Dry needling is a broad term used to differentiate “non-injection” needling from the practice of “injection needling” which utilises a hyperdermic syringe and usually involves the injection of an agent such as saline, local anaesthetic or corticosteroid into the tissue or specific anatomical structures .In contrast to this, dry needling utilises a solid, filament needle, as is used in the practice of acupuncture, and relies on the stimulation of specific reactions in the target tissue for its therapeutic effect.
The term dry needling is also used to differentiate the use of needling in a western physiological paradigm from the use of needling in an oriental paradigm which is referred to as acupuncture.
There are several popular, well established schools of dry needling practice such as Chan Gunn’s IMS and Myofascial Trigger Point Release pioneered by Janet Travell, and they commonly involve the needling of myofascial trigger points using acupuncture needles to deactivate and help resolve trigger points.
These approaches have become very popular due to them being:
- Quick and easy to learn technique
- No emphasis on skill acquisition over time
- Appeal to non manual therapists
- Simple treatment paradigm initially based on shortened muscle concept-“de-activate TP’s and stretch”
- Research dominated by TP needling approaches due to quick to learn/simple paradigm and is therefore self propagating
Despite their popularity, there are many limitations to these approaches, some of which are:
- 1/3 of patients become hot and sweaty and treatment must be discontinued (Hugenin 2003)
- Depending on the source, figures of between 15% to 40% of patients are considered to be non responders to trigger point techniques
- The muscle twitch reaction to trigger point dry needling often produces a cramp like sensation, not enjoyed by many patients and may be quite stressful for therapists applying the techniques
- If the underlying cause of trigger points is not addressed, even successfully deactivating them will only be temorary
This is due in part to the limited variety in needle technique used and the reliance on the presence of trigger points. A muscle twitch response is simply too much input for many nervous systems and the dose of neurological stimulation is simply too great. Consequently many practitioners, after an initial burst of enthusiasm post studying dry needling, apply it less and less in the clinic until it it is barely being used by them at all.
The myofascial trigger points emphasised in these other dry needling approaches, are addressed indirectly and effectively using the unique Integrated Dry Needling quadrant approach. The movement dysfunction and adverse neurophysiological load resulting from it is addressed during the treatment process to ensure and tissue reactions, trigger points included, do not return.
The Integrated Dry Needling approach addresses many of the limitations of established dry needling practice by differentiating between a variety of needling techniques and applying them to specific changes identified in the tissue by means of skilled palpation and logical, range based physical assessment .
The Integrated Dry Needling approach demands a higher skill level of the practitioner than other approaches,however the rewards of investing time in attaining excellent assessment skills and needle technique are many.
In the hands of a skilled practitioner, dry needling can be used in most cases the majority of the time and with less energy expenditure on behalf of the practitioner and equal or better effect than other manual techniques currently being used.If practiced well there is also a remarkable absence of the “post treatment tissue soreness” often experienced by the subject following other manual therapy interventions.