Dry Needle

Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. Dry needling is used for management of a variety of neuromusculoskeletal pain syndromes by treating muscles, ligaments, tendons, scar tissue, subcutaneous fascia, peripheral nerves, and neurovascular bundles.26 Dry needling is defined as the penetration of a solid needle through the skin without the introduction of any drug to stimulate trigger points and connective tissue for the management of neuro-musculoskeletal pain.27

A systematic review is a type of literature review that collect and critically analyze multiple research studies or papers. In a systematic review, Morihisa et al. analyzed the effectiveness of dry needling for the reduction of symptoms associated with muscular trigger points.27 Based on chosen criteria, of 2,232 potential studies screened for eligibility, only 6 were identified for inclusion.  The review suggests that dry needling is effective in reducing pain associated with lower quarter trigger points in the short term, however it does not have a positive effect on function, quality of life, depression, range of motion, or strength.27  Other studies have shown that ASTR treatment can have positive effects on function, range of motion, and strength. ASTR stands for Advanced Soft Tissue Release, a manual therapy specialty developed by Dr. Joesph Jacobs, DPT. ASTR takes a holistic approach to treating the source of soft tissue restriction in a way that is virtually pain-free and highly effective.

A systematic review is a type of literature review that collect and critically analyze multiple research studies or papers. A systematic review of 13 studies, including a total of 723 participants by Gattie, et. al assessed the effectiveness of dry needling for musculoskeletal conditions in a 12-week follow-up period.25 Evidence of low-quality to moderate-quality suggests dry needling performed by physical therapists is more effective when compared to no treatment, sham dry needling, and other treatments for reducing pain and improving pressure pain threshold.25 Evidence showed a small but significant effect of dry needling for improving functional outcomes when compared to no treatment or sham needling. The long-term benefits of dry needling is currently lacking supportive evidence.25 While the long-term benefits of dry needling are lacking evidence, substantial evidence has shown that ASTR treatment can provide the long-term benefits that dry needling lacks. 

A systematic review is a type of literature review that collect and critically analyze multiple research studies or papers. In a systematic review, Matthew Cotchett et al. evaluated the effectiveness of dry needling and/or injections of myofascial trigger points associated with plantar heel pain.28 Of the 342 studies identified, only 3 quasi-experimental studies fulfilled the inclusion criteria. Plantar heel pain is one of the most common musculoskeletal pathologies of the foot, estimating to affect 10% of the population at some time in their life. The findings of the studies were combined using a narrative rather than a quantitative approach, noting poor methodological quality and secondary outcome measures. The review suggests limited evidence for the effectiveness of dry needling and/or injections of myofascial trigger points associated with plantar heel pain, due to the poor quality and heterogeneous nature of the included studies.28

Narrative reviews describe and discuss the state of the science of a specific topic or theme from a theoretical and contextual point of view. A narrative review by Dunning, et. al suggests that although there are several studies which have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points; however, there are no high-quality long-term trials supporting dry needle techniques at exclusively muscular trigger points. Overall, dry needling has been beneficial for reducing pain short-term, but there is poor evidence to support long-term effectiveness. ASTR treatment has strong evidence from studies to support that it can provide the long-term effectiveness in pain relief that dry needling lacks. 

 

A systematic review is a type of literature review that collect and critically analyze multiple research studies or papers. A systematic review of 90 studies, where 15 studies met the criteria, were evaluated by Espejo-Antunez, et. al on how effective dry needle treatment is for myofascial trigger points compared to other interventions such as oral drugs, acupuncture, and placebo.19 Although there is evidence that implies dry needling may have a positive short term effect on pain and mobility in comparison to the placebo, there are no demonstrations of long term effects. Further randomized clinical trials must be conducted using dry needling to determine the effectiveness of this application.19 

 

 

References:

24. Rubinstein SM, Terwee CB, Assendelft WJ, Boer MRD, Tulder MWV. Spinal manipulative therapy for acute low-back pain. Spine. 2011;36(13):825-846. doi:10.1002/14651858.cd008880.pub2.

25. Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2017;47(3):133-149. doi:10.2519/jospt.2017.7096.

26.  Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews. 2014;19(4):252-265. doi:10.1179/1743288x13y.0000000118.

27. Morihisa R Eskew J McNamara A, et al. Dry Needling in subject with muscular trigger points in the lower quarter: a systematic review. Int J Sports Phys Ther. 2016;11(1):1-14. 

28. Cotchett MP, Landorf KB, Munteanu SE. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. J Foot Ankle Res. 2010;3:18.

29. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review.Arch Phys Med Rehabil 2001;82:986-92. 

 

30. Xue CC, Helme RD, Gibson S, et al. Effect of electroacupuncture on opioid consumption in patients with chronic musculoskeletal pain: protocol of a randomised controlled trial. Trials. 2012;13:169. doi:10.1186/1745-6215-13-169.