Dry Needling FAQs

Dry needling is an invasive procedure in which a solid filament needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle.

There are many similarities and differences between dry needling and acupuncture. Licensed physical/occupational therapists in a growing number of states can use dry needling under the scope of their practice. Dry needling also falls within the scope of acupuncture practice. CHTs at Annapolis Hand to Shoulder Center are not licensed acupuncturists and do not practice acupuncture. In contrast to most schools of acupuncture, dry needling is strictly based on Western medicine principles and research.

The exact mechanisms of dry needling are not known. There are mechanical and biochemical effects. Based on the pioneering studies by Dr. Jay Shah and colleagues at the National Institutes of Health, we know that inserting a needle into trigger points can cause favorable biochemical changes, which assist in reducing pain. It is essential to elicit so-called local twitch responses, which are spinal cord reflexes. Getting local twitch responses with dry needling is the first step in breaking the pain cycle.

Dry needling can be used for a
variety of musculoskeletal problems. Muscles are thought to be a primary contributing factor to the symptoms. Such conditions include, but are not limited to neck, back and shoulder pain, arm pain (tennis elbow, carpal tunnel,golfer’s elbow), headache to include migraines and tensiontype headaches, scar tissue adhesions, etc. The treatment of muscles has the greatest effect on reducing pain mechanisms in the nervous system.

Most patients do not feel the insertion of the needle. The local twitch response elicits a very brief (less than a second) painful response. Some patients describe this as a little electrical shock; others feel it is more like a cramping sensation. Again, the therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.

Yes, we only use sterile disposable needles.

Most patients report being sore after the procedure. The soreness is described as muscle soreness over the area treated and into the areas of referred symptoms. Typically, the soreness lasts between a few hours and two days.
There are some potential more serious, but rare side effects including infection, bruising/bleeding, pneumothorax, epidural hematoma and autonomic responses. If you have concerns about these rare but possible side effects, your therapist can provide more information.

Our recommendations vary depending on the amount of soreness you have and on the individual response to the treatment. Recommendations may include applying heat or ice over the area, gentle stretches and modifications of activities.

Typically, it takes several visits for a positive reaction to take place. Again, we are trying to cause mechanical and biochemical changes without any pharmacological means. Therefore, we are looking for a cumulative response to achieve a certain threshold after which the pain cycle is disturbed.

Generally speaking, dry needling is the modality of choice when it comes to treating patients in the clinic. More frequently, dry needling is needed in the beginning in order to break the pain cycle. Once that is achieved, other treatment options are introduced.

The musculoskeletal system is under constant pressure from gravity, stress, work etc. A regular exercise program combined with good posture can prevent many problems. If the pain comes back, “tune-ups” are recommended to treat and prevent serious injuries.