By Alex Earl, DC DACRB DNSP
This week on the Health Restoration Blog, we are highlighting an important issue, Dry Needling. We wanted to provide helpful information regarding one of the most popular trends in physical therapy, physical medicine, strength training and overall longevity.
Today’s article focuses primarily on how Dr. Alex Earl views dry needling therapy for his patients and, more importantly, the main reasons why someone looking to relieve their discomfort with dry needling should be warned BEFORE ever getting needled. The reason for this is quite simple, a skilled clinician will focus on identifying and rectifying the ROOT PROBLEM (and not masking underlying symptoms, which dry needling is very good at doing.
He believes you deserve a solid clinical reasoning process and an individualized treatment plan that may or may not include dry needling!
What is Dry Needling Therapy?
Before I get into the specifics, I must disclose that I am an international dry needling instructor. My education organization, MWRI, has certified thousands of chiropractors, physical therapists and students in dry needling.
I’m not saying this to brag or boast, but to be totally honest with you.
Dry Needling is not the holy grail many providers (and patients) proclaim it to be. The goal of this article is to share with you the facts about dry needling that appear to have been swept under the rug…
Dry needling involves the precise insertion of thin needles into specific areas of muscles or fascia to address pain and enhance mobility. This technique aims to stimulate healing responses within the body by targeting areas of tension or restricted movement. While some advocate for the benefits of dry needling in managing musculoskeletal conditions, there are contrasting viewpoints that question its efficacy and safety for certain individuals.
Reason #1: Dry Needling Doesn’t Work Without a Clinical Reasoning Process.
Many times, clinicians abdicate from the clinical responsibilities of the job. When it comes to dry needling, many doctors choose to render the treatment because the patient requests it, but is that an acceptable form of clinical practice? I would make the argument that, no, it is not acceptable.
By using a clinical reasoning process to listen to the patient’s concerns, history and internal fears about their situations, providers will get a better understanding of what to do for treatment and what the particular patient will respond best to.
Too many clinicians already have pre-determined treatment plans for their patients.
Too many clinicians skim through an exam and begin treatment without actually listening to the patient.
A clinical reasoning process in the context of dry needling involves a systematic approach to evaluating a patient’s condition before determining the appropriateness of this treatment method.
This process typically begins with a thorough assessment of the individual’s medical history, current symptoms, and physical examination findings. Healthcare providers use this information to formulate a diagnosis and treatment plan tailored to the specific needs of the patient.
Through clinical reasoning, practitioners consider factors such as the underlying pathology, contraindications, potential risks, and expected outcomes to ensure that dry needling is a suitable intervention in the given clinical scenario. This structured approach helps healthcare professionals make informed decisions and provide safe, effective care to their patients.
Reason #2: Dry Needling Does NOT Eliminate Trigger Points.
Despite the common belief that dry needling targets and eliminates trigger points, there is ongoing debate and evidence suggesting that this technique may not effectively eradicate these localized areas of muscle tension.
While dry needling may provide temporary relief by promoting muscle relaxation and improved blood flow to the targeted areas, the long-term elimination of trigger points remains a point of contention.
Some studies indicate that trigger points may reoccur after dry needling sessions, highlighting the need for a more comprehensive approach to managing these myofascial abnormalities.
Therefore, individuals considering dry needling for the sole purpose of eliminating trigger points may need to explore alternative therapies to address these persistent muscular issues effectively.
One of our favorite therapies to choose over dry needling is blood-flow restriction, which targets the cellular level of injured muscle for optimal recovery.
Reason #3: Dry Needling Does NOT Provide Long-Term Results.
The limited evidence of long-term efficacy associated with dry needling raises important considerations for individuals seeking this treatment option.
While initial research suggests that dry needling can offer short-term pain relief and functional improvements for certain musculoskeletal conditions, the sustained benefits over an extended period remain less conclusive.
This uncertainty regarding the long-term effectiveness of dry needling underscores the importance of exploring alternative or complementary therapies that may provide more reliable and durable outcomes for individuals managing chronic pain or persistent musculoskeletal issues.
As research in this field continues to evolve, future studies focusing on the extended effects and lasting benefits of dry needling could provide valuable insights into its role in comprehensive pain management strategies.
Real Life Case Study: How a New Patient Ended up in the Emergency Room! (It’s not what you think!)
Recently a colleague shared this incredible story that I feel compelled to share with you as well! A runner came in with bilateral leg pain after returning home from a trip away with his friends. He noticed his legs were sore and called to schedule an appointment for “dry needling” of his sore legs at my colleague’s office.
When he showed up, a complete new patient exam was performed, which included a thorough examination of his movements. My colleague was not able to reproduce his soreness and discomfort during our exam, which is quite unusual.
This immediately raises “red flags” for us as doctors.
Could this be something in the non-mechanical world? Could there be something deeper going on that we should investigate further?
We thought so, too and therefore, we elected to not dry needling his sore calves after all.
Instead, we asked him about any changes in his heart and/or lungs. The patient replied that he was feeling very winded after simple physical activities, like walking up and down the stairs or getting up from a seated position.
That was enough for my colleague to hear and he referred the patient to the Emergency Department nearby.
A few hours later, the patient’s wife contacted my colleague and informed him that the patient had a DVT (deep vein thrombosis) and multiple pulmonary embolism (PE). The soreness he was feeling in his calves were actually the DVTs.
Now, this is a one-in-a-million clinical scenario, but I was grateful for my colleague’s training to properly assess and refer to the case out in this non-mechanical case. It probably saved a life.
Here’s my point as if it were written on a bumper sticker:
A clinician using a clinical reasoning process is far better than one who does not and simply dry needles every sore leg that walks in their door.
If you’re an athlete or an active individual who is interested in learning more about dry needling but don’t know what to do, then don’t wait any longer. We believe you deserve a clinical experience unlike any other.
Give us a call or text us at (630) 765-0575 to get started on your own complete recovery today – with or without dry needling!
Do this next!
- Share this Article with a Friend or Family member who has been dealing with constant back, neck, shoulder, hip or knee pain. Dry needling could help!
- Call our office TODAY at (630) 765-0575 to book your Dry Needling Taster Session today OR click here to book online.
- Keep an eye out for next week’s article!
References:
- Hsieh, C. Y., Hong, C. Z., Adams, A.H., Platt, K. J., Danielson, C. D., Roehler, F. K., & Tobis, J. (2000). Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. Archives of Physical Medicine and Rehabilitation, 81(3), 258-264. https://doi.org/10.1016/sooo3-9993(00)90068-6
- Kietrys, D. M., Palombaro, K. M., Azzaretto, E., Hubler, R., Schaller, B., Schlussel, J.M., & Tucker, M. (2013). Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 43(9), 620-634. https://doi.org/10.2519/jospt.2013-4668
- Lucas, N., Macaskill, P., Irwig, L., Moran, R., & Bogduk, N. (2009). Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. The Clinical Journal of Pain, 25(1), 80-89. https://doi.org/10.1097 / AJP.obo13e31817e13b6
- Myburgh, C., Larsen, A. H., & Hartvigsen, J. (2008). A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Archives of Physical Medicine and Rehabilitation, 89(6), 1169-1176. https://doi.org/10.1016/j.apmr.2007.12.033
- Quintner, J. L., Bove, G. M., & Cohen, M. L. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford, England), 54(3), 392-399. https://doi.org/10.1093/rheumatology/keu471
- Quintner, J. L., & Cohen, M. L. (1994). Referred pain of peripheral nerve origin: an alternative to the “myofascial pain” construct. The Clinical Journal of Pain, 10(3), 243-251.https://doi.org/10.1097/00002508-199409000-00012
- Wolfe, F., Simons, D. G., Fricton, J., Bennett, R. M., Goldenberg, D. L., Gerwin, R., Hathaway, D., McCain, G. A., Russell, I. J., & Sanders, H. 0. (1992). The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. The Journal of Rheumatology, 19(6), 944-951.
Alex Earl
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