I often get asked if I do dry needling. Many acupuncturists
become defensive when asked this, and there is currently some contention in the
fields of acupuncture and physical therapy, as PTs either have it in their
scope of practice to do dry needling (in some states) or are trying to get it added
to their scope (in other states, such as Florida). Many acupuncturists feel
that dry needling is just another name for acupuncture and that PTs are trying
to add acupuncture to their scope.
So, what is dry needling and why is there any controversy?
First off, I want to state that this blog post is not intended to state any
profession opinion or get into the politics. Instead I am going to discuss the
technique, goals, and give a brief history of dry needling.
Dry needling as a technique and name grew out of work
primarily from Dr. Janet Travell, MD. Dr. Travell, along with her colleague,
Dr. David Simons, MD wrote a very influential two-volume book in the field of
pain management called Myofascial Pain and Dysfunction: The Trigger Point
Manual. In this book, they discussed trigger points (TrPs) which are
defined as hypersensitive spots found in taut bands of muscle (click to read more about TrPs). When palpating
muscles that are dysfunctional, there are notable taut bands. Following these
taut bands, physicians might find a hypersensitive nodule, often in the belly
of the muscle along these taut bands. Pressing these yields hypersensitivity
and often a characteristic referral pattern is noted, many times quite a
distance from the location of the TrP. These two volume books gave a detailed
description of the palpation, signs and symptoms, and pain referral zones of
these TrPs for each muscle in the body.
In addition to clinical information regarding locating and
diagnosing these TrPs, these books also discussed treatment. Many protocols were discussed, but TrP injections were primary treatments outlined in
these books. It became increasingly understood that the mechanism that was at play with TrP injections was the mechanical stimulation from the needle. Most
often what was injected were substances such as lidocaine which served the
purpose of reducing sensation as a relatively thick hypodermic needle probed
into a hypersensitive TrP. Dr. Travell did discuss dry needling, differentiating between using a hypodermic needle to inject a substance versus using a hypodermic needle without injecting a substance (which was, therefore, 'dry-needling'). Over time, especially as acupuncture was becoming
more popular in America, other practitioners determined that the use of a thinner
solid filiform acupuncture needle could serve the same purpose.
Actually, in the history of acupuncture in China these
same techniques were discussed and the Chinese referred to these hypersensitive
nodules as Ashi points. Ashi means something along the lines of
‘That’s it’. Imagine a physician palpating for the source of a patient’s pain
and the patient proclaims ‘Ashi’. The
needle technique involves with needling Ashi points is extremely similar to
those described in TrP injection and dry needling circles. Notably this
involves locating the hypersensitive nodule, inserting a needle, bringing the
needle back to the subcutaneous layer and redirecting the needle. Imagine a
needle pointing to numbers on a clock and, from the same point, the needle
touches 12, 1, 2, 3, etc. This describes the lifting and thrusting technique
discussed in the classics of Chinese medicine. When doing these techniques,
there is a characteristic muscle twitch or fasciculation that is achieved as
the TrP is being deactivated.
This technique can be extremely effective in reducing pain
associated with TrPs which is a very common source of pain. Increasingly, TrPs
are being understood to be a major contributor to pain. Needling TrPs with an
acupuncture needle is one of the most effective tools to treat these. I feel
that acupuncturists are best suited to treat TrPs, as we have the greatest
amount of training with needle technique and we have the greatest ability to
incorporate this technique into a balanced acupuncture session. However, while
all acupuncturists have had some training on needling sensitive points, those
who have undergone more continuous training with emphasis on a detailed
understanding of anatomy and palpation are going to yield the greatest results.
While not all acupuncturists have this understanding, there is growing movement
within acupuncture circles to incorporate a more detailed understanding of
Western anatomy and utilizing a more integrative approach to treating patients.
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