MECHANISMS OF DRY NEEDLING

Mechanical Effects Dry needling of an MTrP may mechanically disrupt the integrity of the dysfunctional motor end plates. From a mechanical point of view, needling of MTrPs may be related to the extremely shortened sarcomeres.It is plausible that an accurately placed needle provides a localized stretch to the contracted cytoskeletal structures, which may disentangle the myosin filaments from the titin gel at the Z-band.This would allow the sarcomere to resume its resting length by reducing the degree of overlap between actin and myosin filaments. If indeed a needle can mechanically stretch the local muscle fiber, it would be beneficial to rotate the needle during insertion. Rotating the needle results in winding of connective tissue around the needle, which clinically is experienced as a needle grasp. Comparisons between the orientation of collagen following needle insertions with and without needle rotation demonstrated that the collagen bundles were straighter and more nearly parallel to each other after needle rotation. Langevin and colleagues report that brief mechanical stimulation can induce actin cytoskeleton reorganization and increases in proto-oncogenes expression, including cFos and tumor necrosing factor and interleukins. Moving the needle up and down as is done with needling of a MTrP may be sufficient to cause a needle grasp and a resultant LTR. (Loca; twitch response) As a result of mechanical stimulation, group II fibers will register a change in total fiber length, which may activate the gate control system by blocking nociceptive input from the MTrP and hence cause alleviation of pain. The mechanical pressure exerted via the needle also may electrically polarize the connective tissue and muscle. A physical characteristic of collagen fibers is their intrinsic piezoelectricity, a property that allows tissues to transform mechanical stress into electrical activity necessary for tissue remodeling, possibly contributing to the LTR.

Neurophysiologic Effects In his arguments in favor of neurophysiological explanations of the effects of dry needling, Baldry concludes that with the superficial dry needling technique,A-delta nerve fibers (group III) will be stimulated for as long as 72 hours after needle insertion. Prolonged stimulation of the sensory afferent A-delta nerve fibers may activate the enkephalinergic inhibitory dorsal horn inter neurons, which would imply that superficial dry needling causes opioid mediated pain suppression. Another possible mechanism of superficial dry needling is the activation of the serotonergic and noradrenergic descending inhibitory systems, which would block any incoming noxious stimulus into the dorsal horn.The activation of the enkephalinergic, serotonergic, and noradrenergic descending inhibitory systems occurs with dry needle stimulation of A-delta nerve fibers anywhere in the body. Skin and muscle needle stimulation of A-delta and C-(group IV) afferent fibers in anesthetized rats was capable of producing an increase in cortical cerebral blood

flow, which was thought to be due to a reflex response of the afferent pathway, including group II and IV afferent nerves and the efferent intrinsic nerve pathway, including cholinergic vasodilators.38 Superficial needling of certain acupuncture points in patients with chronic pain showed similar changes in cerebral blood flow.Gunns and Fischers techniques of needling both the paraspinal muscles and peripheral muscles belonging to the same myotome, appear to be supported by several animal studies. For example, Takeshige and Sato determined that both direct needling into the gastrocnemius muscle and into the ipsilateral L5 paraspinal muscles of a guinea pig resulted in significant recovery of the circulation, after ischemia was introduced to the muscle using titanic muscle stimulation. They also confirmed that needling of acupuncture points and non-acupuncture points involved the descending pain inhibitory system, although the actual afferent pathways were distinctly different. Acupuncture analgesia involved the medial hypothalamic arcuate nucleus of the descending pain inhibitory system, while non-acupuncture analgesia involved the anterior part of the hypothalamic arcuate nucleus. In both kinds of needle stimulation, the posterior hypothalamic arcuate nucleus was involved. There is no research to date that clarifies the role of the descending pain inhibitory system with needling of MTrPs.

Chemical Effects The studies by Shah and colleagues demonstrated that the increased levels of various chemicals, such as bradykinin, CGRP, substance P, and others, at MTrPs are immediately corrected by eliciting a LTR with an acupuncture needle. Although it is not known what happens to these chemicals when a needle is inserted into the MTrP, there is now strong albeit unpublished data that suggest that eliciting a LTR is essential.

What's the Difference between Dry Needling and Acupuncture?

Just because they are using our needles now does not mean these practitioners are performing acupuncture. Here are the main differences:

1) Dry needling aims for trigger points and knotted muscle fibers whereas acupuncture employs and is based on the meridian system. As discussed in previous blog entries (here and here), the meridian system maps out the flow of Qi throughout the body - to the various organ systems and body tissues. We are able to relieve pain by stimulating points along specific meridians, and often the site of the needling is far away from the painful area. Dry needling does not take into account this fundamental aspect of Chinese medicine.

2) Dry needling treats symptoms while acupuncture address underlying causes of pain. Pain in your shoulder can stem from an issue in your elbow or a problem near your spine. Essentially, Qi stagnation in a meridian can cause pain anywhere along that meridian, so it's not always useful to needle the site of the pain. Furthermore, what is causing the stagnation of Qi? Is there heat in the meridian? Cold? Blood stagnation, as well? Are you frequently straining muscles because they are not properly nourished by Blood and Yin? Is emotional constraint preventing the Qi from flowing properly? Dry needling isn't going to be able to treat Yin deficiency or Liver Qi constraint, nor can it be used as preventative medicine. That's why the effects of acupuncture tend to be stronger and longer-lasting.

3) Dry needling is only used for orthopedic complaints, generally muscle pain. Acupuncture is awesome for pain, but of course it also treats conditions which would fall into the category of internal medicine such as digestive problems, high blood pressure, infertility, anxiety, flu, and on and on.

4) Dry needling tries to excite the muscles into twitching, which can be uncomfortable or painful. Acupuncture is generally painless and very relaxing.

5) The level and quality of training is very different. PTs and chiropractors can perform dry needling with as few as 23 hours of training. This is basically a course or workshop in an adjunctive therapy very unlike the main techniques of these professions. The acupuncturists at Meridian Acupuncture undertook a 4-year Master's program in acupuncture and oriental medicine, learning many different needling techniques. More importantly, we have gained a full understanding of traditional Chinese medicine theory, allowing us to practice acupuncture needling within the context in which it was created, develop a diagnosis and treatment plan, and incorporate herbal medicine when appropriate.

How Does this Affect the Medicine?

That's a tough question to answer. On the one hand, I personally don't agree with the principles and treatment philosophy behind dry needling. Compared to acupuncture, which has grew out of an established system rooted in 5000 years of tradition, dry needling just doesn't have as much to offer. The effects aren't as strong or long-lasting, and the root cause of the problem isn't even considered. Worse yet, the minimal training required for dry needling practice leaves me wondering if it isn't potentially dangerous to perform on a large patient base.

Dry needling From Wikipedia, the free encyclopedia Jump to: navigation, search Dry needling is the use of solid filiform needles for therapy of muscle pain, sometimes also known as intramuscular stimulation.[1] Acupuncture and dry needling techniques are similar. Although the needles used have been called "acupuncture needles" and were described as such in the Huang Di Nei Jing in the Han dynasty and at one time were manufactured for use by acupuncturists they are now more properly referred to as solid filiform needles and are used in both procedures. Dry needling contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or corticosteroids to the same point. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue. Analgesia produced by needling a pain spot has been called the needle effect.[2] Dry needling for the treatment of myofascial (muscular) trigger points is based on theories similar, but not exclusive, to traditional acupuncture; however, dry needling targets the trigger points, which is the direct and palpable source of patient pain, rather than the traditional meridians, accessed via acupuncture. The distinction between trigger points and acupuncture points for the relief of pain is blurred. As reported by Melzack, et al., there is a high degree of correspondence (71% based on their analysis) between published locations of trigger points and classical acupuncture points for the relief of pain.[3] What distinguishes dry needling from traditional acupuncture is that it does not use the full range of traditional theories of Chinese Medicine. Dry needling would be most directly comparable to the use of so-called 'a-shi' points in acupuncture.[4] The debated distinction between dry needling and acupuncture has become a controversy because it relates to an issue of scope of practice of various professions.