Welcome to the first installment of my pregnancy series! My intention for this series is to share...
Let's talk all things dry needling! Dry needling is a great tool to facilitate positive changes in patients' pain levels and abilities to activate inhibited musculature. Dry needling can hasten the recovery process from injury or strenuous activity, and can provide relief from chronic pain, when paired with therapeutic movement or activities. Today we'll start with the basics, and move on to my experience as a provider of dry needling!
The Basics - Quick Facts
1. Dry needling is the use of a thin solid filament needle that is inserted into a muscle belly to decrease musculoskeletal pain and increase muscle activation. Throughout this article, I will refer to Trigger Point Dry Needling (TDN), as opposed to the dry needling of tendons, dry needling combined with electrical stimulation, or other forms.
2. Dry needling works on both mechanical and cellular levels by stimulating a healing response and instigating positive physical changes in the muscle, including decreasing the amount of inflammatory neurotransmitters in circulation and the improvement of the alignment of muscular cells
3. Dry needling is different than acupuncture, though the needles are similar! Acupuncture, based in Eastern medicine, targets pre-established meridians and energy channels to facilitate systemic changes, while dry needling targets muscular trigger points based on an individual's anatomy
4. Depending on your state, physical therapists, occupational therapists, doctors, chiropractors, veterinarians, and more can dry needle with qualification
5. Not everyone is a candidate to receive dry needling treatment - each dry needling provider should perform an evaluation to ensure that it is appropriate before starting
Getting Started - Training
During my various internships throughout graduate school, I observed first hand the power that dry needling had to facilitate positive patient outcomes in a timely fashion. I knew that when I was eligible, I would seek further training in dry needling. After graduating with my PT degree and establishing myself in the outpatient orthopedic setting, my job actually requested that I take a dry needling course, if I was amenable to it (always see if your employer is willing to pay for, partial or in full, the cost of dry needling courses as they tend to be very expensive). After researching several courses (some are better than others) and gaining the opinions of several PTs, I decided to take my courses through Myopain Seminars (check the list of approved programs by your state PT/OT/etc. board). I highly recommend Myopain's courses for the most thorough instruction, prioritization of safety and practical tips for immediate success in the clinic!
Thanks to North Carolina (NC) law and our state physical therapy practice act, I was able to dry needle clients after passing my Level 1 course. Because I loved it, I went on to gain certification in Level 2 and 3 Dry Needling courses through the same program, but this was not required to practice in the state of NC. Each course concludes with practical and written exams, but the final, Level 3 course is by far the most daunting (though doable) set of exams. People do fail, and it can be a serious investment of time, money and energy to retake, but passing that final level did teach me skills to treat TMJ, deeper cervical spine muscles involved in whiplash, hand and foot intrinsic musculature, and more, all of which I have actually used in the clinic (for clients who were very grateful afterwards). Going through all levels of a course may be required in your state, so be sure to consult your practice act to confirm what you need to start needling as a provider.
Value of Learning TDN Early in my Career
When I was a physical therapy student, my clinical instructors always told me to hone my basic manual clinical skills - joint mobilizations, soft tissue mobilization, etc. - before taking on dry needling training, as dry needling could quickly become “the only thing you’ll reach for,” to the detriment of other skills. However, since I acquired my dry needling skills, I continue to keep my interventions simple and lead with less invasive measures first, where appropriate, offering dry needling as a therapeutic tool when indicated. I consider dry needling a form of manual therapy, and as such I always combine its use with follow-up therapeutic movement for best results. Research continues to show the superior power of trigger point dry needling combined with therapeutic exercise, versus dry needling alone or exercise alone. I have found that undergoing dry needling training early on in my career has advanced my practical knowledge of anatomy, enhanced my palpation skills, and improved my ability to provide clear and concise patient education before and after any intervention (including informed consent).
Pros + Cons
Pros: Efficiency of treatment - many of my clients tend to see results the next day if not within the first 1-3 weeks of weekly treatment; results are fantastic - clients generally perceive a strong, positive difference in their symptoms; most patients are willing to try needling or are open to it with proper patient education (even those who are needle-averse); dry needling is a great tool for making a difference in clients with chronic pain, not just in acute cases
Cons: Needling is not covered by most insurances (extra cash charge can deter some clients); dry needling training is expensive and time-intensive to acquire; dry needling requires extra time/patient education within a session, including informed consent before intervention and set up
Fun Fact
Humans have been sticking each other with needles for thousands of years for pain control! Archaeologists have found cave art depicting the earliest humans treating one another using sharp objects. We were onto something great, so early!
I hope that this article helps any potential dry needling clients feel more confident about considering needling as a treatment option, and I hope that this article also encourages potential dry needling providers to look into it further or even book some training! The results I have delivered have changed numerous patients' lives and patients are incredibly grateful, which is encouraging as a therapist. If you have any questions or comments about dry needling, or suggestions of other courses to take, leave them in the box below!
