physiotherapist don mills and steeles

By: Hamed Pardehshenas

Dry needling is a technique that I often use in clinical practice to help patients to move and feel better. I’m often asked what is dry needling and how it works? Is it the same as acupuncture and if not, how is that different?  I hope that the following blog will provide you with a better understanding of dry needling.


 What is Dry Needling?

Dry needling is the insertion of a very fine needle usually into a muscle, to normalize muscle tension, reduce pain and improve function. Dry needling is a technique used by trained physiotherapists  to treat trigger points and manage musculoskeletal problems. It is usually performed at the site of pain or very close to it.  Dry needling shouldn’t be confused with an acupuncture treatment.

Why is it called “Dry needling”?

Dry needling is a broad term used to differentiate “non-injection” needling from “injection needling” (wet needling) which utilizes a syringe to inject an agent such as corticosteroids (cortisone shots) into a tissue.


What is a Trigger Point? Are they real?

A muscular trigger point is a painful, dysfunctional area within a muscle, often described by patients as it feels like a ‘knot’. The presence of these knots in muscles has been confirmed by research. At the physiological level, they seem like as an excessive “noise” on muscle activity on EMG studies. Unfortunately, these trigger points can manifest a lot of physiological changes at peripheral (muscle) and central (brain) levels as they become more persistent. These additional manifestations are often termed “neuropathic changes”. The contributions of trigger points often are not considered and you may have gone through many unsuccessful treatment regimens with multiple diagnostic pathways. that is why any treatment approach without addressing your trigger points will usually fail.

How do Trigger Points Form?

Muscles should always be operating at an optimal length in coordination with other muscles. In a dysfunctional state, a muscle can be upregulating or downregulating. In other words, they might be overworking or underworking; contributing too much or too little to the task being performed. Multiple factors such as muscle weakness, joint dysfunction, muscle fatigue, poor posture, repetitive activities and trauma can irritate your muscle and lead to the development of a trigger point. Often times developing a trigger point is a sign of compensation for another problem area.

Why are Trigger Points a Problem?

The problem is that in response to long standing pain, your body may have already developed a fear of movement, coping skills, altered breathing patterns, abnormal muscle activation patterns and an anticipation of pain with certain movements or activities. This means your whole system may start contributing to your overall pain experience. This is where your pain becomes persistent and a lot more complex.  But, the good news is that all of the above can be reversed if treated properly.

How Does Dry Needling work?

The body of evidence on exact mechanisms of dry needling is still growing and there are many hypotheses that have already been established. Typically, when dry needling is performed, the optimal outcome of the technique is called a “Local Twitch Response” which feels like your  muscle is jumping or twitching. Eliciting a twitch/jump is important when inactivating the trigger point and confirms that the needle was placed accurately into a trigger point and treatment was successful. Several studies have confirmed that a twitch/jump can reduce or even eliminate the typical noise associated with that trigger point. Additionally, eliciting the twitches by dry needling appears to reduce the unwanted high concentrations of many chemicals found in the immediate environment of a knot, such as calcitonin gene-related peptide, substance P, serotonin, interleukins, and epinephrine, among others.

Long story short, it is believed that dry needling may disrupt these knots. It may also trigger the same chain of events similar to the normal muscle regeneration process. Interestingly, dry needling also causes a small increase in blood flow to the area, which may assist tissue remodeling of scar tissue.

How will I feel after my Dry Needling session?

The most common post treatment symptom is soreness. You may feel as if you hit the gym the other day and now muscles are really sore. Some describe the sensation as a ‘bruise’ or ‘cork’ which gradually eases over the next day or two. Continue moving normally as the muscle soreness fades away. Athletic tape and taking a hot shower can also help. Your muscle performance should improve and the tension should resolve within days. Your physiotherapist will always try to tailor the technique to your needs to ensure your comfort with the technique being used.

Is Dry Needling Painful?

Dry needling doesn’t have to be a painful experience per se as it can vary depending on a number of factors including:

  • The method used by your physiotherapist
  • Your expectations
  • Your prior experiences with needles
  • Your level of anxiety

The technique can be superficial or deep and can be combined with electrical stimulation in order to cause more mechanical stress which is required for tissue remodeling.

How many treatment sessions will I need?

The answer to this really depends on several factors including the number of trigger points involved and how long they have been there. If there are only a few trigger points and your symptoms are relatively new, you may only require one session.  Chronic or severe muscle dysfunction or multiple areas may require more dry needling sessions, sometimes up to 12-14 sessions, especially if there are associated neuropathic changes.

Is Dry Needling Safe?

Dry needling is a very clean and safe technique. Your physiotherapist will use sterile, single-use, disposable needles. As with any technique that goes under your skin, The needles that are used are very fine flexible needles so  there is usually no bleeding. Occasionally a small droplet of blood may appear which can result in a small bruise.

Is Dry Needling appropriate for everyone?

Your physiotherapist will ensure that you are the right candidate for receiving dry needling by discussing more details with you during your appointment. Physiotherapists are extremely well-trained in anatomy so the chances of any injury associated with needling is highly unlikely.

Are you wondering if dry needling is appropriate for you? One of our therapists would be happy to discuss your treatment options with you.

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Don't let pain ruin your day

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