Dry Dry NeedlingNeedling quite the sexy modality as of late, especially here in Colorado.  For those of you that don’t know what dry needling is, it involves placing needles in the “trigger points” of the muscles with the goal of decreasing pain.  Historically, there has been very little concrete data to support the use of dry needling, or how effective the treatment is compared to other forms of interventions in physical therapy.

My personal reservation about adopting dry needling in my clinical care is that my outcomes are already pretty good. (I know because I keep track of them).  I have worked several conversations with colleagues who are really into dry needling, but I didn’t see their patients getting better any faster overall.  Most clinics charge an extra fee for performing dry needling, anywhere from $5 to $20 per visit. Therefore, the cost to perform the procedure is more money out of pocket for the patient, so it better work better, right?

For those of you that want a straight answer, it’s beginning to look like dry needling works better only when you compare it to a sham procedure or no other interventions performed (1,2,3)  It has been shown to offer no additional value in shoulder pain when compared to personable evidence based practice of physical therapy in terms of outcomes and duration of care(4).  For whiplash low back pain, dry needling works better in the short and medium term, but offers no advantage in outcomes when compared to physical therapy interventions (5,6).  It does not appear to have any long term advantages to dry needling (5).  It’s beginning to look like orthopedic manual therapy ( joint manipulation and mobilization) may work better compared to dry needling (7) or, at the very least, has similar outcomes (8)

From my perspective, I don’t see the advantage of using dry needling as a primary treatment modality.  It takes up a lot of time in the clinic to perform correctly, and there are other things we do in physical therapy that have better long term prospects (exercise, manual therapy, good overall patient management).

If you fail a particular set of interventions, or are progressing more slowly than usual, dry needling may provide some benefit and a nice adjunct to move you along in care for those suborn problems.  You probably will respond well to dry needling if the trigger point is the primary source of your pain without any other additional peripheral triggers.  But if you have an acute disc herniation, it may not be your best bet for a good, cost-effective outcome.

If you do the math, the national average shoulder care for physical therapy is 12 visits.  Assume you’re paying $10 extra for dry needling over the counter, you are paying $120 dollars cash for, at the very least, the same outcome.  I’m not sure people are getting their money’s worth when you add dry needling to a plan of care that does not really need to have it.

References:

1)            Gerber et al, Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion, PM R. 2017 Feb;9(2):105-112.  Available at: https://www.ncbi.nlm.nih.gov/pubmed/27297448

2)            Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects With Chronic Myofascial Pain, PM R. 2015 Jul;7(7):711-8

3)            Lui et al, Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis, Arch Phys Med Rehabil. 2015 May;96(5):944-55.  Available at: https://www.ncbi.nlm.nih.gov/pubmed/28158962

4)            Pérez-Palomares S et al, Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial, J Orthop Sports Phys Ther. 2017 Jan;47(1):11-20, Available at: https://www.ncbi.nlm.nih.gov/pubmed/27937046

5)            Gattie et al., The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis, J Orthop Sports Phys Ther. 2017 Mar;47(3):133-149.  Available at: https://www.ncbi.nlm.nih.gov/pubmed/28158962

6)            Sterling et al., Dry-needling and exercise for chronic whiplash-associated disorders: a randomized single-blind placebo-controlled trial, Pain. 2015 Apr;156(4):635-43.  Available at: https://www.ncbi.nlm.nih.gov/pubmed/25790454

7)            Campa-Moran et al., Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study. Pain Res Treat. 2015;2015:327307.  Available at: https://www.hindawi.com/journals/prt/2015/327307/

8)            Llamos-Ramos et al., Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014 Nov;44(11):852-61.  Available at: https://www.ncbi.nlm.nih.gov/pubmed/25269764