DRY NEEDLING: NOT THE "SHARPEST" TOOL IN THE SHED

Dry needling…You’ve heard about it. You’ve seen posts on social media about it. Maybe you’ve personally had it done to you.

Either way, we have all heard the claims, that it can “cure any musculoskeletal pain you may be having!”. But, do we actually know what it does? And do we know if it works or not?

In this post, with the help of research, we are going to review why the new therapeutic fad of dry needling is indeed not the sharpest tool in the shed (and yes, that was meant to be punny).

WHERE DID DRY NEEDLING COME FROM?

First and foremost, we need to answer the following question: “What is dry needling, and why is it named as such?”

Dry needling was developed by a Czech physician named Carel Lewit in 1979, in which thin, non-medicated filiform needles are inserted deep into the belly of any muscle (within reason) in the body that is suspected, by your provider, to be the cause of your aches and pains.

Dry needling has gained momentum throughout the years by way of countless personal testimonies on the positive results that individuals have had due to needling therapy (or so they believe). However, it is key to note that personal testimony, though I admit is not completely unimportant or baseless, is not and cannot be hailed as factual science.

HOW DOES DRY NEEDLING THERAPY WORK?

The main theory suggested is that, in muscles with trigger points (i.e. what we call “knots”), the needles cause a slight twitch-and-relax response, resulting in complete relaxation of the “knotted up” muscle fibers. Additional physiological mechanisms have been proposed, but the twitch-and-relax theory carries the greatest weight.

An alternative theory (and probably the most likely) is that it is simply placebo effect. Placebo effect essentially is a term used to say that something works only because you THINK it works, even though there is no physical proof that it does anything physiologically.

This “placebo effect” is something that sports and fitness companies such as Nike, Under Armor, etc. have adopted to sell you various pieces of clothing and equipment over the years, such as shooting sleeves that make your basketball shot better, or soccer cleats that make you contact the ball better (future post on THAT topic to come at a later date). Don’t get me wrong though, I still love that fancy neon Nike athletic equipment. Who doesn’t, right?

The formula seems successful…you have knots, knots cause pain, and pain causes altered movement. Therefore, if there were only a way to get rid of the knots, then, theoretically, our movement should improve, right? Well, let’s continue on to see if that’s case.

WHO CAN PERFORM DRY NEEDLING?

Though most commonly performed by physical therapists, chiropractors, or massage therapists, little do people know that anyone who is willing to take a course (upwards of $900 or more, mind you) in dry needling can then become certified to provide dry needling services wherever they want and to whoever they want, whether that’s a service run out of their own home, out of a clinic, or by way of in-home visitation.

5 KEY POINTS FROM THE RESEARCH:

(WARNING: Big words ahead.)

So, now we know what dry needling is. Next, we must answer the major question: “Does this really work the way it is supposed to?”.

Fortunately for you, as consumers, I have done the dirty work for you. I’ve read through countless articles, some high-quality and some very low-quality. From that I have compiled 5 key, over-arching themes that I have rendered from the results of the current research that is available today.

Key point #1: If you are waiting for high-quality research articles to finally make a conclusion, you will be waiting a couple more years. That level of research just isn’t there yet.

According to an article from Boyles et al. (et al = “and peers/colleagues”), written in 2015, to date “no systematic reviews of high-quality randomized controlled trials investigating dry needling to multiple body regions exists” (I warned you there would be big words).

Key point #2: Don’t be discouraged, there IS research out there, it is all simply just low-to-moderate quality at best. This means that, as the methodologies of research improve, we will begin to see higher quality studies coming forth.

As we see in an article written by Cotchett et al., in 2014, analyzing the results of dry needling therapy being used in individuals with heel pain, most likely from plantar fasciitis, “there is only poor quality evidence supporting its use”, and though dry needling did show improvements in pain, “the magnitude of its effect” should be taken only lightly.

There was even an article, which was in fact a high-quality study, written by Gattie, Cleland, and Snodgrass in 2017, which stated that the evidence for dry needling therapy was so low-quality, that they could not “prove that dry needling therapy was better than no treatment at all for pain relief in the short term”. Wow, what a statement! They can’t even say with confidence that dry needling therapy was better than doing absolutely nothing…..let that sink in.

Key point #3: The evidence, though low-quality, is clear that dry needling therapy shows benefits, however, the benefits are highly restricted and short-lived.

As you can read in an article written by Liu and Huang in 2015, dry needling therapy only shows significant improvements in pain in the short term, and shows no real improvements in function or pain relief in the medium to long term. The authors state that dry needling was determined to be effective at reducing pain, though in the short term only (roughly 3 days to a couple of weeks, the article specifies).

Key point #4: If you are looking to improve your long term success, whether that be by improving your quality of movement or your quality of life, dry needling therapy is not the way to go for you. And if you do chose dry needling therapy, you must combine it with other forms of exercise or therapy.

Dry needling, as written in 2019 by Cesar Fernandez de Las Penas and Jo Nijs, is to be used as an adjunct therapy only, and is to never be used as a stand-alone treatment. They state that dry needling therapy is only effective for improving long term pain and function if it is "combined with pain neuroscience education, exercise, manual therapy" and other alternative therapeutic techniques.

Key point #5 (if you’ve taken nothing else away from reading this, please hear this): Anyone who tells you they can CURE any musculoskeletal pain you are experiencing by using dry needling therapy, is just flat out wrong. Dry needling has absolutely 0 curative properties….

Let me say that again…..

DRY NEEDLING THERAPY HAS ABSOLUTELY ZERO CURATIVE PROPERTIES.

FINAL THOUGHTS:

Now, you have to keep in mind, as a student of physical therapy, I think not just in terms of pain relief, but in terms of functional improvement, movement improvement, and a better quality of life in the LONG term. I am more concerned with permanent (or at least somewhat permanent) results.

As we have seen from the research, dry needling therapy has only shown to be effective in taking away muscle-related pain, and even so, that effect only lasts for a couple of days or weeks. So, for me, from a physical therapy viewpoint, dry needling therapy is not all that it has been lauded to be. It certainly is not some magical fix that can cure you of any pains you are feeling.

Finally, if you are skeptical of the results I have reported, please feel free to keep me accountable! Read the articles yourself. Come up with your own conclusion. Let me know if I am way off base, or if I am dead on.

ARTICLES USED:

1. Boyles R, et al. Effectiveness of trigger point dry needling for multiple body regions: a systematic review. Journal of Manual Manipulative Therapy. 2015; 23(5): 276-293.

2. Cotchett M, Munteanu S, and Ladorf K. Effectiveness of trigger point dry needling for plantar heel pain: a randomized control trial. Physical Therapy. 2014; 94(8): 1083-1094.

3. Gattie E, Cleland J, and Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic-Review and Meta-analysis. Journal of Orthopedic Sports Physical Therapy. 2017; 47(3): 133-149.

4. Liu L, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2015; 96(5): 944-955.

5. Fernandez de las Penas C. and Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current prospectives within a pain neuroscience paradigm. Journal of Pain Research. 2019; 12(1): 1899-1911.