Dry Needling

Dry Needling

Trigger-point dry needling is an invasive procedure where a fine needle or acupuncture needle is inserted into the skin and muscle.It is aimed at myofascial trigger points (MTrP) which are hyperirritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band. Trigger point dry needling can be carried out at superficial or deep tissue level.

Indication

Dry needling may be indicated for myofascial pain with the presence of trigger points. Dry needling has also been shown to be beneficial for the management of strains, osteoarthritis and tendinopathies

Electrical Dry Needling

Electrical dry needling (EDN) is a technique in which two needles are inserted as electrodes for passing an electric current. One of the main advantages in using EDN in clinical practice or acupuncture research is its capacity to set stimulation frequency and intensity objectively and quantifiably.

In clinical practice, both low- and high-frequency electrostimulation are used often for diverse conditions. Low-frequency stimulation is specifically recommended for muscular atrophy , whereas highfrequency stimulation is recommended for spinal spasticity.On animals for example EDN with 2-Hz stimulation seems to induce acupuncture analgesia by the release of endomorphin, β-endorphin and enkephalin binding to μ and δ opioid receptors. EDN with 100-Hz stimulation, however, enhances the release of dynorphin binding to the opioid receptor in the spinal cord dorsal horn to produce acupuncture analgesic effect

Most studies demonstrated a broad neuromatrix response that involved the limbic system and limbic-related brain structures including the amygdala, hippocampus, hypothalamus, cingulate, prefrontal and insular cortices, basal ganglia, and cerebellum. On human infact results demonstrated greater effect on the limbic and limbic-related brain structures with real EDN than with nonspecific or placebo stimulation. Specifically, the hemodynamic response produced signal increase in notable limbic-related regions such as the insula, thalamus, cerebellum, and the anterior middle cingulate cortex. Interestingly, however, the subgenual anterior cingulate showed signal decrease.

Clinical Relevance

  • The inclusion of electrical dry needling into a manual therapy and exercise program was more effective for improving pain, function, and related-disability than the application of manual therapy and exercise alone in individuals with painful knee osteoarthritis.
  • The inclusion of electrical dry needling into a program of manual therapy, exercise and ultrasound was more effective for improving pain, function and related-disability than the application of manual therapy, exercise and ultrasound alone in individuals with patello-femoral pain at mid-term (3 months).
  • EDN and upper cervical and upper thoracic HVLA thrust spinal manipulation were shown to be more effective than nonthrust mobilization and exercise in patients with cronic headache, and the effects were maintained at 3 months.
  • EDN combined with cervicothoracic manipulation c resulted in greater reductions in pain, disability, and medication intake than nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current in patients with subacromial pain syndrome . The effects were maintained at 3 months.