Basics of dry needling

1. DR. SUBHANJAN DAS, PT
Subhanjan_82@yahoo.com
+91 8967549104
Dry Needling Instructor
MPT (Musculoskeletal & Sports)
Assoc. Prof., BIMLS, Burdwan

2. Also in the series
 http://www.slideshare.net/SubhanjanDas/introduction-to-dry-needling
 http://www.slideshare.net/SubhanjanDas/2-brief-hisory-of-needling
 http://www.slideshare.net/SubhanjanDas/3-superficial-dry-needling
 http://www.slideshare.net/SubhanjanDas/4-indications-of-dry-needling
 http://www.slideshare.net/SubhanjanDas/6-dangers-of-dry-needling
 http://www.slideshare.net/SubhanjanDas/7-physiologic-background-of-dry-needling
 http://www.slideshare.net/SubhanjanDas/8-dn-vs-acupuncture
 http://www.slideshare.net/SubhanjanDas/9-electroacupuncture
 http://www.slideshare.net/SubhanjanDas/10-legalities-involved-in-dry-needling

3. What comes to our mind first when
we think of Dry Needling

4. What comes to our mind first when
we think of Dry Needling
Acupuncture

5. What comes to our mind first when
we think of Dry Needling
CHINESE

6. What comes to our mind first when
we think of Dry Needling
Placebo

7. What comes to our mind first when
we think of Dry Needling
UNSCIENTIFIC?

8. What comes to our mind first when
we think of Dry Needling
And still, we feel a little curious!

9. Is it acupuncture?
“ From a physical therapy perspective, TrP-DN has no
similarities with traditional acupuncture other than
the tool.”- Jan Dommerholt1

10. Is it Chinese?
Early proponents of dry needling include Klellgren
(British), Chan Gunn (Canadian) and other people of
western world.

11. Is it unscientific?
 A no. of independent research validates Dry Needling.
 2 systematic reviews3,4 have validated dry needling
including a Cochrane review (highly prestigious!)

12. Is it placebo?
Various studies in animal and human models have found
specific physiological changes related with dry
needling. Some placebo effects may be present but
there is a sea of evidence showing objective
measurable changes which rules out ‘placebo only’
theories.

13. What is dry needling?
 Dry needling is a procedure where filiform needles are
tapped through the skin to the target tissue to bring
about a therapeutic effect.
 No medicine is delivered, thus it is called ‘dry’,
compared to injections, which are ‘wet’.
 Other names/variations are IMS, TrP DN etc.

14. Needles
 Needles can be as short as12.5 mm or as long as 100
mm. the choice of needle is based on the target
tissue and specific techniques used.
 Disposable filiform acupuncture needle with
guide tube is used. (filiform= solid)
 Guide tube minimizes pain

15. Disposable sterile needles packed

16. Needles with guide tubes

17. Needles sans guide tube

18. How is it performed?  With careful precision the structure to be needled is
chosen. Then sterilized disposable needles are pierced
through the skin into the target tissue.
 Choice of needle is dependent upon depth of target
tissue.
 A clean field technique is used. As there is minimal or
no bleeding, sterile field is not needed.
 The needles are kept inserted for a span of 30 seconds
to few minutes and then withdrawn and disposed
properly.

19. How is it performed?
 A sharps bin is
mandatory for needle
disposal.
Alternate to sharps bin

20. Specific techniques
 Deep Dry Needling: When needle is pierced deep into
the muscle/target tissue. Local Twitch Response is
elicited.
 Superficial Dry Needling: Started by Peter Baldry,
where only the skin overlying the target tissue is
pierced.
 Periosteal pecking
 Needle manipulation
 Intramuscular electrical stimulation (PENS)

21. PENS

22. Response to needling  Dry needling, much like MWM, when indicated,
produces immediate effect.
 Different people respond to needling differently and
are thus classified as strong, average and weak
responders. A strong responder will need minimal
needle stimulation to achieve needling effect;
overstimulation can worsen patient’s pain2.

24. To sum up
 With proper judgment and precision dry needling is a
powerful tool for the physiotherapist.
 It is a quick, cost efficient treatment which when
indicated produces immediate result.
 The risks are real. Need for training and safety
precautions can not be over emphasized.

26. References
1. Dommerholt et. al, Trigger point dry needling.
2. Baldry P. Acupuncture treatment of fibromyalgia and
myofascial pain. Fibromyalgia syndrome. Elsevier,
2010:149
3. Cummings TM, White AR. Needling therapies in the
management of myofascial trigger point pain: a
systematic review. Arch Phys Med
Rehabil2001; 82: 986–92.
4. Furlan AD, van TulderMW, et al. Acupuncture and
dry-needling for low back pain. Cochrane Database
Syst Rev 2005;(1):CD001351

27. References
5. Travel and Simon’s Myofascial pain and dysfunction
the trigger point manual
6. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo
microanalytical technique for measuring the local
biochemical milieu of human skeletal muscle. J Appl
Physiol 2005;99:1980-1987.
7. Lundeberg T, Stener-Victorin E. Is there a
physiological basis for the use of acupuncture in pain?
Int Congress Series 2002;1238:3-10.

28. References
8. Baldry PE. Acupuncture, Trigger Points and
Musculoskeletal Pain. Edinburgh, UK: Churchill
Livingstone, 2005.
 9. 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;207:767-774