Dry Needling helps to relieve active trigger points in muscles that surround the affected joint. Needles are placed around the joint and help to release the joint tension and thereby releasing the stiffness. It also reduces the arthritic pain.
Muscles may be imbalanced around a joint and by needling the over developed muscle this helps to balance the joint out and reduce the pain. It also restores smooth movement at the joint.
Dry needling also increases the blood circulation around a joint. This means the bodies natural healing and repair toolkit can be attracted to the joint to help restore and heal the joint. This toolkit is the bodies esonophils and macrophages that are normally found in the blood. Dry needling will act as an additional stimulus or probe to attract more blood and therefore more esonophils and macrophages to the joint and help heal the tissue inside the joint and surrounding the joint.
Generally after a needling session there is significantly reduced pain levels and also the joint will feel lighter and have an increased range of movement.
You may need between three and four dry needling sessions. This may be combined with other techniques such as cupping or remedial massage, some stretches and some joint mobilization movements depending on the joint and also on the scenario.
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How dry needling Affects Arthritis
However, scientific evidence suggests alternate explanations for why dry needling might provide pain relief.
“There’s a lot of research that says when we put a dry needle into the body, a number of physiological mechanisms occurs,” says Brian Berman, MD, professor of family and community medicine and director of the Center for Integrative Medicine at the University of Maryland School of Medicine.
A well-placed needle sets off a cascade of events, Dr. Berman explains, producing a signal that travels along the spinal cord to the brain, triggering a release of neurotransmitters called endorphins and enkephalins, which scientists believe reduce the sensation of pain. Research also shows that inserting an acupuncture needle induces the production of cortisol, a hormone that helps control inflammation. Acupuncture may stimulate activity of other pain-relieving chemicals in the body as well.
But do all these biochemical changes relieve sore, stiff joints? A study by Dr. Berman and his colleagues found that after 26 weeks, patients receiving real acupuncture felt significantly less pain and functioned better (as measured by how far they could walk in six minutes) than their counterparts who received sham acupuncture.
What the Research Shows
Other studies haven’t been as positive, and acupuncture’s benefits have been hard to prove because high-quality studies on the subject of arthritis and acupuncture have been limited. Here’s a look at some of the recent research that has been done:
- Osteoarthritis. Even though patients offer anecdotal evidence that acupuncture has helped them, most studies have found acupuncture offers minimal pain and stiffness relief for osteoarthritis (OA). A 2018 Cochrane review of six studies evaluating acupuncture for hip OA concluded acupuncture probably has little or no effect in reducing pain or improving function compared to sham acupuncture in people with hip osteoarthritis. One unblinded trial found that acupuncture as an addition to routine primary physician care was associated with reduced pain and improved function. However, these reported benefits are likely due at least partially to participants’ greater expectations that acupuncture can help.
- Rheumatoid Arthritis. Recent research suggests dry needling may hold a beneficial role in treatment for some people with rheumatoid arthritis (RA). A review of 43 studies, conducted between 1974 and 2018 and reported in Evidence-based Complementary and Alternative Medicine, concluded that “dry needling alone or combined with other treatment modalities is beneficial to the clinical conditions of RA and can improve function and quality of life, and is worth trying.” The review cites several possible ways dry needling effects RA, including its anti-inflammatory effect, antioxidative effect and regulation of immune system function. However, the review acknowledges that there is still inconsistency among trial findings and that further research is needed to evaluate the effects of dry needling and how it works.
- Fibromyalgia. In a 2014 review article in Journal of Traditional Chinese Medicine, researchers analyzed the results of nine studies on acupuncture for fibromyalgia. Though a few studies found dry needling worked better than drugs to manage the condition, most of the studies weren’t well designed. The authors concluded there wasn’t enough evidence to prove acupuncture works better than placebo.
Dry needling’s primarily focused on reducing pain and restoring function through the release of myofascial trigger points in the muscle.
What is a Myofascial Trigger Point?
A myofascial trigger point, also known as a knot in the muscle, is a group of muscle fibres that have shortened when activated but have not lengthened back to a relaxed state after use. A myofascial trigger point develops a sensitive nodule in the muscle (Simons, Travell & Simons, 1999). In addition to this nodule, the remainder of the muscle also tightens to compensate (Simons et al., 1999; Simons, 2002). This hypersensitivity occurs as the muscle fibres become so tight that they compress the capillaries and nerves that supply them (McPartland, 2004; Simons et al., 1999). As a result, the muscle cannot frequently move, obtain a fresh blood supply containing oxygen and nutrients, or flush out additional acidic chemicals (McPartland, 2004; Simons et al., 1999). The presence of a myofascial trigger point in a muscle can lead to discomfort with touch, movement and stretching, decreased joint motion, and even a temporary loss of coordination (Simons et al., 1999).
How Does Dry Needling Work?
Dry needling assists with decreasing local muscular pain and improve function by restoring a muscle’s natural ability to lengthen and shorten by releasing myofascial trigger points.
What Does Dry Needling Do?
When the delicate filament needle inserts into the centre of a myofascial trigger point, blood pools around the needle, triggering the contracted muscle fibres to relax. This reaction, in turn, leads to the decompression of the local blood and nerve supply. It also helps to provide those fibres with fresh oxygen and nutrients and flushing away any additional acidic chemicals.
What Causes a Myofascial Trigger Point?
A myofascial trigger point develops as part of the body’s protective response following:
- injury – the muscle will tighten in an attempt to reduce the severity of an injury;
- unexpected movements, e.g. descending a step that is lower than initially anticipated;
- quick movements, e.g. looking over your shoulder while driving;
- change in regular activity or muscle loading, e.g. an increase in the number or intensity of training sessions for sport;
- sustained postures e.g. prolonged sitting for work or study;
- nerve impingement – the muscle will tighten to protect the nerve;
- stress;
- illness (bacterial or viral);
- nutritional deficiencies, or;
- metabolic and endocrine conditions.
(Simons, et al., 1999)
When Is Dry Needling Treatment Recommended?
Dry needling can assist in treatment:
- to help release myofascial trigger points (muscle knots);
- to assist with pain management, and;
- to restore movement at a joint if inhibited by myofascial trigger points.
What Will You Feel During Dry Needling Treatment?
During a dry needling treatment, you may feel a mild sensation as the needle inserts and withdraws. Patients don’t report any discomfort during needle manipulation.
A brief muscle twitch may occur during a dry needling treatment. This twitch may happen when the needle directly stimulates a myofascial trigger point.
Where Does Dry Needling Fit Within Your Rehabilitation Program?
Dry needling is one of many techniques that your physiotherapist can utilise to assist with your rehabilitation. We combine dry needling with other physiotherapy techniques, including massage, manual therapy, and exercise prescription.
What are the Side Effects of Dry Needling?
Every form of treatment can carry an associated risk. Your physiotherapist can explain the risks and determine whether dry needling is suitable for you based on your injury and general health.
When dry needling occurs, single-use, sterile needles are always used and disposed of immediately after using a certified sharps container.
Is Dry Needling Safe?
Everybody is different and can respond differently to various treatment techniques, including dry needling. In addition to the benefits that dry needling can provide, some side effects may occur, including spotting or bruising, fainting, nausea, residual discomfort or even altered energy levels. However, these symptoms should last no longer than 24 to 48 hours after treatment.
Can You Exercise After Dry Needling?
We recommend avoiding strenuous or high impact activities immediately after dry needling to allow the body time to recover and maximise the treatment benefits.