Dry Needling

 

Immediate Long Lasting Results

What is Dry Needling?

Dry Needling (DN) has opened a new world of possibilities for improved tissue healing and pain reduction. By inserting thin monofilament needles into muscle, tendons, fascia, perineurally, ligaments, and scar tissue we are able to access and target deeper anatomical structures. Electrical stimulation with DN has been proven to stimulate changes biomechanically, chemically, vascularly, and endocrinologically in pathological tissue.

What does that mean? Dry needling with electrical stimulation actually changes your body's perception of pain neurologically and corrects the chemical stimulus of pain locally. See 'Science Stuff' below for the full rundown.

What Can you Treat with Dry Needling?

A variety of diagnoses, including tendonitis, overuse injuries, scar tissue, headaches, migraines, sprains, strains, muscle spasms, muscle tightness, trigger points, chronic pain, arthritis, impingement, nerve compression, nerve entrapment, carpel tunnel and so much more!

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The Benefits of Dry Needling

Immediate Results

After one session of dry needling patients feel a reduction in pain and better mobility

Effective and Versatile

Dry Needling can treat back and neck pain, cervicogenic headaches, muscle strains, osteoarthritis, tendinopathies, rotator cuff pain, plantar fasciitis, and MUCH more

Faster Progress

Accelerated healing times by eliminating trigger points, increasing blood flow and oxygenation in local tissue

Pain Reduction

Affects both the local and central nervous system responses, pain is immediately reduced after one treatment

Tissue Specific

Targets deep anatomical structures that cannot be reached by manual techniques for more specific release work

Performance Enhancing

Improve muscular strength and power after one session by activating inhibited muscles.  

Read the Research
Dry Needling Brickell

FAQ's of Dry Needling

Not really, but let's give it a try. When injury becomes chronic, several things happen.

First, you have deprivation of oxygen due to compression of local vasculature. This makes the body store the neurotransmitter, Acetylcholine (ACh) in the neuromuscular junction, when this chemical builds up, you get a trigger point (this is a gross oversimplification, but bear with me). Through the insertion of very small needles, we are able to release trigger points by stimulating a chemical response in the body.

Second, with chronic injury (over 10 days) the body increases the number of local pain receptors to 'protect' the area. The body also over time protectively draws more attention to the painful area by increasing the representation of this area in the brain. With dry needling, through a domino effect of many hormonal reactions, we are able to decrease the number of pain receptors locally in the pathological tissue, and change the abnormal representation of the area in the brain. This allows the body to decrease the hypersensitivity of the tissue, and return to the normal perception of everyday stimuli.  

I know we said simple, but believe it or not, this is a simple explanation. See 'Cool Science Stuff' below for the real deal.

Almost everyone. Because dry needling works both on the local tissue and the nervous system it is beneficial for many physical therapy diagnoses. It can improve the rate of recovery for almost every diagnosis. 

No. Acupuncture focuses on the movement of Qi, the energy flow of the body. Dry needling is based on Western medicine focusing on anatomical structures and neurological/physiological responses. While there is some overlap between acupoints and trigger points, we conduct a full physical evaluation of the body and use dry needling as another method to make positive changes in combination with manual therapy and exercise. 

Not really, the needles used are very small. The team at Symmetry has been trained on techniques to mitigate any discomfort. Some patients experience a little local soreness post treatment, but the benefits and pain relief FAR outweigh the temporary discomfort. 

Absolutely! Dry needling is one of the most effective ways to reduce scar tissue. We combine Dry needling with the use of the Winback machine for really incredible results.

Extremely! Each needling is individually wrapped and sterile. The needles used at Symmetry are one-time use only and surgical grade metal. The size of the needle is only 1/10 of a 'typical injection' needle. 

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More Info

Want to learn more? Feel free to contact us or take a look at our Research Page to keep learning!

Dry Needling is used by our physical therapists as an additional means of rehab to assist in speeding up recovery and tissue healing. It is often integrated into a comprehensive recovery program which will include additional forms of manual therapy, joint mobilizations, and strength training.

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Dry Needling with Cupping

Learn How Dry Needling Works

 

Dry Needling

A Deep Dive Into the Science

The section below is meant for physicians to learn about the neurophysiology behind trigger points, chronic pain, headaches, blood-flow changes, tissue reorganization, use of electrical current, peri-neural needling, regenerative medicine, and pain reduction.

Interested in reading the actual articles? Take a look at our research page.

Acupuncture Vs. Dry Needling

Dry needling is a powerful tool that is extensively used as one of many treatment strategies at Symmetry physical therapy.  It is procedure that that has become increasingly more popular among Western, health care practitioners for the treatment of neuromusculoskeletal conditions.1  While both western-based dry needling and traditional acupuncture incorporates thin, monofilament needles (i.e. without the use of medicine), the theoretical construct that underlies both procedures is distinctly different.1,2 In short, the practice of dry needling is not meant to move energy or “qi” along the meridians of the body for purpose of treating diagnoses typically associated with traditional Chinese Medicine.1,2 While we respect that acupuncture can be a powerful treatment strategy in some patients, the dry needling performed at Symmetry Physical Therapy is uniquely different.   There are a number of biochemical, biomechanical, endocrinological and neurovascular mechanisms that underlie the use of dry needling within the context of physical therapy for decreasing pain and inflammation.1

Myofascial Trigger Points

Myofascial trigger points were first introduced by Travell and Simon3 and expanded by Gerwin4 to describe an overactive neuromuscular junction secondary to overuse5, poor biomechanics6,7, scar tissue formation,8 etc. This hypertonicity is propagated by excessive acetylcholine build-up in neuromuscular junctions and subsequent Ca release from the sarcoplasmic reticulum of muscle fibers has been associated with a metabolic crisis, leading to the release of inflammatory factors and irritability.9,10 While robust evidence presently does not exist for identifying the existence and/or location of myofascial trigger points11, there is 92% overlap between traditional acupoints and trigger points.12 Nevertheless, dry needling is commonly used to treat trigger point via fast in-and-out insertions by eliciting localized twitch responses.13 The localized twitch response is thought to represent a break in hypertonicity via the clearing of excessive acetylcholine from the neuromuscular junction, but recent studies suggest that it may help to wash out factors of inflammation via an increase in vasodilation.14-17 The localized twitch response continues to be a topic of debate in the literature,13 the but the use of dry needling to treat myofascial trigger points is widely accepted, particularly when packaged within the context of a multifaceted needling framework.18 That is, dry needling is a useful tool used at Symmetry Physical Therapy for treating trigger points, but our use of dry needling is not confined to the treatment of trigger points.

Dry Needling and Increased Blood Flow

A number of studies have reported a significant increase in vasodilation following acupuncture and dry needling, which may be useful for driving pain reduction and tissue repair.  The vasodilation is likely due to temporary increases in CGRP, which binds to CGRP1 receptors on smooth muscle and endothelial cells, and the release of nitric oxide from mast cells.19 Manual needling stimulation has also been shown to activate TRPV1 receptors, which initiates the release and breakdown of ATP into adenosine.20 Adenosine has not only been linked to pain reduction via the activation of A1 adenosine receptors, it also facilitates vasodilation via prostaglandins and nitric oxide.20 Importantly, vasodilation from dry needling has been shown to increase by up to 72%15 and persist up to 60 minutes21 after the completion of the treatment.  The increased blood flow following dry needling has been linked to collagen proliferation and tendon healing with high quality evidence.22,23 Moreover, increased blood flow has been shown to have three primary effects on osteoarthritic joints.  Given that reduced microcirculation has been identified as a risk factor in OA and degenerative rotator cuff lesions, dry needling may be able to stop, prevent and/or reverse changes associated with OA.24-26 The increased blood flow also facilitates the recruitment of opioid producing immune cells that may help to reduce inflammatory cytokines associated with joint pain.27-29 Finally, there is limited evidence that vasodilation stimulates an increase in hyaluronic acid, which helps to lubricate and improve the overall health of joints.30 Manual and electric needle stimulation close to the periosteum may further block IL-6 mRNA in bone marrow, limiting inflammation and inhibiting osteoclast activity.31 To date, there is robust evidence for using dry needling and acupuncture for treating tendon injuries32-35 and osteoarthritis joint36-41, and we have certainly seen significant outcomes in these patient populations at Symmetry Physical therapy when used pre and post-surgical intervention.

Pain Reduction

The anti-nociceptive effects of acupuncture and dry needling is thought to be medicated by the gate control theory of pain42,43, serotonin and norepinephrine release from the brainstem (i.e. diffuse inhibitory noxious control)1,23,44, and opioidergic pain reduction.1,29,45 While electroacupuncture may change the resting membrane potential of neighboring cells, which could facilitate signaling required to reduce pain, manual needle stimulation provides mechanotransduction.46-48 In fact, the perception of a deep ache or a spreading warmth (often referred to in acupuncture as “de qi”) is thought to be mediated by the physical connection between the needle and the cells in the target tissue.49 This mechanical stimulation of tissue has also been shown to promote ATP release, which is broken down into adenosine and recognized by A1 adenosine receptors on peripheral nerves.50 In doing so, adenosine blocks adenylyl cyclase and attenuates cAMP and phospholipase C, ultimately inhibiting the cellular cascade responsible for delivering pain the central nervous system.51,52 Interestingly, recent studies suggests that there be an analgesic effect of dry needling both at sites related and unrelated to pain.  While needling at the site of pain causes histamine release from mast cells, which provokes an itch response, pain inhibits itch at the level of the spine.53 However, needling to stimulate histamine release away from the site of pain allows itch and pain to enter the central nervous system at segmentally distinct levels.  In doing so, the itch response of the needling is able to inhibit pain at the tuberomammillary nucleus of the hypothalamus, thereby blocking pain in the brain.54-56 

Tissue Reorganization and Healing

Dry needling is thought to improve tissue healing in a three-pronged manner.1 First, dry needling activates toll-like receptors on fibroblasts, which increases type-1 collagen synthesis.57,58 Second, needling mechanotransduction leads to activation of rho and rac kinases,46,57 which leads to the transient disassembly of the actin cytoskeleton and changes the viscoelastic properties of cells, allowing them to be more easily remodeled.50 Finally, the mechanical stimulation of fibroblasts stimulates collagen synthesis via the extracellular signal regulated kinase (ERK) pathway.57,59 To date, a number of studies of tendon injuries in animal models have demonstrated an increase in the number, size and organization of collagen fibers.32,33

Electric Dry Needling

In general, randomized control trials from the acupuncture literature achieve enhanced analgesia when multiple needles are inserted, needles are left in-situ from 8-30 minutes, and when electricity is used to stimulate needles.1,18 While only one systematic review has directly compared electric with manual needle stimulation, the use of electric stimulation of joint OA was superior.60 A number of different theories have attempted to explain the importance of electric needle stimulation.  For example, the electric stimulation is thought to prolong mechanotransduction associated with acupuncture, leading to increased vasodilation and analgesia.61,62 Evidence from the acupuncture literature also suggests that it may help to control peripheral levels of CGRP.63 Although CGRP in high levels causes inflammation and may lead to peripheral sensitivity via hyperalgesic priming, low levels of CGRP may help block the cellular correlates of peripheral hypersensitivity.64,65 Electric needles stimulation has also been shown to stimulate the hypothalamic pituitary adrenal axis, which helps to maximize endogenous opioids while limited systemic factors of inflammation such as interleukin factors and tumor necrosis factor alpha.66-68

Peri-neural Needling

Peri-neural needling has been shown to be a useful treatment strategy in a number of patient diagnoses, to include carpal tunnel69,70, Bells Palsy71,72, trigeminal neuralgia73, sciatica74,75, neuropathy76, and peripheral radiculopathy.77 Electric dry needling in peri-neural tissue has been shown to decrease pain by promoting endogenous opioids such as beta-endorphins, enkephalins, and dynorphins.1,2 It has also been shown to improve microcirculation via nitric oxide, resulting in enhanced intra and extra neural blood flow.21 A number of studies have reported increased differentiation of endogenous oligodendrocyte precursor and stem cells, clearance of myelin debris, and remyelination of central neurons, which correlated with significant improvement in function in animal models of multiple sclerosis.78,79 Recent evidence further suggests that electric dry needling may even promote neural repair peripherally by promoting schwann cell proliferation and migration.80

Dry Needling and Regenerative Medicine

A recent systematic review of 23 studies by Griswald et al. concluded that dry needling had similar short, medium and long-term effects in pain and disability compared to platelet-rich plasma injections and better long-term outcomes than cortisone injections.81 In a separate randomized control trial, Saornil et al. concluded that the combination dry needling plus hyaluronic acid provided the best conservative treatment option for patients with osteoarthritis.82 The fact that electroacupuncture has been linked to the mobilization83, release83, survival84 and differentiation84 of mesenchymal stem cells further suggest that dry needling may augment stem injections for orthopedic conditions. 

Works Cited

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  67. Lee JH, Jang KJ, Lee YT, Choi YH, Choi BT. Electroacupuncture inhibits inflammatory edema and hyperalgesia through regulation of cyclooxygenase synthesis in both peripheral and central nociceptive sites. Am J Chin Med. 2006;34(6):981-988.
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  76. Shin KM, Lee S, Lee EY, et al. Electroacupuncture for Painful Diabetic Peripheral Neuropathy: A Multicenter, Randomized, Assessor-Blinded, Controlled Trial. Diabetes Care. 2018;41(10):e141-e142.
  77. Inoue M, Hojo T, Yano T, Katsumi Y. Electroacupuncture direct to spinal nerves as an alternative to selective spinal nerve block in patients with radicular sciatica--a cohort study. Acupunct Med. 2005;23(1):27-30.
  78. Ding Y, Zhang RY, He B, et al. Combination of electroacupuncture and grafted mesenchymal stem cells overexpressing TrkC improves remyelination and function in demyelinated spinal cord of rats. Sci Rep. 2015;5:9133.
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  80. Liu YP, Luo ZR, Wang C, et al. Electroacupuncture Promoted Nerve Repair After Peripheral Nerve Injury by Regulating miR-1b and Its Target Brain-Derived Neurotrophic Factor. Front Neurosci. 2020;14:525144.
  81. Griswold D, Learman K, Ickert E, et al. Comparing dry needling or local acupuncture to various wet needling injection types for musculoskeletal pain and disability. A systematic review of randomized clinical trials. Disabil Rehabil. 2023:1-15.
  82. Saornil JV, Sanchez Mila Z, Campon Chekroun AM, et al. Comparative Study of the Efficacy of Hyaluronic Acid, Dry Needling and Combined Treatment in Patellar Osteoarthritis-Single-Blind Randomized Clinical Trial. Int J Environ Res Public Health. 2022;19(17).
  83. Salazar TE, Richardson MR, Beli E, et al. Electroacupuncture Promotes Central Nervous System-Dependent Release of Mesenchymal Stem Cells. Stem Cells. 2017;35(5):1303-1315.
  84. Ding Y, Yan Q, Ruan JW, et al. Electro-acupuncture promotes survival, differentiation of the bone marrow mesenchymal stem cells as well as functional recovery in the spinal cord-transected rats. BMC Neurosci. 2009;10:35.

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Symmetry Physical Therapy is a privately owned one-on-one, patient-centered physical therapy clinic in Downtown Miami/Brickell. Every treatment is with the same Doctor of Physical Therapy for the entire hour. Symmetry’s specialized, dedicated, and passionate team of physical therapists is fully committed to each patient’s success.

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10+ Years as a Therapist Owned Physical Therapy Practice

Types of Therapy offered at Symmetry:

 

Physical Therapy Treatments
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28 W. Flagler St. Ste. 901 Miami, FL 33130

T: 305-331-2277

F: 305-424-9361

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