Dry Needling by a Physical Therapist: What You Should Know

I got questions about DN a lot recently. So here is a useful link to learn about Dry needling.

https://www.moveforwardpt.com/Resources/Detail/dry-needling-by-physical-therapist-what-you-should

A licensed PT with DN training will help you to deal with tightness, pain, and headache.

My personal feeling about Dry Needling was not as great at the very beginning, mainly because of the limited evidence we have now.  But after seeing the change of my clients after DN, I recommend DN to all providers and clients.

The baseline is the anatomy. Now I see the DN technique as a new approach to get to the deep and sensitive muscles. Usually, I will have to do a lot stretching and adjustment of the spine before the "angry tissues" will relax. That means more pain during the process and less compliant with my client.

Now with DN approach, I can pinpoint the compensated tissues quickly. I mean genuinely PINPOINT the target tissue, such as scalene muscles.

The front bundle of the scalene is sitting behind the clavicle head of the SCM (green triangle) with the brachial plexus nerve, internal jugular vein and common carotid artery as its neighbors. Due to a lot of the tension in the neck and shoulder, this group of scalene muscles might develop high muscle tone with trigger points. Dry needling directly onto the muscle bundle through the safety window (dark triangle) will give quick relief of the muscle tone. The front and middle bundle of this muscle group are attached to the first rib. When the muscle tone is too high, the first rib might be pulled up all the time and cause impingement of the brachial nerve and vessels. Thoracic Outlet Syndrome might be diagnosed based on that. Numbness and/or tingling will develop in the distal arm of the same side.

So how did my clients respond to DN approach?

Client 1 : "I think the dry needling has really helped. I am feeling better than I've felt in a long time."
Client 2 : "I was being very pleased with how it's been doing over the past few weeks, no pain in the shoulder blade and less pain in the front. I was really excited."
Client 3: " I have much less numbness/tingling in the right hand after DN on scalene muscles."
Client 4: " I can move the shoulder better." His shoulder flexion/scaption range of motion improved from 140 to 180 degrees without pain after DN on the coracoclavicular ligament, anterior GH ligament, and coracoid bone with E stim.

I still spend time checking the biomechanics of human body and trying to educate and restore the normal sequencing of the muscle performance.
DN is not the answer to all the problems. Clients still need to work on the muscles!

"Is Dry Needling safe?"

Drowsiness, tiredness or dizziness occurs after treatment in a small number of patients (1-3%) and if affected, you are advised not to drive. Minor bleeding or bruising occurs after dry needling in 15-20% of treatments and is considered normal. Temporary pain during dry needling occurs in 60-70% of treatments. Existing symptoms can get worse after treatment (less than 3% of patients); however, this is not necessarily a "bad" sign. Fainting can occur in certain patients (0.3%), particularly at the first treatment session when needling the head or neck regions. Dry needling is very safe; however, serious side effects can occur in less than 1 per 10,000 (less than 0.01%) treatments. The most common serious side effect of dry needling is pneumothorax (lung collapse due to air inside the chest wall). The symptoms of dry needling-induced pneumothorax commonly do not occur until after the treatment session, sometimes taking several hours to develop. The signs and symptoms of a pneumothorax may include shortness of breath on exertion, increased breathing rate, chest pain, a dry cough, bluish discoloration of the skin, or excessive sweating. If such signs and/or symptoms occur, you should immediately contact your physical therapist or physician. Nerves or blood vessels may be damaged from dry needling which can result in pain, numbness or tingling; however, this is a very rare event and is usually temporary. Damage to internal organs has been reported in the medical literature following needling; however, these are extremely rare events (1 in 200,000).

Let me know if you have questions.

Dr Sheng Wu,PT,DPT

Text : 505 908 5553