Dry Needling

Dry needling is a technique used by many different healthcare disciplines, including acupuncturists, physical therapists, physicians, and chiropractors, among others. Acupuncturists usually maintain that dry needling is adapted from acupuncture, but others consider dry needling as a variation of trigger point injections. Dry needling is a pseudoscience. Dry needling is sometimes referred to as intramuscular stimulation (IMS), especially in Canada. It involves the use of either solid filiform needles or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome.

Dry needling is mainly used to treat myofascial trigger points, but it is also used to target connective tissue, neural ailments, and muscular ailments. The American Physical Therapy Association defines dry needling as a technique used to treat dysfunction of skeletal muscle and connective tissue, minimize pain, and improve or regulate structural or functional damage.

Origin
The origin of the term dry needling is attributed to Janet G. Travell. In her 1983 book, Myofascial Pain and Dysfunction: Trigger Point Manual, Travell uses the term dry needling to differentiate between two hypodermic needle techniques when performing trigger point therapy. However, Travell did not elaborate on the details on the techniques of dry needling; the current techniques of dry needling were based on the traditional and western medical acupuncture. The two techniques Travell described are the injection of a local anesthetic and the mechanical use of a hypodermic needle without injecting a solution

Technique
Technique for dry needling depends on which tissue is being targeted and what the overall objective of the treatment is. For example, one of the most common treatment objectives for dry needling, myofascial trigger points (TrPs), differs physiologically from treatments for scar tissue, connective tissue issues, and other medical issues.

In the treatment of trigger points for persons with myofascial pain syndrome, dry needling is an invasive procedure in which a filiform needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple, hyperirritable contraction knots related to the production and maintenance of the pain cycle; essentially, myofascial trigger points will generate much local pain upon stimulation or irritation.

Efficacy
There is currently no standardized form of dry needling. There is a general scarcity of extensive research in the field. Many studies published about dry needling are not randomized, contain small sample sizes, and have high dropout rates. A review recommended the usage of dry needling, compared to sham or placebo, for decreasing pain immediately after treatment and at 4 weeks in patients with upper quarter myofascial pain syndrome. However, the authors caution that "the limited number of studies performed to date, combined with methodological flaws in many of the studies, prompts caution in interpreting the results of the meta-analysis performed".

Similarly, a second review of dry needling found insufficient high-quality evidence for the use of direct dry needling for short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. The same review reported that robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis is lacking and that high-quality studies demonstrate that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners.