In this series of articles on alternative management of injuries, so far we have looked at the science behind steroid injections and platelet-rich plasma (PRP).
For each of these, there is some evidence to suggest benefits in specific cases, but not for the majority of the ailments for which they are advertised.
None of the treatments that I have looked at thus far have been specifically targeted towards alleviating muscle soreness or pain.
What Is Dry Needling?
Dry needling is a popular modality among physiotherapists and triathletes alike. Not to be confused with acupuncture where a practitioner places needles remote from an injury and aims to manipulate Chi, dry needling has the insertion of needles directly into the affected area.
When a physiotherapist uses dry needling, myofascial trigger points are directly stimulated with the needle. These trigger points are believed to arise as a consequence of overuse or injury. They are hyper-irritable bands of muscle that spontaneously produce pain — and when stimulated — reproduce the pain of injury.
The actual mechanism by which dry needling is postulated to exert its effects remains unclear. The current working theory is that by stimulating these trigger points there are both local and central responses within the nervous system that result in a reduction in sensitization to and the perception of pain.
Additional theoretical mechanisms include ascending and descending reflexes in the spinal cord that are activated when the needle is manipulated that results in local changes in muscle tone, less pain and improved range of motion.
Does Dry Needling Actually Work?
While physiotherapists are often very keen to use dry needling in their practice, the research on this modality has never produced results worthy of the kind of enthusiasm that it often generates in this group of professionals.
In study after study, low-quality evidence suggests that dry needling is better than sham needling or placebo for decreasing pain in certain kinds of musculoskeletal injuries.
But in no case has dry needling ever shown improvements in functional recovery of shoulder pain, back pain or neck pain.
“Dry needling is really controversial,” said Dr. Daniel Cushman, associate professor of physical medicine & rehabilitation at the University of Utah in Salt Lake City. “Some people swear by it, some others think it’s rubbish. My opinion of it is that it has its place but it is certainly not a cure all.”
Unexpected Results of Dry Needling Effectiveness Among Runners
Recently, Cushman led a team who evaluated dry needling for the reduction of post-race soreness and muscle cramps in recreational runners.
In 2018 at the Salt Lake City Marathon and Half Marathon, runners were recruited as they finished and randomized to either receive dry needling or sham needling and were then followed for a week afterwards to evaluate whether or not there was any effect from the procedure.
Unexpectedly, dry needling was associated with a statistically and clinically significant increase in pain compared to sham needling for the first three days after the race. By the seventh day, there was no difference between the two groups.
With respect to muscle cramps, dry needling was not associated with any difference compared to controls.
Cushman was surprised by these results.
“We have seen in many studies on this therapy that it decreases pain but doesn’t really fix anything at the tissue level,” he said. “The role for this is really best thought of as something that can accelerate pain control in the mind to allow for improved rehabilitation but more than anything, dry needling is an adjunctive treatment and not ever going to be the mainstay to manage injury.”
When Dry Needling Should Be Considered
Still, Cushman does think there are some specific ailments for which dry needling is specifically well suited.
“Iliotibial band syndrome and patellofemoral syndrome are examples of ailments associated with biomechanical misalignments and may be particularly amenable to treatment with dry needling,’ Cushman said. “I’m not saying that they are going to get better faster but that people with these problems will feel that their pain will be better managed, allowing them to rehabilitate and address the underlying biomechanics faster and I am interested to see how the research in these areas plays out.”
I should point out that there is no research that backs up Cushman’s beliefs in this regard, but this is his professional opinion.
He also believes that even in a broader sense dry needling works for some people far better than for others.
“Anecdotally, when we see a lot of higher-end athletes who swear by dry needling, I think it is probably because it works for them. That placebo effect, if it is a placebo effect, is a good thing and if they are feeling better because of it then that is great.”
Cushman has found in his work that people who really believe in dry needling tend to be those who benefit the most from it. This would seem to affirm his supposition of a strong and very real placebo effect that should not be discounted.
Still, it is clear that while a select group of people may derive significant benefit from dry needling, most people do not and its role in treating acute injury and soreness seems to be very limited.
Train hard, train healthy.
REFERENCES
Gattie, E., Cleland, JA & Snodgrass, S. The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017;47(3):133-149. doi:10.2519/jospt.2017.7096
Hall, ML, Mackie, AC & Cury Ribeiro, D. Systematic review Effects of dry needling trigger point therapy in the shoulder region on patients with upper extremity pain and dysfunction: a systematic review with meta-analysis. Physiotherapy. 2018;104:167-177. doi:10.1016/j.physio.2017.08.001
Hu, H-T. et al. Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis. Medicine (Baltimore). 2018;97(26):e11225. doi:10.1097/MD.0000000000011225
Espejo-Antúnez, L. et al. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. 2017. doi:10.1016/j.ctim.2017.06.003
Pérez-Palomares, S. et al. Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial. J Orthop Sport Phys Ther. 2017;47(1):11-20. doi:10.2519/jospt.2017.6698
Cushman, DM. et al. Postrace Dry Needling Does Not Reduce Subsequent Soreness and Cramping-A Randomized Controlled Trial. Clin J Sport Med. 2021;31(3):225-231. doi:10.1097/JSM.0000000000000794
