Dry Needling, Manual, and Manipulative Therapy
What is Dry Needling?
Dry needling is this fantastic treatment that has been known to the Western world of medicine for hundreds of years. Muscle pain also commonly referred to as Myofascial pain is extremely common and is a very treatable condition although almost always ignored by physicians and not treated by physical therapists even in most rehabilitation environments. People experiencing myofascial pain often report chronic pain syndromes and mention diagnoses such as RSD, CPRS, or fibromyalgia. I think Fogelman (2) says is best in his recent review “Dry needling, also referred to as Intramuscular Stimulation, is a method in the arsenal of pain management which has been known for almost 200 years in Western medicine, yet has been almost completely ignored. With the increase in research in this field over the past two decades, there are many high-quality studies that demonstrate dry needling to be an effective and safe method for the treatment of myofascial pain when diagnosed and treated by adequately-trained physicians or physical therapists”.
Kietrys et al performed a search for peer -reviewed articles discussing the use of dry needling to treat the pain and comparing it to other treatments or even sham treatments. Of the initial search which revealed 246 published articles, only twelve articles that were randomized controlled trials (RCT) were selected. The authors used a methodological quality score to identify the level of the articles which ranged from 23 to 40 points, with a mean of 34 points (scale range, 0-48; best possible score, 48). Here is an excerpt from their abstract:
“The findings of 3 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can immediately decrease pain in patients with upper-quarter MPS, with an overall effect favoring dry needling. The findings of 2 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can decrease pain after 4 weeks in patients with upper-quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There was evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks.”
Based on the best current available evidence (grade A), we recommend dry needling, compared to sham or placebo, for decreasing pain immediately after treatment and at 4 weeks in patients with upper-quarter MPS. Due to the small number of high-quality RCTs published to date, additional well-designed studies are needed to support this recommendation.
For more information about manual therapy click here
- Fogelman Y, Kent J. Efficacy of dry needling for treatment of myofascial pain syndrome. JBMR. 2014
- Kietrys DM, Palombaro KM, et al. Effectiveness of Dry Needling for upper- quarter myofascial pain: a systematic review and mta-analysis. JOSPT. 2013;43:620-634