Trey Martin stuck two thin needles in a volunteer’s lower back to demonstrate a technique called dry needling and waited for what is called the “local twitch response” – when the tight muscles nearby contract before relaxing.
The twitch means the needles found a trigger point, a tender spot that can be causing pain. A therapist will move the needles up and down to get the twitch.
During his demonstration, Martin attached what looked like tiny jumper cables to the needles to send a light electrical current into the problem area for a deeper stimulation.
“A lot of people who have low back pain also have hip pain, so there have been cases where I’ve done probably eight needles in someone’s low back and four down their hip,” said Martin, a physical therapist with HealthActions in Dothan.
Physical therapists use exercises, stretching and even massage to help patients dealing with pain. For physical therapists like Martin, dry needling has become another tool and is used in combination with other techniques for all sorts of pain – knee osteoarthritis, low back pain, neck pain, headaches, plantar fasciitis, tennis elbow and carpal tunnel syndrome.
“Dry needling is another tool in the toolbox of treatments that we offer,” Martin said. “It can be beneficial for everyone.”
The needles used at HealthActions range in length from 15 mm to 40 mm and up to 75 mm. For some people, the sensation of the needle going into the skin is only a little more than a pin prick or dull ache. To Martin, dry needling is no more painful than stretching a tight muscle.
“It’s not that it’s a painless procedure but it is a very, very, very temporary pain,” Martin said. “If I put a needle in anyone and they have pain that lasts more than three or four seconds, I’m taking the needle out.”
Dry needling − called “dry” because there is no injection of medicine − looks a lot like acupuncture, the traditional Chinese medical practice that has been around for thousands of years. Both approaches involve inserting thin needles into the skin, and both claim to help with pain. That’s pretty much where the similarities end.
Acupuncture focuses on the body’s energy flow, acupuncture points and meridians as ways to treat a number of ailments, including pain; dry needling has been around since the late 1970s and takes a more Western-medicine approach to target trigger points causing pain.
A dry needling session may last anywhere from 10 to 20 minutes, depending on whether it’s your first time seeing a therapist or not.
Of course, if you have an aversion to needles, the technique is probably not for you.
Chynna Dulac, a physical therapist with Physical Therapy Specialists of Dothan, received dry needling training about three years ago. She sought training while working as a traveling physical therapist with the show “Stomp” after dancers kept asking her to dry needle them.
She has since received a second level of training and has treated patients for everything from chronic headaches to jaw pain and low back pain to ringing in the ears. Along with patients who have a fear of needles, Dulac will not dry needle recent surgical areas on patients, such as a hip or knee replacement without consulting with the surgeon.
The thin needles, she said, allows a physical therapist to relieve tension and reduce nerve pain in areas where hands just can’t reach, even areas that have caused pain for patients for years.
“It treats a multitude of different things but it’s not all we do,” Dulac said. “We’re doing dry needling in combination with hands-on manual therapy, modalities like ultrasound, electrical stimulation and exercise. Just because I release something, that’s great, but then we need to exercise that new range of motion.”
Like Martin at HealthActions, Dulac is the only physical therapist trained to do dry needling at Physical Therapy Specialists. The dry needling has become so popular that the owner of the practice, also a physical therapist, plans to receive training next month, Dulac said.
There are differences in regulation and licensing for both acupuncture and dry needling depending on where you live. In Alabama, there is no licensing board for acupuncturists despite past efforts by nationally-certified acupuncturists to change that. Most patients who want acupuncture end up seeing a licensed medical doctor, an osteopathic doctor or a chiropractor who does acupuncture as a part of their medical practice.
The licensing boards in Alabama for both chiropractors and physical therapists – the Alabama State Board of Chiropractic Examiners and the Alabama Board of Physical Therapy − have expanded rules to include dry needling with specifications for additional training and certification. The Alabama Board of Medical Examiners has rules for licensed doctors who choose to do acupuncture but none on dry needling.
In Alabama, physical therapy sessions typically require a referral from another medical practitioner.
There are generally few complications from dry needling or acupuncture when done by a trained practitioner and with sterile needles. However, when done improperly and with nonsterile equipment, there can be serious side effects such as infections and nerve injuries.
So if you decide to try dry needling or acupuncture, it’s important to visit a trained practitioner. Everybody’s different and results may differ for people.
Both Dulac and Martin said there needs to be a good dialogue between therapist and patient before proceeding with dry needling.
“I hate that it gets to the point of desperation before people will agree to do this, but sometimes it just gets to that point and that’s OK,” Martin said. “The pain the needle will cause is minimal compared to the pain you’re going through.”