Dry needling

Dry needling is a special acupuncture technique used to treat myofascial trigger points using sterile, disposable acupuncture needles . Since dry needling is an invasive technique, it may only be practiced by doctors or alternative practitioners in Germany and used as a supplement to other therapy methods and specifically for manual trigger point therapy . Dry needling emerged from clinical observations during injections with local anesthetics , in which it was found that dry needling also had therapeutic effects after the local anesthetic was used. It is not the injection that is responsible for the success of the trigger point treatment, but the prick itself directly into the trigger point is effective. Patients with chronic or acute myofascial pain often respond very well to the use of dry needling.

Dry needling techniques

In dry needling, a distinction is made between so-called intramuscular stimulation (IMS) and superficial afferent stimulation (SAS) . The IMS is the "actual" dry needling, in which the myofascial trigger points (MTrP) are searched for and treated directly with the needle. With SAS, the needles are only inserted superficially into the skin.

Intramuscular stimulation (IMS)

One of the early adopters of IMS was Chan Gunn . He developed the so-called Gunn Approach. The target is not aimed directly at the trigger points, but the whole muscle is treated with the aim of general muscle relaxation . The trigger point model of dry needling was later developed from the Gunn approach, in which the clinical diagnostic criteria for myofascial trigger points are applied. This includes:

• the reproduction of the symptoms of the trigger point
• the hard tension cord
• the local tenderness within the tension cord
• the pain transmitted from myofascial trigger points
• the local twitch response of the tension cord in response to mechanical stimulation

A distinction is made between two techniques in practical application, dynamic and static intramuscular stimulation.

Dynamic intramuscular stimulation

The hard tension cord with the needle is first sought conically. When this is found, the hard tendon is punctured until the local twitching reaction subsides. Many patients as "good pain" and expectorant, similar to the feeling of cracking at a joint mobilization .

Static intramuscular stimulation

The difference to the dynamic IMS is that the needle is left in place as soon as the myofascial trigger point has been found. A cramp-like feeling similar to the De-Qi (feeling) known from acupuncture can arise. It is important to keep the needle in the tension cord until the local cramp subsides. The static IMS is suitable for so-called strong responders , whereas the dynamic IMS is suitable for weak responders . This distinction and careful selection of the correct application of intramuscular stimulation is particularly important, otherwise overreactions can occur.

Superficial Afference Stimulation (SAS)

The superficial afferent stimulation is based on the work of Peter Baldry . The needles are inserted into the skin just a few millimeters above the myofascial trigger point and left for a few minutes. Before and after the treatment, pressure pain measurements can be made using a pressure dolorimeter in order to measure the treatment result. SAS is suitable for strong responders or to get the patient used to the needles.

Possible mechanisms of action

The effects of IMS and SAS are not the same. There is scientific evidence that the local twitching reactions triggered by the needle in IMS lead to a change in the local biochemical milieu of the myofascial trigger point. Microdialytic procedures have shown that dry needling leads to a reduction in the concentration of various inflammatory vasoactive substances . The analgesic and consecutive tonussenkende effect of SAS based Baldry according to Gate Control Theory - similar mechanisms.

Indications and contraindications

The indication for intramuscular stimulation is the treatment of trigger points. The indication of the SAS is broader: trigger points, attachment tendopathies , scar pain and other pain in the musculoskeletal system . Among the contraindications include anticoagulation , local skin irritation, lymphedema , lack of compliance of the patient, hematoma , performance status.

Possible complications

If dry needling is applied professionally, by trained medical personnel, with above-average good three-dimensional, topographical knowledge of anatomy and in compliance with the contraindications and hygiene criteria, then dry needling is a safe reflex therapeutic measure with few complications. Possible harmless complications include a small local hematoma , sore muscles-like post-treatment pain that can last 3–5 days, and very rarely vegetative reactions. If used improperly, the following serious complications can occur: pneumothorax , injuries to other internal organs, injuries to nerves and vessels, and infections .

Therapeutic use

By law in Germany, dry needling may only be used by doctors and alternative practitioners. In Switzerland, physiotherapists with proof of a successful qualification are also allowed to practice dry needling.

See also

• Muscle hardening
• Myogelosis
• Trigger point therapy
• Tension

References and footnotes

1. ↑ PE Baldry: Acupuncture, trigger points and musculoskeletal pain. Churchill Livingstone, Edinburgh 1993.
2. ^ CC Gunn: The Gunn approach to the treatment of chronic pain. Churchill Livingstone, Edinburgh 1996.
3. ↑ B. Jaeger, SA Skootsky: Double blind controlled study of different myofascial trigger point injection techniques. In: Pain. [Suppl], 4S, 1987, p. 292.
4. ^ K. Lewit: The needle effect in the relief of myofascial pain. In: Pain. 6, 1979, pp. 83-90. PMID 424236
5. ↑ Segura-Ortí E, Prades-Vergara S, Manzaneda-Piña L, Valero-Martínez R, Polo-Traverso JA. Trigger point dry needling versus strain-counterstrain technique for upper trapezius myofascial trigger points: a randomized controlled trial. Acupunct Med. 2016 Jun; 34 (3): 171-7
6. ^ CC Gunn: The Gunn approach to the treatment of chronic pain. Churchill Livingstone, Edinburgh 1996.
7. ↑ PE Baldry: Acupuncture, trigger points and musculoskeletal pain. Churchill Livingstone, Edinburgh 1993.
8. ^ JP Shah, TM Phillips, JV Danoff, LH Gerber: An in vitro microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. In: Journal of Applied Physiology . 99, 2005, pp. 1977-1984. PMID 16037403
9. ↑ JP Shah, JV Danoff, MJ Desai et al .: Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. In: Archives of Physical Medicine and Rehabilitation. 89, 2008, pp. 16-23. PMID 18164325
10. ↑ Training in dry needeling
11. ↑ Swiss guidelines for safe dry needling (DVS)

Web links

• Dry Needling Association Switzerland
• International Myopain Society
• Abstracts on dry needling, trigger points and myofascial pain
• German Society for Trigger Point Resolution for Pain Treatment

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !