Dry needling
Dry needling is a treatment method employed by some medical professionals, particularly physicians and physical therapists, aimed at alleviating persistent pain. The technique involves the insertion of thin needles into specific areas known as trigger points, which can cause referred pain in other parts of the body. While dry needling shares similarities with acupuncture in terms of needle insertion points, it is distinct in its approach; dry needling practitioners focus on musculoskeletal knowledge rather than the energy flow concepts foundational to acupuncture. Originating from research by Janet G. Travell in the 1940s, dry needling has gained popularity, though it remains a topic of controversy, particularly concerning the sufficiency of training for physical therapists compared to acupuncturists.
Critics express concern about the training duration for physical therapists, arguing it may not adequately prepare them for the technique, while proponents maintain that their education in physiology equips them to administer the method safely. The practice is typically well-tolerated, with minor side effects such as tenderness at the insertion sites. Currently, there is a growing interest in researching the efficacy of dry needling, as many patients report positive outcomes, even when traditional treatments have not succeeded. However, the role of placebo effects in these reported successes remains an area for further exploration. Overall, dry needling is a relatively accessible treatment option, with costs varying widely, but it is not always covered by
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Dry needling
Dry needling is a medical technique used by some physicians and physical therapists to relieve persistent pain. It involves inserting slender needles into areas called trigger points to try to relieve the pain. While it is similar to acupuncture, dry needle practitioners rely solely on knowledge of how the muscles and skeleton are aligned. Acupuncturists incorporate concepts from Eastern medicine, such as the realigning of the body's energy flow. The practice of dry needling is somewhat controversial, as few detailed medical studies have been conducted to document its effectiveness and much of the evidence in its favor is anecdotal. Acupuncturists also take issue with physical therapists taking part in the practice because they believe that therapists do not have sufficient training.
Background
Janet G. Travell popularized the term dry needling in a 1982 text called Myofascial Pain and Dysfunction: The Trigger Point Manual. Travell experimented with the use of long slender needles inserted into trigger points for pain in the myofascial tissue. This tough tissue forms a covering over muscles and bones. It can sometimes cause pain in one area of the body to be transferred to a completely different part; for instance, a muscle that is injured in the neck may cause pain somewhere along the arm. These are called trigger points.
Travell began working in the 1940s to identify the places on the body that triggered pain elsewhere, a condition known as referred pain. She experimented with "wet" needles, or those that were treated with a medication, and "dry" needles, those without any medication, and determined that the dry needles worked just as well as the wet ones. The needles used were generally very thin solid needles, though some dry needling work has been done with hollow hypodermic needles.
Other medical practitioners began to adopt the practice, which some patients found to bring relief from long-term pain. In 1997, some practitioners began teaching the procedure to physical therapists. Physical therapists are professionally trained and credentialed medical practitioners, but they are not trained in the same way as physicians. They are schooled in the function of the musculoskeletal system, and they undergo additional training to integrate dry needling into their practices. In concept, dry needling fits into the parameters of physical therapy because it is a technique to alleviate pain and restore function, the primary goals of physical therapy treatment. However, the practice is not without controversy.
Overview
Dry needling involves locating the trigger points that are causing the referred pain the patient is experiencing. The practitioner then inserts the needle into the skin and muscle beneath it, sometimes to a depth of four inches. The insertion causes localized irritation of the nerves and muscles, which respond with spasms and twitching. This is caused by electrical impulses and results in additional electrical impulses being released from the trigger point. When these impulses cease, the patient generally feels relief in the painful area.
The technique is similar to acupuncture, and both methods use about 90 percent of the same needle insertion points to elicit relief. However, practitioners of both techniques point out that there are significant differences. Acupuncture began in the seventh century when Chinese physician Sun Ssu-Mo first used the technique of triggering pain points with needles. Ssu-Mo, sometimes known as Sun Simiao, called the points ah-shi points. Acupuncturists believe that these points are connected to meridian lines that control the flow of energy, or chi, throughout the body, and they feel that the practice provides a way to realign that energy flow.
Acupuncturists go through years of training to learn about these points and study the techniques for triggering them with needles. In the United States, doctors who also perform dry needling and are part of the American Academy of Medical Acupuncturists undergo three hundred hours of training in addition to standard medical school training to become licensed practitioners. They may also use local anesthesia to numb the area and limit any discomfort or pain resulting from inserting the needles, which physical therapists cannot do.
Physical therapists generally take a course lasting two to three days on dry needling techniques in addition to their standard training. Critics say this is not sufficient to learn the technique adequately. They warn that too little training can result in accidents, such as punctured lungs, though they acknowledge that such instances are very rare.
Physical therapists say that their training in physiology is sufficient to identify the points where needles should be inserted and that a few additional days of training in the actual use of the needles is enough for them to be successful with the technique. They also note that dry needling is usually done in conjunction with more traditional physical therapy techniques, such as manual manipulation of painful areas and specialized exercises. They argue that dry needling is relatively safe and has few side effects, usually minor bleeding and tenderness at the insertion sites, regardless of who is administering the treatment.
Because of these conflicting views, dry needling by physical therapists is legal in some areas and not in others. In some cases, acupuncturist organizations have taken the matter to court in an attempt to require additional training and certification for physical therapists who want to perform dry needling. Although there is no official documentation on the number of physical therapists who practice dry needling, the number is estimated to be in the thousands.
Today, there is increasing interest in research that could determine the effectiveness of dry needling. In the meantime, many patients claim to have had good results with the technique, even in instances where traditional medicine has failed. It is unclear how much of this success might be due to the placebo effect, in which the thought that a medical procedure will work leads to the perception of improvement. Dry needling costs between $10 and $75 or more for each session, and most sessions are not covered by health insurance.
Bibliography
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Kalichman, Leonid, and Simon Vulfsons. "Dry Needling in the Management of Musculoskeletal Pain." Journal of the American Board of Family Medicine, vol. 23, no. 5, Sept.-Oct. 2010, www.jabfm.org/content/23/5/640.full.pdf+html. Accessed 27 Mar. 2017.
"On Pins and Needles: Just What Is Dry Needling?" Mayo Clinic, 26 Jan. 2017, mayoclinichealthsystem.org/hometown-health/speaking-of-health/on-pins-and-needles-just-what-is-dry-needling. Accessed 27 Mar. 2017.
Painter, Kim. "'Dry Needling' for Pain Therapy Is Under Scrutiny." USA Today, 17 July 2016, www.usatoday.com/story/life/2016/07/17/dry-needling-acupuncture-pain/86940278/. Accessed 27 Mar. 2017.
Reno, Jamie. "Acupuncturists and Physical Therapists Declare War over 'Dry Needling.'" Healthline, 7 Sept. 2016, www.healthline.com/health-news/acupuncturists-declare-war-over-dry-needling#6. Accessed 27 Mar. 2017.
Ries, Eric. "Needling: Getting to the Point." PT in Motion, May 2015, www.apta.org/PTinMotion/2015/5/DryNeedling/. Accessed 27 Mar. 2017.
Sager, Marshall, and Rey Ximenes. "AAMA Policy on Dry Needling." National Certification Commission for Acupuncture and Oriental Medicine, 2 Feb. 2016, www.nccaom.org/resource-center/press/press-releases/aama-policy-on-dry-needling/. Accessed 27 Mar. 2017.