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Treatment of the Future

Therapy-based treatment shows dry needling technique can relieve some soft-tissue dysfunction.

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Dry needling technique is a fairly new treatment for many physical therapists, but has been in existence for some time. Recently this treatment has been featured at state physical therapy meetings and is gaining exposure, especially in the field of professional athletes. 

Dry needling is also referred to as the following: ISDM (integrative systemic dry needling), IMT (intramuscular therapy), and TDN (trigger point needle therapy). DNT is a non-specific physiological therapy used to treat soft tissue dysfunction. The proposed mechanism of dry needling is by causing tiny micro-lesions in the soft tissue which causes the peripheral sensory nerves to be stimulated. The PNS signals the CNS to restore the normal physiology of the bodily system and microenvironment, resulting in an anti-inflammatory immune system reaction and self-healing. 

"Wet needling" uses a needle to provide an injection, such as a steroid. This requires a larger gauge needle. DNT uses an extremely narrow fine gauged needle. Some physicians began to suspect that it was the needling itself that caused the healing process, regardless of the injection substance. 

Soft-tissue dysfunction can include inflammation, contracture of soft tissue (which may develop into a trigger point), edema, trophic deficiencies, adhesions, scarring and biomechanical imbalances. DNT can cease the progression of these soft tissue dysfunctions and speed the healing rate. There is a cellular change noted via microscope with an increase in mitochondrial production and a change in the calcium concentration in the cell after the use of DNT.

How It Is Effective

The use of DNT is an external stimulus of the acupuncture needle to create an internal change in the body. The micro-lesions of the acupuncture needle causes the skeletal muscle to relax by stimulating the spinal cord and brain to secrete neurobiochemicals such as endorphins (similar to a TENS unit.) This changes the awareness of sensation by stimulating the end branch of the nerve to send signals to the brain, thus relaxing the muscle in spasm. Once the muscles are relaxed and circulation is improved, the likelihood of a muscle spasm progressing into a trigger point is tremendously decreased. 

Nerves, muscles and connective tissue may all be affected by the use of DNT to accelerate the healing rate. The connective tissue may include tendons, ligaments, joint capsule and fascia. This may be a very exciting way to improve the healing of multidirectional shoulder instability, speed the healing of an ankle sprain and partial ligamentous tears. The needling may be used to specifically target the deformed connective fibers and stretched muscles, thus causing improved circulation and promote accelerated soft tissue healing.

Although many patients may benefit from DNT, only 28 percent are thought to be "excellent" responders to it. This means that they will have significant pain relief and rapid return to function quickly, with a minimal number of visits. Sixty-four percent are felt to be good or average responders, therefore this treatment may be used in conjunction with other PT treatments. Eight percent are non-responders to DNT or have adverse effects to DNT and they are not good candidates for this treatment.

The benefits of DNT may include that it may be performed on cancer patients with no contraindications.  The needles are fairly inexpensive and the technique is relatively easy to learn for PT's because they already have an extensive knowledge of the body and anatomy. It can be very effective for certain patients and large areas may be treated at the same time with no mal effects.  It can be considered an alternative modality for those patients who have not responded well to other treatments. 

Some Side Effects

The side effects can include soreness, bruising, syncope, nausea or worsening of a condition. A pneumothorax can be the most dangerous side effect, therefore only a .5 inch needle may be safely used where a rib is palpated. A 1" needle may be used on the thoracic paraspinals and upper trapezius, but carefully. All treatment must be mindfully thought out for each patient and care must be taken with the use of Coumadin and patients with enlarged organs. People with a "fear of needles" are generally poor candidates for DNT, as their anxiety negates the positive effect of DNT.

DNT in the use of professional athletes is a fairly new therapy. The thought is that DNT can be considered a performance enhancing treatment because it decreases the scarring of the tissue. The scarring of the muscle tissue is the career ending factor for most professional athletes, it causes them to lose their speed of the contractile tissue and become prone to injury. DNT is felt to prevent injury due to the muscles maintaining their normal length-tension. The needling also decreases DOMs (delayed onset muscle soreness), reduces the tension of the muscle, decreases the muscle spasms and decreases the effect of overtraining. All of these factors show what a huge influence DNT can make in the realm of professional sports, as this population has so much to gain from this treatment.

It is difficult to prove or disprove why DNT is helpful when performing case studies, but on a scientific level this treatment has shown to increase healing rate. Research has shown significant changes which occur on a molecular and cellular level. Each patient will have their own response to treatment, but the benefit of having another exceptional modality that increases healing rate and decreases pain is well worth learning. This is a relatively new, exciting treatment which can be easily learned, benefit your PT practice and improve patient outcomes.

References

Federation of State Board of Physical Therapy, Intramuscular Manual Therapy (Dry Needling).  Resource Paper.

Kalichman, L., & Vulfsons, S. (2010). Dry Needling in the Management of Musculoskeletal Pain. The Journal of the American Board of Family Medicine, 23(5), 640-646.

Ma, Y., et al. (2005). Biomedical Acupuncture for Pain Management.  Elsevier Churchill Livingstone, MO.

Ma, Y. (2011). Biomedical Acupuncture for Sports and Trauma Rehabilitation.  2011: Elsevier Churchill Livingstone, MO.

Melissa Felder is a staff physical therapist at Flagstaff Medical Center, Flagstaff, AZ.

 


 

I am interested to learn more about this. does anyone knows where to get the training? -Wilna,PT

Wilna  Cubelo March 20, 2013
CARLSBAD , NM




     

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