356 | What is Dry Needling? When is it Beneficial?

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom, and we are Doctors of Physical Therapy bringing you the body tips and physical

[00:00:13] therapy pearls of wisdom to help you begin to understand your body, relieve your pains

[00:00:17] and restrictions, and answer your questions. Along with expert guests, our goal of the

[00:00:21] Optimal Body Podcast is really to help you discover what optimal means within your

[00:00:26] own body. Let's dive in!

[00:00:29] Before we hop into the pearl, I just need to talk about one of Jen and my favorite

[00:00:32] topics, which is foot health and how important it is to start from that foundation to really

[00:00:37] build up your movement health and how beneficial it can be to use barefoot shoes. And that's

[00:00:43] why Jen and I have worn vivo barefoot shoes almost exclusively for the last four to five

[00:00:48] years now. They have shoes for every type of occasion. And something super exciting

[00:00:53] for me is one of their new shoes has actually cracked into my top favorite vivos to wear.

[00:00:58] It's the Vivo Census. It literally feels like you're wearing nothing. It is a barefoot shoe

[00:01:03] that is true to form and allows my foot to move and grow how it's supposed to. Their

[00:01:09] shoes are wide, thin and flexible so they allow the toes to move and naturally build

[00:01:13] in that mobility. And just by wearing them throughout the day your feet will gain strength

[00:01:18] through the arch, through the toes. Again, building our foundation and our movement

[00:01:23] from the ground up. So if you go down to the link in the show notes, whether

[00:01:27] you're adding in a new shoe, I would recommend taking a look at that census or getting your

[00:01:31] first pair. Some of our absolute favorites are the Primus light knit and the Primus Asana

[00:01:36] just because they're so darn comfortable and you can use them for just about everything.

[00:01:41] Grab the link in the show notes. Make sure you use code TOB at checkout to get 15%

[00:01:46] off your entire order. All right, let's hop into the PD Pearl.

[00:01:49] Quick update before you go. There has been a code update. So you can actually

[00:01:55] get 20% off only now through July 1st. So you've got to get on this now. 20% off any

[00:02:03] Vivo Barefoot shoes that are not already discounted using code TOB20. So get on it.

[00:02:10] We're talking about dry needling today. Now, this is a pretty hot topic, especially if

[00:02:15] you have been to a physical or physiotherapist that does dry needling. What is it really

[00:02:20] doing? What did the study say? When is it appropriate? Is everything that we want

[00:02:24] to cover so that you're well informed and understand what you can ask for when it's most

[00:02:29] beneficial within your body? Yeah. And just get down to it because we have done another

[00:02:33] podcast with one of my good friends, Dr. Alex Anderson, who kind of touched on this a little

[00:02:39] bit in her episode. What episode was that again? That was episode 171.

[00:02:43] 171. And that's a great episode just on pain neuroscience in general. She does

[00:02:48] a little talk about dry needling as well and where that can be beneficial. But we

[00:02:53] wanted to look a little bit into the research. What is dry needling claiming to

[00:02:58] do? How effective is it in what scenarios might it be beneficial? And we do this

[00:03:03] about a lot of these, what we call manual therapies. I mean, essentially this is

[00:03:07] in the umbrella or under the umbrella of manual therapies because it's something

[00:03:12] someone is doing to you so that we can hopefully see a physiologic change in

[00:03:17] the body and in the way that you're feeling. And pain reduction. I think

[00:03:20] a lot of people go because it's like, Oh, I have this scar tissue or this, you know,

[00:03:26] trigger point and I'm going to go and get this done to help me. So is it really?

[00:03:31] You know, let's let's understand it.

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[00:04:58] And that's something that dry needling again, like claims to be

[00:05:02] attacking is these trigger points because it's such a specific area.

[00:05:08] And another thing we see overlap in is, you know, with the acupuncture

[00:05:12] community and the art of acupuncture in general, it looks similar, you know,

[00:05:17] using needles, putting needles into the body in order to feel something

[00:05:21] different. I think that there's just like a theoretical difference

[00:05:27] in what they're saying is happening or, you know, what they're

[00:05:30] purporting is happening in the body. What are the intention behind it?

[00:05:34] The intention behind it, what acupuncture is aiming to address

[00:05:38] versus dry needling being much more specific to actually trying to address

[00:05:43] the trigger point areas or the exact pain points.

[00:05:46] Right, right. Rather than the meridians and flow of energy that is

[00:05:52] the practice of acupuncture, which I know very little or nothing about.

[00:05:55] So we're not going to talk about acupuncture. We're just going to

[00:05:58] stick to dry needling on this one. But essentially it's the insertion

[00:06:01] of these thin monofilaments into typically muscles, ligaments, tendons,

[00:06:07] subcutaneous fascia and scar tissue without the use of injectables.

[00:06:12] However, the needles can be, you know, inserted near peripheral nerves

[00:06:18] and or neurovascular bundles to manage various neuromuscular pain

[00:06:23] syndromes as well. However, it's primarily found in intramuscular

[00:06:27] procedures targeting myofascial trigger points.

[00:06:30] And that's typically what you're going to go and see and be reported

[00:06:35] that what is happening is kind of getting to the trigger point,

[00:06:39] something that feels taut within the muscle.

[00:06:41] And I think even when we say trigger point, people kind of understand

[00:06:44] what we're talking about. It's that not or that knob that you feel that

[00:06:49] you just want to rub out.

[00:06:50] Yeah, that tight band, that tight bundle of muscles.

[00:06:53] And when we look at muscle physiology, this is a thing that

[00:06:59] we talk about the muscle spindle and essentially what the muscle spindle

[00:07:02] is, it's something within our muscle that regulates kind of the

[00:07:06] length of the muscle and it senses changes in the length of the muscle.

[00:07:10] And so when these muscle spindles become overactive,

[00:07:14] they might just be holding really tight on a certain section of muscle

[00:07:18] fibers. And that is what we think is causing these really tight bands of muscle.

[00:07:25] Yeah. I mean, I look at it more of like a theory of, you know,

[00:07:29] trigger points and the physiology of what's really happening behind

[00:07:32] that tautness and what is also interesting when we look at the research.

[00:07:36] This is very similar to like when we look at research where we're looking at

[00:07:40] trying to measure.

[00:07:41] Yeah, trying to measure between physical therapists.

[00:07:44] So the reliability from therapist to therapist in kind of finding these

[00:07:49] exact trigger points on people and are they the exact location each

[00:07:54] in every time? Or are we kind of finding differences?

[00:07:57] And it's the same kind of idea of when we're measuring the pelvis

[00:08:01] alignment and like where we're kind of finding, you know, rotations or differences

[00:08:07] or even anterior versus neutral and all these differences.

[00:08:10] We have a low reliability therapist to therapist.

[00:08:14] So you could be going to one therapist saying, Oh, here's your trigger point spot

[00:08:18] where another one is going to find it somewhere else.

[00:08:20] So that's where for me, it lacks a little bit of the

[00:08:25] reliability and, you know,

[00:08:28] concrete evidence to be able to say, OK, we're looking at trigger points alone

[00:08:33] and this is what's really going to help.

[00:08:35] However, you know, we're going to get into it more of like how this can help

[00:08:39] along the pain journey and when it's appropriate.

[00:08:41] Yeah, there was different studies that we saw one done by Lucas and his

[00:08:45] colleagues and one done by Lou and his colleagues.

[00:08:48] I'm just read what it says here.

[00:08:51] Lou at all highlighted the absence of an accepted reference standard

[00:08:55] for trigger point diagnosis with conflicting data on the reliability

[00:08:59] of physical examination for trigger points.

[00:09:02] Lou at all reported low inter examiner agreement,

[00:09:06] 21 percent while Scotty at all noted significant error rates among

[00:09:13] examiners attempting to identify specific trigger point locations.

[00:09:17] So just what Jen said, you go to one therapist and they say,

[00:09:21] here's your trigger point.

[00:09:22] You go to another therapist to say, here's your trigger point.

[00:09:24] Even if it's an inch apart, that's thousands potentially of muscle fibers,

[00:09:30] you know, away from where the other therapist is saying your trigger point

[00:09:34] is so very low reliability on if we're actually hitting the same spot every time.

[00:09:38] And if we're actually identifying that first study says there's a low

[00:09:42] agreement on what qualifies as a trigger point, what is a trigger point?

[00:09:47] So again, every time you go to physical therapists,

[00:09:50] are they hitting the exact same spot?

[00:09:52] Are they hitting the exact same muscle fiber or muscle fiber bundle that,

[00:09:58] you know, is tight and is that quote unquote trigger point?

[00:10:02] Maybe maybe not.

[00:10:03] Yeah.

[00:10:04] I think take that with, you know, the grain of salt.

[00:10:07] It doesn't have to be perfect and that's okay.

[00:10:09] You know, we're still going to see benefits that we're going to kind

[00:10:12] of talk about when that's appropriate again.

[00:10:15] But you know, we're more so attacking the theory behind

[00:10:18] what people might be saying they're doing.

[00:10:20] Yes.

[00:10:20] You know, like, oh, I'm going to get this exact trigger point.

[00:10:23] Well, are you, does that mean it's going to feel any different?

[00:10:26] Or does that mean it's not going to feel good?

[00:10:27] No, you know, like it's still very well might feel beneficial,

[00:10:32] but are they doing exactly what they're saying?

[00:10:34] I think that's what we're trying to outline.

[00:10:35] Yeah.

[00:10:36] And we can see that, like, you know, we looked at another study

[00:10:39] looking at organizations teaching physical therapists, you know,

[00:10:43] to look for a trigger point to search and destroy

[00:10:46] and kind of use that method of dry kneedling is really not evidence

[00:10:49] based. So if we're just, you know, really using dry

[00:10:52] kneedling because I'm going to hit every trigger point and I'm

[00:10:55] going to help you and this is what it's going to do.

[00:10:58] Like that's actually not evidence based physical therapy.

[00:11:02] Physical therapy should be a little bit more targeted based

[00:11:05] on your pain experience and your current symptoms, not just

[00:11:08] we're going to randomly go through your body and look for

[00:11:10] any trigger points and say this is related to your pain.

[00:11:14] It has to be specific to what you are experiencing always.

[00:11:18] It's individual.

[00:11:20] And I think that's what's really important to point out as well.

[00:11:23] And when it comes to trigger points, whatever they are and

[00:11:27] wherever they are, essentially the thing that's important to us

[00:11:30] is pain, like we're in pain. That's real, you know, like,

[00:11:34] like we're not trying to discount that there's pain in the area.

[00:11:37] And when we have consistent pain or feeling of tightness in an area,

[00:11:41] it does a lot to us physiologically and neurologically

[00:11:45] in a way that the more we feel pain in an area and the more

[00:11:49] consistently it is, we start to have sensitization in that area.

[00:11:53] So that means that our body is more susceptible to feeling

[00:11:56] more pain in the area. We start to have altered muscle

[00:11:59] contractions and also like altered coordination of the

[00:12:04] muscles in the area. So the pain itself can be very

[00:12:08] detrimental to the operations in that area, to the

[00:12:11] functionality of where we're experiencing that.

[00:12:15] And so essentially what we're doing with dry needling is very

[00:12:18] similar effects of what we see in a lot of different types of

[00:12:22] manual therapy that involve touch and pressure to the system.

[00:12:26] We're stimulating particular nerves or tissues by needles,

[00:12:30] in this case, which can increase the input of the central

[00:12:32] biasing mechanism. And this kind of closes the gate on the

[00:12:36] pain inputs from selected body areas. So we're essentially

[00:12:40] trying to, you know, talk to our central nervous system,

[00:12:44] talk to our brain to mitigate some of those influences of

[00:12:48] pain that's really coming and decrease that pain threshold

[00:12:52] leading to that muscle or that particular area of the body.

[00:12:55] And so it's again, where it becomes very similar to someone

[00:13:01] using a massage gun in the same area, using a grassden type

[00:13:05] scraping method in the same area, using deep tissue

[00:13:09] massage in the same area trigger point massage. You know, a

[00:13:14] lot of these become start to become very familiar even

[00:13:18] though the idea behind dry needling is that I'm going to put it

[00:13:23] into this tight band and as I take it out or if I put some

[00:13:27] stimulation on it, it's going to help to release that

[00:13:30] tension. But the same thing can be said in general with

[00:13:35] touch. And I think that's an important thing to remember.

[00:13:37] And that's the thing that I mean, that's the benefit that Jen

[00:13:40] just outlined is that we do see people have pain reduction. We

[00:13:45] do see people feel that they have more freedom and more

[00:13:49] accessibility to that area. And just like Jen said, we're just

[00:13:53] talking to the nervous system, and we're hoping that we get a

[00:13:56] positive result or a positive adaptation in our body's ability

[00:14:01] to feel a reduced amount of pain in the area, feel like

[00:14:04] we have more mobility. But what a lot of the studies show is

[00:14:08] that in one dry needling session, those benefits might only

[00:14:12] last between 24 and 72 hours. And that is similar to the

[00:14:17] research we see in a lot of other the modalities that Jen

[00:14:19] just outlined, you know, these passive manual type therapies,

[00:14:24] we tend to see benefit for 24 to 72 hours. So how do we get

[00:14:30] that to last longer? How do we get to have long term

[00:14:33] change? It tends to and we say this at Nazim and all our other

[00:14:38] podcasts too, it tends to require including some sort of active

[00:14:42] therapy or exercise therapy.

[00:14:44] Exactly. And the other important thing to know in order to

[00:14:48] kind of get this positive effect, because I've known

[00:14:50] plenty of patients who have gotten dry needling in the

[00:14:53] past and it didn't work for them, right? It wasn't the

[00:14:56] thing that was the magic fix as they were told. And one

[00:15:00] thing that's very beneficial in a 2005 study, they looked at

[00:15:03] the expectations and beliefs around dry. And this is where

[00:15:08] studies have shown that the expectancy level significantly

[00:15:12] influences acupuncture anesthesia or dry needling

[00:15:15] with patients optimism and anxiety playing a role. So this is

[00:15:21] huge, right? If I feel really nervous about the dry needles

[00:15:25] and I'm very hesitant whether this needling is really going

[00:15:29] to be beneficial, it probably won't. But if I am going in

[00:15:33] because I've been told from a friend or family member or the

[00:15:36] physical therapist that this is what's gonna really help this

[00:15:40] is going to release your muscle tension. This is going to

[00:15:42] get us moving again. As long as you're combining that with

[00:15:45] exercise and education, it's probably going to be the thing

[00:15:48] that's going to help because you believe in it so much. So

[00:15:50] belief and what you expect to happen plays a huge role in

[00:15:56] the actual what you're feeling.

[00:15:58] Which is kind of tough for me because I feel like that's the

[00:16:02] reason physical therapists grab on to Oh, tight band of muscle

[00:16:07] stick the needle in release the type and a muscle that's easy

[00:16:10] for people to understand. That's that's like easy. Oh yeah,

[00:16:14] stick the muscle stick the needle in it and the muscle

[00:16:16] is going to release like I get where that messaging can be

[00:16:19] effective and it can get people to buy in and say like, oh,

[00:16:22] that's what's happening. This is gonna work. And it gets

[00:16:25] people on that positive mindset. Not too dissimilar to when we

[00:16:28] talk about manipulations and adjustments, it's gonna put you

[00:16:31] back in a place gonna put you back into place and when people

[00:16:33] believe that and you go in and you get the crack in the pop

[00:16:36] and then it feels great and you're like, oh man, it worked.

[00:16:40] Do that's where sometimes I don't want to say I feel bad

[00:16:43] about giving the education because we want people to

[00:16:45] understand exact like actually what it's doing. But are we

[00:16:49] breaking those beliefs down that will help people help it

[00:16:53] be effective for them because they go in optimistic or should

[00:16:57] we want you to be optimistic for a different reason? Like, yes,

[00:17:01] this still can work. Even though it might not be releasing the

[00:17:05] type and a muscle like,

[00:17:06] Yeah, like you think it is like people are telling you it is

[00:17:08] like, it still can work and it still can be effective part

[00:17:12] of the treatment.

[00:17:13] And we want you to understand why we want to understand

[00:17:15] that this isn't a magical fix. Unfortunately, a lot of things

[00:17:18] that we do on you is not a magical fix. You are your

[00:17:22] magical fix like what you do with an own body and how you're

[00:17:25] guided and educated from a clinician is going to be the most

[00:17:29] beneficial thing. And your magic pill, your magic fix rather

[00:17:33] than what we're doing on you, what we're doing on you is just

[00:17:37] assisting in the symptoms of pain so that we can get you

[00:17:41] along that journey of movement and your own magical fix

[00:17:45] even more. And I hope that is, you know, the message

[00:17:48] like because when you go and get that manipulation, you

[00:17:51] rely on that to put you back into place. What are you going

[00:17:53] to rely on every single time? Yeah, that right? And episode 90,

[00:17:57] if you want to understand a little bit more on adjustment

[00:18:00] and manipulation, we talk about that a lot. Or that is the

[00:18:03] whole episode. But I think understanding, you know, okay,

[00:18:07] how can this when can this play a role? Is it really

[00:18:10] needed? I think you get to decide that too. If you feel

[00:18:14] like you're moving well in your body and you can just

[00:18:16] rely on exercise to help you feel something different than

[00:18:19] I think that you don't have to have the dry needling though.

[00:18:23] But if it is beneficial, then great.

[00:18:25] Jen's looking at me like, don't say that. Don't feel bad if

[00:18:28] we're educating people, put the power back in the people's

[00:18:31] hands. Yeah, but that's actually what we want to do. And

[00:18:35] you know, be optimistic, if you're going to go get dry

[00:18:37] needling, be optimistic about it. It will change. It

[00:18:40] will make change for you. So just looking at some studies,

[00:18:43] you know, there are a decent amount of like meta analysis

[00:18:46] and like high quality research studies. There was one from

[00:18:50] 2021 that showed there is a large treatment effect within 72

[00:18:54] hours after the treatment. That's kind of what I just said.

[00:18:56] However, there were no significant differences

[00:18:58] found between dry needling and other therapies like

[00:19:01] kinesiotaping or manual therapy in chronic neck pain.

[00:19:05] Also what we've kind of already said that we will see

[00:19:08] similar changes in many manual therapies when it comes to

[00:19:12] pain or functionality. A single session of dry needling was

[00:19:16] effective in reducing neck pain due to decreased muscle

[00:19:19] fatigability and or increased motor activation in the area.

[00:19:25] Okay, that's that.

[00:19:28] Well, when we touch something, when we stimulate

[00:19:31] something, we're helping the brain kind of better map

[00:19:33] where that is. And these are just kind of points that

[00:19:35] we had highlighted from these studies that support a lot of

[00:19:38] what we've already said.

[00:19:40] Exactly. Overall, I think what we can look at from that

[00:19:43] main study is that we can see that dry needling can be a

[00:19:46] cost effective way of like kind of aiding into a physical

[00:19:49] therapy treatment plan, especially if we're talking

[00:19:52] about reducing pain, right? You're not going and you're

[00:19:54] not getting drugs, you're you're able to move, you're

[00:19:56] working with a physical therapist. It's it's a great

[00:19:59] tool to be able to utilize. However, when we're looking

[00:20:02] overall at the evidence, like it's just lower quality

[00:20:05] evidence. So we can see that it's more effective than

[00:20:08] you know, a sham dry needling session or just exercise

[00:20:12] alone sometimes. But still, it's not the great quality

[00:20:18] of evidence that we want to see to really say that

[00:20:20] definitively and prove that so take that for what it is

[00:20:25] you know, just meaning to say again, this can be

[00:20:28] something that you include, it doesn't have to be

[00:20:31] the only way.

[00:20:32] Yeah, this 2020 study, again, to kind of outline a

[00:20:36] point that we've brought up already, the addition of

[00:20:39] trigger point dry needling to an evidence based

[00:20:42] therapeutic exercise program is more effective at

[00:20:45] achieving long term functional disability reduction

[00:20:48] compared to exercise alone. And that's something we

[00:20:52] see in a lot of the other passive or manual

[00:20:55] therapies that having the manual therapy plus

[00:20:58] exercise might show faster or quicker or better

[00:21:02] results long term than just exercise alone. And

[00:21:05] that's something that we support. If you're using

[00:21:07] that therapy to get the pain reduction, to get the

[00:21:10] improved range of motion or mobility so that you can

[00:21:13] exercise easier and get better faster, quicker,

[00:21:17] you know, great.

[00:21:18] Now something I thought was interesting from this

[00:21:20] 2017 study we kind of looked at. And in short,

[00:21:24] they're kind of showing how dry needling, you

[00:21:27] know, in short term and after a week after

[00:21:29] three weeks, it's seeing more benefit, you know,

[00:21:32] with exercise than just exercise alone. However,

[00:21:35] but they also pointed out which I thought was

[00:21:37] really crucial here is that the dry needling group

[00:21:42] is receiving the who's receiving the additional

[00:21:45] procedure also spent more time with the physical

[00:21:48] therapist as a result of getting this extra

[00:21:52] treatment. So you're not just working with a

[00:21:54] physical therapist or an aide who's doing, you

[00:21:57] know, exercise with you, but you're also

[00:21:59] working and spending a little bit more time with

[00:22:01] the physical therapist, which that alone can be

[00:22:04] more beneficial because you're talking about

[00:22:06] what's happening. I've had patients cry on the

[00:22:08] table when we spend more time together. You

[00:22:10] know, we're getting emotionally to understand

[00:22:13] deeper the whole bio cycle social model of

[00:22:16] what's happening with your pain, what's

[00:22:18] happening within your life that could be

[00:22:19] contributing to this pain. Is it the dry

[00:22:22] needling alone? That's really helping or is

[00:22:25] it the fact that you're spending a little

[00:22:26] bit more time with a physical therapist

[00:22:28] able to talk through things that are

[00:22:30] happening, getting more of that socialization,

[00:22:32] that connection, which also helps to reduce

[00:22:35] pain symptoms. So I think that's a really

[00:22:38] cool point to bring up and why even though

[00:22:41] Dom and I will talk about, you know, all of

[00:22:43] these manual therapies and say, you know, are

[00:22:46] they as effective? Who knows? However, we

[00:22:48] still do them. We still use it with our

[00:22:50] patients because we do believe that this

[00:22:51] connection, this understanding, this touch,

[00:22:53] this talk is 100% a part of therapy and

[00:22:58] understanding where your pain is really

[00:22:59] coming from. So I love that this study

[00:23:02] kind of like pointed that out as well.

[00:23:03] I mean, just getting extra 20, 30 minutes

[00:23:05] with somebody who's going to be able to

[00:23:07] talk to you, maybe give you some extra

[00:23:09] education and again, like in the methods

[00:23:11] of the study, I don't know if the

[00:23:12] therapist just like sat there put the

[00:23:14] needles in and was quiet or

[00:23:16] But you had to spend more time with

[00:23:17] someone who's a professional.

[00:23:19] You're talking, they're educating you a

[00:23:20] little bit more so the amount of

[00:23:22] benefit that can come from that is

[00:23:23] something that we can't really measure

[00:23:25] and we can't really take into account

[00:23:27] or take control as a variable per se.

[00:23:31] So I don't really know what more we can

[00:23:34] say about dry needling in general that

[00:23:37] is it actually attacking these top

[00:23:39] bands and muscle trigger points?

[00:23:42] The research isn't super solid on that.

[00:23:45] Is it reducing pain and potentially

[00:23:47] making us feel better in the short term?

[00:23:49] Yeah. Yeah, you know, we definitely

[00:23:51] are seeing that, especially if you go

[00:23:53] in positive. So if you go into have

[00:23:55] dry needling believe it's going to change

[00:23:56] you. If it's done with exercise, is it

[00:24:00] a lot more effective than when it's

[00:24:01] when you're just getting the dry

[00:24:03] needling? Yes, absolutely.

[00:24:05] And that's what our main message is

[00:24:07] pairing a passive modality like dry

[00:24:10] needling with exercise and a research

[00:24:13] based therapeutic program is going

[00:24:15] to be the thing that's more effective

[00:24:17] than just doing dry needling alone

[00:24:19] or just doing exercise.

[00:24:21] So I think that's a good idea.

[00:24:23] Thanks so much for tuning into another

[00:24:24] PT Pearl. Have you had dry needling done?

[00:24:26] Do you know of somebody who's been doing

[00:24:28] it or considering it?

[00:24:30] If so, please pass this podcast along to

[00:24:31] them. That is the best way for the word

[00:24:33] to continue to get out if you haven't

[00:24:35] consider leaving a rating and review

[00:24:37] on your favorite podcasting platform.

[00:24:39] And of course we will see you next time

[00:24:41] on the optimal body podcast.