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Dry needling

Dry needling, unlike Chinese or eastern acupuncture, is a technique used by physiotherapists and in orthopedics. It is a technique base on evidence based research, physiological, anatomical and bio- mechanical principles. There is no reference in this technique to the energy system, meridians or other terminology used in acupuncture. There are 2 types of dry needling:

1. Superficial dry needling (SDN):

This technique is used with acupuncture needles at a length of 15 mm. The needle is inserted superficially for 5-10 mm and is being moved in a rotational or "in and out" movements. The purpose of this technique is either pain reduce/ control or the release of thick fibrotic scars that may cause pain or influence the fascia system.

2. Deep dry needling (DDN):

When muscles are over activated beyond their ability or in excess due to overtraining, trauma etc. a trigger point phenomenon occurs. A trigger point is a situation where some of the muscles fibers, that suppose to contract in harmony with their adjacent fibers, contract within themselves. This causes "internal contraction" points that stay contracted within the muscle and cause over tension in the rest of the fibre. The trigger point disables the function of that specific fibre but ultimately causes a reduce in function and stretch ability of the entire muscle, which cause limitation in range of motion and general muscle function.

The trigger point is usually a cluster of a few small trigger points. This point is tense and tender when touched and often radiates pain to areas far from it anatomically and sometimes cause sympathetic symptoms such as sweating, increased heart rate etc.

the way to release the trigger point can be done by massage and other manual techniques but sometimes DDN is the only way to release it.

In DDN the needling is being done with acupuncture needles at lengths of 15mm-100mm (depending of course on the depth of the tissue from the skin surface). The needling is causing a small bleeding in the affected point which immediately allows for blood and O2 flow to the area, thus releasing the trigger point. The patient feels a small "twitch" or "jump" in the muscle and the function improves instantly. Never the less, the needling area might feel sore for 1-2 days after.

Important patient information:

  1. It is absolutely necessary to receive the patient's consent to the treatment and if it is a minor, a consent must be given from the minor and from his parents.
  2. It is necessary to avoid this treatment if you suffer from hyper anxiety, phobia or fear of needles, allergy to metal such as medical steel, infection, fever, cardiac problems, lymphatic edema or if you are pregnant (in areas of the lower back especially in the 1st 3 months of pregnancy). You have to inform your physiotherapist if you have any of these conditions.
  3. It is advised to eat something before therapy to elevate the blood sugar level. Don't come to treatment on an empty stomach (but this is not a definite necessity or contra-indication).
  4. Patients sometimes feel nausea or dizziness during needling, especially in tired or tensed patients. This is not a cause for alarm or worry but does require the patient to notify the physiotherapist that stop the treatment then and perform a few steps to stop this feeling.
  5. It is necessary for the patient to know that certain areas around the chest or upper torso have a risk of developing a pneumothorax in which the chest wall and pleura is being penetrated and a part of the lung collapses due to accumulation of air outside the lung (even though it is a rare complication of course if the physiotherapist knows his anatomy and is experienced in this kind of technique). Never the less, the patient must be aware of symptoms such as shortness of breath, fatigue and chest pressure and pain while breathing, falling blood pressure, dry cough, bluish skin. If so, you must rush to the hospital and ask for a CXR and check oxygen saturation levels. This information is stated here out of professional responsibility, ethics and concern for the patient's health. This information must be given to the patient by the therapist when performing this technique under law.
  6. A day or 2 after the needling, the needled area might feel a bit sore or over worked. It is important that you do not carry our strenuous workout or activity in this area for 24 hours.
  7. The physiotherapist performing this technique must hold a certificate issued by the israeli ministry of health and certified to perform this technique by the IPTS (Israeli physiotherapy society)

I bet many of you now feel alarmed and scared but just remember it is a well known, researched and highly practiced technique for many years now in physiotherapy and in orthopedics. Many athletes actually like this technique because it has very effective results and it is a good treatment tool. None the less, it is not a "quick fix" technique but just another tool. The entire physiotherapy treatment ensures that these trigger points will not come back and to a greater part, the exercise plan you receive from your therapist.