Purpose of Dry Needling
Dry Needling is used to strengthen tendons and ligaments, stimulate Golgi receptors and muscle spindles, deactivate trigger points, treat overactive motor points, provide growth and blood factors to hemodynamically disturbed tissues (commonly seen in Myofascial pain syndromes) reset motor points and neural control and stimulate other reflex mechanisms.
Strengthening Tendons and Ligaments
Needling may strengthen soft tissues such as tendons and ligaments by inducing a local inflammatory response. Fenestrations of areas of tendinosis and ligament insufficiency by needling may promote beneficial bleeding into new channels created through degenerated mucoid tissues.
- The mechanical trauma caused by needling may injure cells, including mast cells, blood cells and vessels
- The mechanism of injury is activated
- Blood products such as platelet growth factors and transforming growth beta factor beta spill and activate healing
- Amines and other inflammatory mediators are released generating an acute inflammatory reaction or flare
- Plasma seeps into the tissues, possibly allowing blood to reach poorly- vascularised areas such as ligaments and tendons. After a delay of several hours,
- The plasma begins to attract polymorphs. In the absence of significant bacterial infection, this leukocytic infiltration is mild and fades quickly.
- Macrophages migrate into the area of inflammation and work to remove red blood cells, fibrin, dead polymorphs and other cellular material. At the same time, with granulocytes, the macrophages work to activate fibroblasts.
- Local fibroblasts begin to hypertrophy and to generate collagen and elastic fibers adding strength to the tissues.
Muscle needling may provide blood products and wash away sensitizing substances. It can break fibrotic tissue that has entrapped nerve endings, and it possibly may be able to replace hyperactive nociceptors with nonpainful tissues.
Travell has reported that active myofascial trigger points can be treated with dry needling since it often leads to characteristic muscle twitches and stretch effects on the adjacent shortened muscle fibers. The resulting muscle relaxation may reduce mechanical stresses on tissues such as intramuscular nerves, blood vessels, and tendons, thereby allowing more effective healing.
Travell and Simons (1983) state:
The needle may mechanically disrupt abnormally functioning contractile elements or nerve endings which are sensor and motor components of the feedback loop believed responsible for sustaining the trigger point activity. Cessation of the neuromuscular dysfunction relieves the tautness of the palpable band of muscle fibers and the hyperirritability of the sensory nerve that is responsible for both the referred phenomena and local tenderness.
Providing Blood and Growth factors
Chronic muscle tension and spasm can cause reduced oxygen and other nutrient supply. This in turn, can possibly result in a small area of abnormal function and ectopic muscle facilitation. Bleeding, which can be an effect of needling, can break microscars in these areas and can provide blood and growth factors to facilitate healing. Platelet-derived growth factor can attract cells and facilitate DNA synthesis as well as stimulate collagen and protein formation. Growth factors may heal localized tissues as well as sensitized nerves. This process may lead to the healing of somatic as well as visceral tissues
Safe Needling Practice
The most common types of needles now used are pre-packaged, single use, stainless steel filiform needle.
The tip is the part that enters the body. To avoid sepsis of any kind, it is crucial that the tip and the body shaft are never touched in any way. In the old days, needles were reused and cleaned in an autoclave. With the invention of the disposable needles by Japanese acupuncturists, the risk of contamination is extremely low. These are now the gold standard for needles. The plastic guide tube was introduced to make needle insertion easier as it provided a quick, safe method of insertion. Previously needles were inserted by hand.
What needling can feel like:
- Distending feeling around the point
- Radiating away from the point
- Deep ache