling treatment cause an increase in symptoms. Although uncommon, some negative reactions associated with needling can include bruising, bleeding, feeling faint or dizzy, sweating, or itching/burning. Approximately 80% of the time, patients have found the procedure to be pain-free. At times, a local twitch response can be felt, which is described by patients as an electric shock, cramp, or aching sensation, but is a normal response. We strive to make the treatment as painless and comfortable as possible.
Does my insurance cover it?
Since dry needling, like many other manual therapy techniques, is a physical therapy treatment targeted at treating soft tissue dysfunction and is NOT acupuncture, your insurance should cover the service.
APTA Public Policy, Practice and Professional Affairs Unit. Description of Dry Needling in Clinical Practice: An Educational Resource Paper. http://www.apta.org/StateIssues/DryNeedling. Accessed February 7, 2018.
Ma Y, Ma M, & Cho ZH. Biomedical Acupuncture for Pain Management: An Integrative Approach. Philadelphia, PA: Elsevier; 2005