A dry needling therapist with a sound background knowledge in anatomy and neurophysiology is very effective in treating musculoskeletal pain. There are similarities but also significant differences between the traditional Chinese system of acupuncture and dry needling. Acupuncture follows rules and beliefs which have been laid down in ancient times.
Channels and meridians
In traditional acupuncture the body is divided by a series of meridians or channels into a organised network. This complex system of channels and vessels is believed to act as a distribution system that carries Chi (energy), blood and the body fluids around the body. The origins of acupuncture are impossible to define because they lie in periods before recorded history. But these channels were described as early as 200 BC in the classic ancient work on acupuncture, the Huang Di Nei Jing.
Chi the energy
The channels (meridians) were compared to the great rivers in china, extending to all parts of the country, keeping it alive by providing the essential water and nutrients. According to traditional acupuncture concepts Chi is the dynamic vital energy present in all living things which flows through the channels regulating the body’s functions. It is believed that these channels connect the interior of the body with the exterior.
The basic principle of acupuncture is that by stimulating points on the surface of the body, an effect occurs that is transmitted through the meridians and ultimately into the interior of the body.
It is suggested that acupuncture can treat a vast range of illnesses as well as reduce pain. In contrast dry needling has been specifically developed for pain relief only.
Dry needling ignores the ancient rules
Modern dry needling principles largely ignores the ancient rules described above. Much of the original Traditional Chinese Medicine is based on pre-scientific ideas. Whereas dry needling is based on modern neurophysiology and anatomy.
An aura of mysticism
There is an aura of mysticism behind the acupuncture theory and its practice. This can appeal to both practitioners and patients. Dry needling however is purely for pain relief and is based on recent understanding in pain science, there is therefore less mystique surrounding dry needling.
Why is dry needling concept different?
To understand the dry needling concept one has to look at the mechanisms involved in pain.
Musculoskeletal pain is often associated with an area of exquisite tenderness (hyperalgesia) at a trigger point site.This site is tender due to sensitised nerve endings. The trigger point site is often accompanied by muscle shortening. A shortened muscle, can in itself become painful, not work properly, pull on the tendonous insertion and cause enthesopathy / tendinosis. For example lateral epicondylitis (tennis elbow). A muscle with trigger points is much weaker due to a pain inhibition. This causes muscle imbalance and secondary biomechanical problems. Trigger points can refer pain by themselves, but also irritate nerves and cause further pain in a remote area. These trigger points can be found in muscle, fascia, ligaments, tendons and the periosteum.
Prior to the treatment
A thorough medical assessment is carried out to rule out sinister pathology. A diagnosis / hypothesis is established in regards to the type of pain mechanism involved and related musculoskeletal dysfunctions..
There are mainly 2 types of pain:
1. Neuropathic pain – from a damaged or dysfunctional nerve. This type of pain is difficult to treat but can respond to dry needling.
2. Nociceptive pain – Which is most common – osteoarthritis, head aches, sprains and strains, myofascial pain. These types of pain respond very well to dry needling
The concept of modern dry needling is based on a trigger point (hyperalgesia) and muscle imbalance model. A dry needling therapist can “feel” with the needle and utilise it as a diagnostic instrument. This is often extremely helpful as tight muscles, contractures and trigger points are invisible to X-rays, CT scans or MRI. Contractures in deep muscles can be felt with the needle, via feed back on the quality of the tissues that it is penetrating. Contracted muscle fibres provide resistance to the needle and may cause a “grasp”. This often reproduces the patient’s symptoms or a deep ache, which the Chinese describes as “deChi”. The neuro-musculoskeletal assessment determines the needling sites. The dry needling therapist seeks out tender (hyperalgesic) and tight muscle bands in affected segments for needling. Following the needling, physical signs such as: shortening, vasoconstriction, and tenderness can disappear in seconds or minutes. More chronic conditions may take several sessions to treat due to a sensitised peripheral and central nervous system.
Following the treatment:
- The muscle tension is reset
- The trigger point is desensitised by the body’s own neurotransmitting chemicals (opiods, enkephalins, serotonin, Beta endorphins etc).
Advantages of dry needling:
- The main advantage of dry needling is that a health practitioner can assimilate the concept to everyday practice.
- One can become an effective dry needling clinician very quickly
- There is no mysticism
- It is quick to perform
- In competent hands it is a safe treatment
Dry needling is based on the current understanding of neurophysiology and functional anatomy. The concept is easy to understand and apply in clinical practice.
References and further reading:
Baldry PE (2005) Acupuncture, trigger Points and Musculoskeletal Pain
Churchill Livingstone 3rd Edition
Baldry PE (2001) Myofascial pain and fibromyalgia syndromes
Gellman H (2002) Acupuncture Treatment for Musculoskeletal Pain
(A textbook for orthopaedics, Anaesthesia and rehabilitation.)
Taylor and Francis
Gunn CC (1996) The Gunn approach to the treatment of chronic pain
Churchill Livingstone, 2nd Edition
Mann F (2000) Reinventing acupuncture
( A new concept of ancient medicine)
Butterworth Heinemann 2nd Edition
Xinnong C (1987) Chinese acupuncture and Moxibustion
Foreign Language press