Dry Needling: All of your questions ANSWERED!

There must not be many “dry needlers” in Frederick, MD…

because I’m CONSTANTLY having to explain what it is to people.  I am answering questions in the morning over email, over lunch when I have lunch meetings, at night over FB messenger while I’m FaceBook stalk…err… doing “social research” over FaceBook, and each time a patient walks into my room and sees my packages of needles.  This initial question of “what is dry needling” is classically followed by a host of other, very predictable questions, all of which I am more than happy and excited to answer.  To save myself from forgetting to explain something, and to better serve my Frederick community and patients, I have compiled a list of questions about dry needling and answered them.  Now the answers about dry needling are all in one place, and hopefully many many people read and share this article, so that many people can be helped by dry needling!

If you have any additional questions you’d like answered, I’d be more than happy to add them to the list and answer them (please leave your question in the comments below)!

What is dry needling?

Dry needling involves taking a very thin needle and inserting it into the skin and muscles.  Often, the needle is inserted into something called a “trigger point,” which is a painful nodule/”knot” in the muscle.  Sometimes though, the needle is inserted into a tender point on the skin, where no known muscle “knots” are found.  The needles used are traditionally acupuncture needles.

There are many techniques available for dry needling.   Some therapists will repeatedly “pepper” a muscle with a single needle, making many tiny perforations in the muscle.  The needle is left in the skin while this happens, so though the needle punctures the muscle many times, it only enters the skin once.  Other therapists will find the most tender spot in the muscle and will only puncture the skin and muscle once.  With this technique, the needle is left in the skin (anywhere from a few minutes to an hour sometimes) and is occasionally twisted during the time the needle is in.  This is the method I use most often.

Why is it called “dry” needling?

What makes the needles dry is the fact that there is no liquid or solution being injected into the skin.  Some doctors can treat trigger points with an injection of a local anesthetic (lidocain), saline, and/or a corticosteroid, which would effectively make this “wet needling.”

How does dry needling work?

Inserting a needle into dysfunctional tissue (like a trigger point) has many effects. The needle causes microtrauma to the area, which is a signal to the body to heal the area by doing the following:

• increasing blood flow to the area
• increasing in white blood cells and regenerative cells (growth factors) to the area
• decreasing in muscle tension

How is dry needling different from acupuncture?

Dry needling uses the same needles as used in acupuncture, but the needles are placed in different areas.  Dry needling places the needles directly into dysfunctional tissue (aka “knots” or “trigger points”), while acupuncture needles are placed in “meridians.”  If you have neck pain, the doctor will put the dry needles in the painful muscles, while the acupuncturist will put the needles in many locations, like your feet, back, arms etc.  The needles during an acupuncture session may not ever be placed in the painful area (the neck in our example).

Are there any side effects of dry needling?

Yes, there is a small chance of side effects, and they are all minor.  A study in 2014 found that only 19% of patients experienced mild side effects, which also means 81% of people had no side effects at all.    Of the 19%:

• 7.5% had bruising
• 4.65% had bleeding
• 3% had pain during treatment
• 2% had pain after treatment
• less than 1% experienced: aggravation of symptoms, drowsiness, headache, or nausea.

http://www.ncbi.nlm.nih.gov/pubmed/25125935

Clinically, I’ve noticed that the most significant side effect is soreness, which is usually experienced the day after needling.  If you are needled on a Monday, I tell patients to expect that Tuesday might be a sore day.  By Wednesday, usually everything feels great.  Though some people experience this, other people don’t experience soreness at all!

How long does dry needling take?

When I dry needle in my office, it usually takes about 5 minutes to get all of the needles in (I usually use between 3-8).  Once they’re in, I keep them in for ten minutes.  Some people keep the needles in much longer (like an hour), but I find the needles don’t need to be in that long in order to be successful.  Plus it’s kind of inconvenient to be laying around for an hour during the day!

How many dry needling treatments will I need?

The total number of treatments and frequency (how many times per week) vary for each person.  Keeping that in mind, most patients respond very well to needling twice per week, for 3 weeks, or once per week for 6 weeks.

Do I need to do anything before or after dry needling?

There is not much you need to do before dry needling.  If you have clothing that allows us access to the area to be needled (ie. a tank top for neck and shoulder needling), you may wear that.  Otherwise, we can provide you with a gown to wear.

After needling, it is VERY IMPORTANT to keep two things in mind:

1.  Make sure you drink plenty of water.  Just like when you get a massage, it is important to hydrate properly after dry needling.  This helps to flush the toxins released from dry needling, and provides the muscles with good blood flow and nutrients to heal itself.

2. Do NOT ice or take any anti-inflammatories/pain medications.  The whole purpose of dry needling is to cause microtrauma to the area, and to bring healing cells (inflammation) to help heal the dysfunctional muscle.  Taking anti-inflammatories and icing will likely slow down (or stop) this healing process, which is the complete opposite of what we want to do.