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Abu Dhabi, UAETuesday 18 December 2018

Dry needling: How the modern treatment aims at easing muscle pain

We look at the increasing popularity of dry needling to counter all kinds of pain, and explains why it shouldn’t be compared to acupuncture

Dry needling uses the same needles as acupuncture, but is a completely different treatment. Getty Images
Dry needling uses the same needles as acupuncture, but is a completely different treatment. Getty Images

It was about four days into a recent string of excruciating headaches when I realised what was happening, and that this time, I knew exactly what to do about it.

Last winter, I had embarked on a sudden and gruelling regime of challenging, CrossFit-type classes, and before long I was experiencing blinding headaches that snaked up from my aching neck over the top of my head. I tried everything I could – Advil, massage, acupuncture, physiotherapy, exercise and drinking lots of water – but nothing helped.

A few days became a week and, seeing that I was clearly at the end of my rope with the pain, a physiotherapist asked if I would consider dry needling. Soon I was face down on a table in his office, two needles being inserted into the taut muscles of my neck. It was one of the more painful half-hours of my life. As soon as the pain subsided, he would twist the needles, and things would start throbbing again. Yet, when I stood up, the pain had subsided. Within a few hours, it had lifted substantially. By the next morning, it was a nagging ache, and eventually, the headaches were gone – from just one session.

This time around, when new intense workouts led to the same pain, I didn’t wait long before booking an appointment with Jennifer Dodge, a physiotherapist at Bounceback Physiotherapy on Yas Island. Same problem, same uncomfortable treatment, same quick recovery. After wrapping up the Dh450 session, I had loads of questions about how it worked.

Although dry needling seems very much like acupuncture – it uses the same impossibly thin needles and offers pain relief – it is not. One is an ancient Chinese practice that works to manipulate the body’s flow of energy, to promote healing. The other is a modern treatment aimed at easing muscle pain. Rather than targeting any of the 4,000 acupuncture points along the body’s energy meridians, the needles are inserted directly into the painful places we call knots, and physiotherapists call myofascial (muscle and fascia) “trigger points”.

The acupuncture needles used in dry needling. Getty Images
The acupuncture needles used in dry needling. Getty Images

In my case, the pain was stemming from the base of the skull, which is a major connection point on the body for the muscles of the head and face, as well as the trapezius, which extends from the mid-shoulder. All it takes to create that kind of cascading pain, Dodge explains, is a weakness, tightness or asymmetry of some sort, coming from any of those muscles, or the fascia that encases them, or both. This then winds, tightens, tugs and creates a trigger point, or several. “It works well for trigger points, mainly, those myofascial points. If you have a knot in your shoulder, you can feel that gristle, so that’s an area of muscle that’s carrying a lot of tension, an ischemic area that’s not carrying a lot of blood flow,” she explains. “The needling works really well to elicit a ‘twitch’ response in that fibre, that then suddenly relaxes the muscle and allows the blood flow to come through.”

At the same time, she says, needling can also help disrupt those signals the brain uses to initiate the pain response, changing the communication and breaking up the pain cycle.

A number of professional athletes have adopted the practice to promote faster healing. Among them is Brett Deledio, a footballer who plays for the Greater West Sydney Giants. He recently told Australia’s Fairfax Media that ongoing dry needling sessions were helping him overcome nagging calf injuries. “I certainly don’t love it, but I haven’t had any hiccups since I’ve been doing it,” he says. “So I’ll continue to do it for the rest of my days, I think.”

My own experiences with dry needling are backed up by a growing body of research into the practice. A review published in the journal Cephalalgia in 2014 found “it may be a useful addition to conventional physiotherapy in headache management” and called for further study. A preliminary clinical trial conducted in Spain in 2015, published in the Journal of Bodywork and Movement Therapies, found that dry needling was effective in easing lower back pain. There are many more studies indicating it can relieve pain in the upper back, jaw, hip, neck, shoulders and feet.

Amy Gilbert is a physiotherapist from the UK who is preparing to open her own clinic, Perfect Balance Rehabilitation, in Reem Island’s Tamouh Tower, later this month. “It’s a fabulous tool in our toolbox; it gets right to the point,” she says. “We’re looking for what we call a local ‘twitch response’. That’s what people crave. It’s almost the body’s recognition: yes, you’re in the right place.”

Dry needling has become increasingly popular in recent years in the West, with physiotherapy schools adding instruction to their curriculum, and those that are already practicing taking weekend workshops to add it to their treatment toolbox.

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Read more:

Beyond the core: can Pilates be the panacea for pain?

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One group in the United States that isn’t happy about the new alternative therapy is acupuncturists. Opponents argue that the two treatments, dry needling and acupuncture, are the same, and that physical therapists don’t get nearly enough training to make sure they are doing it safely. Acupuncture organisations have been lobbying against the practice in the United States, with their efforts leading to at least a half-dozen states banning the practice.

There have been injuries and several lawsuits, particularly in the US. However, in an article on the topic published in May by Quartz, the American Physical Therapy Association countered the criticism by saying the 25 dry needling complaints received between 2011 and 2015, represent less than one per cent of a total of almost 4,000 complaints.

Although the needles are the same, Gilbert maintains that the two practices are based on entirely different approaches to the body. “The big difference is that dry needling is based on Western medicine; we are inserting the needle directly where we think there is a problem,” she says. “Whereas acupuncture is based on Chinese medicine, and you insert the needles along energy lines, and work on balancing qi, so they are very very different.”

Gilbert, who is governed by the Health Care Professions Council in the UK, as well as the UK Chartered Society of Physiotherapy, says the practice is fully endorsed by both bodies. “They will only allow you to practice it legally if there is a strong body of evidence that suggests that it works,” she says.

Both Gilbert and Dodge, who have been practicing without issue or incident for years, are careful who they offer dry needling to. Patients who are very fearful of pain could tense up and make it worse – and be put off physiotherapy altogether. “I have been doing it for six or seven years with no adverse reactions,” says Dodge, who also dry needles her own knee. “I have had people who are not overly impressed with it, but that’s about it.”