WHAT ARE THE POTENTIAL EFFECTS AND COMPLICATIONS OF ‘DRY NEEDLING’ AND WHAT’S THE DIFFERENCE BETWEEN ‘DRY NEEDLING’ AND ACUPUNCTURE?
Author: Paul Dardagan and Matthew Craig – bounceREHAB Physiotherapists
Introduction
Dry needling is used by Physiotherapists and other allied health clinicians and is often confused or associated with acupuncture. Although the needles are the same there are quite distinct differences between the principles and underlying methodology of each technique.
Complications of Dry Needling
It is important to understand the potential effects and complications of ‘dry needling’. Dry needling is an invasive technique that can run the risk of an adverse effect. Brady, McEvoy et al. (2014) defines an adverse affect as any ill effect, no matter how small, that is unintended and non-therapeutic. This systematic review classified adverse effects as mild or significant. Mild events were described as short term, non serious, with no change in function. Significant adverse events included moderate or major events that are serious, distressing and require further treatment.
Brady, McEvoy et al. (2014) looked at adverse events per 100 treatments and consisted of a small number of only mild reactions; these included:
Bleeding (7.55)
Bruising (4.65)
Pain during treatment (3.01)
Pain after treatment (2.19)
,Aggravation (0.88)
Drowsiness (0.26)
Janz and Adams (2011) found further adverse events associated with dry needling which included pneumothorax, peripheral and central nervous system injuries, organ puncture, puncture of large blood vessels and syncope. These were considered very rare!
Most physiotherapists will be able to say with confidence that they have never had a patient with a serious adverse event and defer to the research that there is a very rare risk of pneumothorax.
Acupuncture
Acupuncture is determined by the traditional Chinese meridian body map. It is suggested that the rational behind this method is based on “Qi”. It is believed that “Qi” becomes blocked or congested in the body, which leads to failure to maintain harmony, leading to disease or illness. The expectation is that these disorders are reflected on the skin or just below it at specific points and that appropriate needling of these points may restore balance in the body (Furlan, Van Tulder et al. 2005). However, modern acupuncturists use a variety of traditional meridian and non- meridian, or extra meridian points (Furlan, Van Tulder et al. 2005). Acupuncturists also claim to deal with non-musculoskeletal conditions which include, fertility, smoking cessation, allergies and other non-musculoskeletal conditions (Unverzagt, Berglund et al. 2015).
Dry Needling
Andrew Hutton, who developed the technique dry needling plus (DNP), defines dry needyling (DN) is the needling of anomalies in tissue to elicit palpable and observable physiological changes. More traditional definitions and methods describe it as the multiple advances of acupuncture type needles into the muscle in the region of a trigger point with the aim to reduce pain, restriction and to visualise local twitch responses. It has been theorised that the needling into a muscle trigger point depolarises a muscle fibre, this leads to micro-stretch effects on the shortened sarcomeres (Chu 2002).
Shoulder Impingement
Shoulder Impingement is a common condition that is caused when the rotator cuffs are pinched as they pass through the subacromial space formed between the Coraco-Acromial arch, AC joint, Acromion and the Glenohumeral joint. This impingement can cause swelling and damage to the muscle and tendons(Brukner 2014). Impingement often occurs secondary to incorrect activation of the rotator cuff muscles (Jonsson 2012). Instability can result due to a superior translation of the humeral head which can impinge the subacromial structures including the supraspinatus and/or subacromial bursa (Jonsson 2012). Active trigger points have been shown in shoulder impingement (Arias-Buría, Fernández-de-las-Peñas et al. 2017). The infraspinatus and upper trapezius muscle have been shown to be the most common hypertonic muscleswith shoulder impingement (Jonsson 2012). Arias-Buría, Fernández-de-las-Peñas et al. (2017) identified that dry needling with an exercise program was effective for improving shoulder pain-related disability. Therefore it is important that identification and treatment of trigger points are undertaken in the early stages of shoulder impingement.
Case study
A patient presented with shoulder pain that has not resided over the last two weeks, the pain started after performing shoulder press exercises at the gym using a shoulder press machine. All other pathologies were ruled out using a comprehensive subjective and objective examination. Upon examination the patient was found to have a painful arc with abduction at 90 degrees, a positive Hawkins Kennedy impingement test and reduced internal range of motion compared to the other shoulder. The differential diagnosis was theorised to be shoulder impingement syndrome. Based on the evidence described above it would be appropriate to begin treatment with dry needling trigger points including the infraspinatus and upper trapeziuscoupled with some light theraband rotator cuff activation in inner range on the first day. Based on the severity and the extent of the injury it would be expected that dry needling is used until the patient achieves a full recovery.
Conclusion
Dry needling is an effective technique for treating myofascial pain, restriction and control disorders. Dry needling provided by a trained therapist can be done safely with serious adverse events being very rare.
References
Arias-Buría, J. L., C. Fernández-de-las-Peñas, M. Palacios-Ceña, S. L. Koppenhaver and J. Salom-Moreno (2017). “Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial.” The Journal of Pain 18(1): 11-18.
Brady, S., J. McEvoy, J. Dommerholt and C. Doody (2014). “Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists.” Journal of Manual & Manipulative Therapy 22(3): 134-140.
Brukner, P. (2012). Brukner & Khan’s clinical sports medicine, McGraw-Hill North Ryde.
Chu, J. (2002). “The local mechanism of acupuncture.” Zhonghua yi xue za zhi= Chinese medical journal; Free China ed 65(7): 299-302.
Furlan, A. D., M. Van Tulder, D. Cherkin, H. Tsukayama, L. Lao, B. Koes and B. Berman (2005). “Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration.” Spine 30(8): 944-963.
Janz, S. and J. Adams (2011). “Acupuncture by another name: dry needling in Australia.” Australian Journal of Acupuncture and Chinese Medicine 6(2): 3.
Jonsson, C. (2012). “The role of myofascial trigger points in shoulder pain: a literature review.” Journal of the Australian Traditional-Medicine Society 18(3): 139.
Unverzagt, C., K. Berglund and J. Thomas (2015). “Dry needling for myofascial trigger point pain: A clinical commentary.” International journal of sports physical therapy 10(3): 402.