It is important to recognize that the origins of Dry Needling are drawn from Western Medicine principals and scientific, research-based conclusions. The technique of Dry Needling has NO historical ties to acupuncture, which is based in Eastern tradition. Dry Needling effectively treats musculoskeletal pain and dysfunction while acupuncture aims to influence “energy” and “meridians.” The only similarity between the two is that they share a common tool, a fine needle. However, just because the same tool is used doesn’t mean the same job is being performed. For instance, a surgeon and a butcher share a common tool but I know who I would want cutting on me.
Injections into myofascial trigger points (hyperirritable spots in muscle) were first proposed by Medical Doctors Janet Travell and David Simons in the early 1940’s. These physicians injected various substances including corticosteroids, analgesics, saline, etc. into trigger points. Dr. Travell was well respected and actually became President John F. Kennedy’s White House physician. The wider use of “Dry” Needling started after a study in 1979 by a Czech physician, Karel Lewit, where it was emphasized that the “needling effect” is distinct from that of the injected substance (“wet” needling). Since then, numerous medical studies have found no difference between injections of different substances and Dry Needling in the treatment of musculoskeletal pain.
Digging a bit deeper, two main conceptual models of Dry Needling developed during the last few decades; most common are the radiculopathy and trigger point models. The radiculopathy model is based on empirical observations by the Canadian physician Dr. Chan Gunn, another pioneer of Dry Needling technique. To distinguish this approach from other methods of Dry Needling, Dr. Gunn named it intramuscular stimulation (IMS). The Gunn IMS technique is based on the premise that musculoskeletal pain is a result of peripheral neuropathy or radiculopathy, defined as “a condition that causes disordered function in the peripheral nerve.” According to Gunn's theory, denervated tissues develop supersensitivity. In the musculature, this manifests as muscle shortening, pain, and the development of taut bands with trigger points. Shortening of the spinal muscles, particularly the multifidi muscles, leads to disk compression and pressure on the nerve root, which subsequently results in peripheral neuropathy and the development of supersensitive nociceptors and pain. Thus, restricted flow of nerve impulses in all innervated structures—including skeletal muscle, smooth muscle, spinal neurons, sympathetic ganglia, adrenal glands, sweat cells, and brain cells—leads to atrophy, aggravated irritability, and sensitivity. According to the second model, the trigger point approach, a fine filament needle (AKA acupuncture needle) is inserted directly into a trigger point of the dysfunctional muscle that may be contributing to pain. In 1942, Dr. Janet Travell and colleagues first published the method of injections into trigger points. In 1979, Dr. Karel Lewit concluded that the effect of injections were primarily caused by the mechanical stimulation of a trigger point with the needle alone (not the medication being injected). Since then, Dry Needling has been widely used for the treatment of trigger points. More recent studies have found Dry Needling to be most effective when local twitch responses are elicited, probably because of rapid depolarization of the involved muscle fibers, which manifests as local twitches. After the muscle has finished twitching, the spontaneous electrical activity subsides and the pain and dysfunction decrease dramatically. Acupuncture technique does not aim to necessarily even pierce muscle tissue, nor cause this important muscle twitch response that is definitive of Dry Needling.
From origins in “wet” trigger point injections performed by physicians grounded in Western Medicine to the use of a “dry” fine filament needle by specialty trained physical therapists, the technique of Dry Needling has had a fascinating evolution. Now by omitting unnecessary medication (and side effects), Dry Needling has established itself as a treatment that is minimally invasive, cost effective and carries a low risk. The ffectiveness has been confirmed in numerous studies already and it will continue to change lives in the future.
Adapted from the Article: Dry Needling in the Management of Musculoskeletal Pain
Published in: Journal of the American Board of Family Medicine. Volume 23, Number 5.