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!
The Benefits of Dry Needling
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.
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.
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.
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
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
- Butts R, Dunning J, Perreault T, Maurad F, Grubb M. Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals. International Journal of Physical Medicine and Rehabilitation. 2016;216(4:2).
- Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014;19(4):252-265.
- Travell JG, Simons DG. Travell & Simons' myofascial pain and dysfunction : the trigger point manual. Vol 1. Baltimore: Lippincott Williams & Wilkins; 1983.
- Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004;8(6):468-475.
- Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Notices. 2014;2014.
- LeBauer A, Brtalik R, Stowe K. The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. J Bodyw Mov Ther. 2008;12(4):356-363.
- Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001;5(5):412-420.
- Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002;65(4):653-660.
- Simons DG. Myofascial pain syndromes: where are we? Where are we going? Arch Phys Med Rehabil. 1988;69(3 Pt 1):207-212.
- Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008;12(4):371-384.
- Sciotti VM, Mittak VL, DiMarco L, et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001;93(3):259-266.
- Dorsher PT. Can classical acupuncture points and trigger points be compared in the treatment of pain disorders? Birch's analysis revisited. J Altern Complement Med. 2008;14(4):353-359.
- Perreault T, Dunning J, Butts R. The local twitch response during trigger point dry needling: Is it necessary for successful outcomes? Journal of Bodywork and Movement Therapies. 2017;3(8).
- Shah JP, Danoff JV, Desai MJ, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008;89(1):16-23.
- Cagnie B, Barbe T, De Ridder E, Van Oosterwijck J, Cools A, Danneels L. The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. J Manipulative Physiol Ther. 2012;35(9):685-691.
- Okubo Y, Kaneoka K, Imai A, et al. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. J Orthop Sports Phys Ther. 2010;40(11):743-750.
- Shinbara H, Okubo M, Sumiya E, Fukuda F, Yano T, Kitade T. Effects of manual acupuncture with sparrow pecking on muscle blood flow of normal and denervated hindlimb in rats. Acupunct Med. 2008;26(3):149-159.
- Butts R, Dunning J, Serafino C. Dry needling strategies for musculoskeletal conditions: Do the number of needles and needle retention time matter? A narrative literature review. J Bodyw Mov Ther. 2021;26:353-363.
- Lundeberg T. Acupuncture mechanisms in tissue healing: contribution of NO and CGRP. Acupunct Med. 2013;31(1):7-8.
- Shinbara H, Nagaoka S, Izutani Y, et al. Contribution of adenosine to the increase in skeletal muscle blood flow caused by manual acupuncture in rats. Acupunct Med. 2017;35(4):284-288.
- Loaiza LA, Yamaguchi S, Ito M, Ohshima N. Electro-acupuncture stimulation to muscle afferents in anesthetized rats modulates the blood flow to the knee joint through autonomic reflexes and nitric oxide. Auton Neurosci. 2002;97(2):103-109.
- Tsikopoulos K, Tsikopoulos I, Simeonidis E, et al. The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis. Phys Ther Sport. 2016;17:87-94.
- Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic effects of dry needling. Curr Pain Headache Rep. 2013;17(8):348.
- Hussain SM, Wang Y, Shaw JE, et al. Retinal arteriolar narrowing and incidence of knee replacement for osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage. 2015;23(4):589-593.
- Findlay DM. Vascular pathology and osteoarthritis. Rheumatology (Oxford). 2007;46(12):1763-1768.
- Biberthaler P, Wiedemann E, Nerlich A, et al. Microcirculation associated with degenerative rotator cuff lesions. In vivo assessment with orthogonal polarization spectral imaging during arthroscopy of the shoulder. J Bone Joint Surg Am. 2003;85-A(3):475-480.
- Ahsin S, Saleem S, Bhatti AM, Iles RK, Aslam M. Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee. Pain. 2009;147(1-3):60-66.
- Huang J, Zhuo LS, Wang YY, et al. [Effects of electroacupuncture on synovia IL-1beta and TNF-alpha contents in the rabbit with knee osteoarthritis]. Zhen Ci Yan Jiu. 2007;32(2):115-118.
- Zhang R, Lao L, Ren K, Berman BM. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology. 2014;120(2):482-503.
- Li ZD, Cao LH, Wang SC. [Effect of moxibustion in treating knee joint osteoarthritis and its relation with contents of hyaluronic acid in serum and synovial fluid]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009;29(10):883-885.
- Liu X, Shen L, Wu M, et al. Effects of acupuncture on myelogenic osteoclastogenesis and IL-6 mRNA expression. J Tradit Chin Med. 2004;24(2):144-148.
- Almeida M, Freitas K, Oliveira L. Acupuncture increases the diameter and reorganization of collagen fibrils during rat tendon healing. Acupunct Med. 2015;33:53-57.
- Almeida M, Aro A, Guerrra F. Electroacupuncture increases the concentration and organization of collagen in a tendon healing model in rats. Connective Tissue Research. 2012;53:542-547.
- Inoue M, Nakajima M, Oi Y, Hojo T, Itoi M, Kitakoji H. The effect of electroacupuncture on tendon repair in a rat Achilles tendon rupture model. Acupunct Med. 2015;33(1):58-64.
- Stoychev V, Finestone AS, Kalichman L. Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review. Curr Rev Musculoskelet Med. 2020;13(1):133-140.
- Corbett MS, Rice SJ, Madurasinghe V, et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage. 2013;21(9):1290-1298.
- Mavrommatis CI, Argyra E, Vadalouka A, Vasilakos DG. Acupuncture as an adjunctive therapy to pharmacological treatment in patients with chronic pain due to osteoarthritis of the knee: a 3-armed, randomized, placebo-controlled trial. Pain. 2012;153(8):1720-1726.
- Vas J, Mendez C, Perea-Milla E, et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ. 2004;329(7476):1216.
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- Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN. Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Arthritis Rheum. 2006;54(11):3485-3493.
- Dunning J, Butts R, Young I, et al. Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis: A Multicenter Randomized Clinical Trial. Clin J Pain. 2018;34(12):1149-1158.
- Bardoni R, Takazawa T, Tong CK, Choudhury P, Scherrer G, Macdermott AB. Pre- and postsynaptic inhibitory control in the spinal cord dorsal horn. Ann N Y Acad Sci. 2013;1279:90-96.
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- Zhang Y, Zhang RX, Zhang M, et al. Electroacupuncture inhibition of hyperalgesia in an inflammatory pain rat model: involvement of distinct spinal serotonin and norepinephrine receptor subtypes. Br J Anaesth. 2012;109(2):245-252.
- Su TF, Zhang LH, Peng M, et al. Cannabinoid CB2 receptors contribute to upregulation of beta-endorphin in inflamed skin tissues by electroacupuncture. Mol Pain. 2011;7:98.
- Langevin HM, Bouffard NA, Badger GJ, Churchill DL, Howe AK. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cell Physiol. 2006;207(3):767-774.
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- Langevin HM, Schnyer R, MacPherson H, et al. Manual and electrical needle stimulation in acupuncture research: pitfalls and challenges of heterogeneity. J Altern Complement Med. 2015;21(3):113-128.
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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.