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 Science Behind Dry Needling
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.
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.
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.
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 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.
- 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.
- Witt C, Brinkhaus B, Jena S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet. 2005;366(9480):136-143.
- 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.
- Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85(4):355-375.
- 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.
- Langevin HM, Bouffard NA, Churchill DL, Badger GJ. Connective tissue fibroblast response to acupuncture: dose-dependent effect of bidirectional needle rotation. J Altern Complement Med. 2007;13(3):355-360.
- 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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- Goldman N, Chandler-Militello D, Langevin HM, Nedergaard M, Takano T. Purine receptor mediated actin cytoskeleton remodeling of human fibroblasts. Cell Calcium. 2013;53(4):297-301.
- Takano T, Chen X, Luo F, et al. Traditional acupuncture triggers a local increase in adenosine in human subjects. J Pain. 2012;13(12):1215-1223.
- Zylka MJ. Pain-relieving prospects for adenosine receptors and ectonucleotidases. Trends Mol Med. 2011;17(4):188-196.
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- Huang M, Zhang D, Sa ZY, Xie YY, Gu CL, Ding GH. In adjuvant-induced arthritic rats, acupuncture analgesic effects are histamine dependent: potential reasons for acupoint preference in clinical practice. Evid Based Complement Alternat Med. 2012;2012:810512.
- Tamaddonfard E, Erfanparast A, Farshid AA, Khalilzadeh E. Interaction between histamine and morphine at the level of the hippocampus in the formalin-induced orofacial pain in rats. Pharmacol Rep. 2011;63(2):423-432.
- Brown RE, Stevens DR, Haas HL. The physiology of brain histamine. Prog Neurobiol. 2001;63(6):637-672.
- Almeida Mdos S, Guerra Fda R, de Oliveira LP, Vieira CP, Pimentel ER. A hypothesis for the anti-inflammatory and mechanotransduction molecular mechanisms underlying acupuncture tendon healing. Acupunct Med. 2014;32(2):178-182.
- Yim YK, Lee H, Hong KE, et al. Electro-acupuncture at acupoint ST36 reduces inflammation and regulates immune activity in Collagen-Induced Arthritic Mice. Evid Based Complement Alternat Med. 2007;4(1):51-57.
- Kook SH, Hwang JM, Park JS, et al. Mechanical force induces type I collagen expression in human periodontal ligament fibroblasts through activation of ERK/JNK and AP-1. J Cell Biochem. 2009;106(6):1060-1067.
- Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010(1):CD001977.
- Tu WZ, Cheng RD, Cheng B, et al. Analgesic effect of electroacupuncture on chronic neuropathic pain mediated by P2X3 receptors in rat dorsal root ganglion neurons. Neurochem Int. 2012;60(4):379-386.
- Cheng RD, Tu WZ, Wang WS, et al. Effect of electroacupuncture on the pathomorphology of the sciatic nerve and the sensitization of P2X(3) receptors in the dorsal root ganglion in rats with chronic constrictive injury. Chin J Integr Med. 2013;19(5):374-379.
- Bullock CM, Kelly S. Calcitonin gene-related peptide receptor antagonists: beyond migraine pain--a possible analgesic strategy for osteoarthritis? Curr Pain Headache Rep. 2013;17(11):375.
- Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003;12(2):59-69.
- Raud J, Lundeberg T, Brodda-Jansen G, Theodorsson E, Hedqvist P. Potent anti-inflammatory action of calcitonin gene-related peptide. Biochem Biophys Res Commun. 1991;180(3):1429-1435.
- Li A, Lao L, Wang Y, et al. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complement Altern Med. 2008;8:20.
- 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.
- Li A, Zhang RX, Wang Y, et al. Corticosterone mediates electroacupuncture-produced anti-edema in a rat model of inflammation. BMC Complement Altern Med. 2007;7:27.
- Badia M, Santafe M. Acupuncture and electroacupuncture for the treatment of carpal tunnel syndrome: systematic review. Journal of Invasive Techniques in Physical Therapy. 2020;3(10).
- Wu IX, Lam VC, Ho RS, et al. Acupuncture and related interventions for carpal tunnel syndrome: systematic review. Clin Rehabil. 2020;34(1):34-44.
- Mayor D. Electroacupuncture: An Introduction and Its Use fo Peripheral Facial Paralysis. Journal of Chinese Medicine. 2007;84(1-19).
- Zheng H, Li Y, Chen M. Evidence based acupuncture practice recommendations for peripheral facial paralysis. Am J Chin Med. 2009;37(1):35-43.
- Yin Z, Wang F, Sun M, Zhao L, Liang F. Acupuncture Methods for Primary Trigeminal Neuralgia: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2022;2022:3178154.
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- Liu XT, Tao X, Ma TM, et al. [Effect of Electroacupuncture Stimulation of Different Tissues at "Huantiao" (GB 30) Acupoint on Expression of Phosphorylated JNK and c-jun in Spinal Cord of Rats with Sciatic Nerve Injury]. Zhen Ci Yan Jiu. 2015;40(5):373-377.
- 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.
- 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.
- 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.
- Zhu K, Sun J, Kang Z, Zou Z, Wu G, Wang J. Electroacupuncture Promotes Remyelination after Cuprizone Treatment by Enhancing Myelin Debris Clearance. Front Neurosci. 2016;10:613.
- 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.
- 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.
- 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).
- 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.
- 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.
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 professionals is fully committed to each patient’s success.