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  • Dr. Jodi Hierholzer, DPT

What is Dry Needling?

So what is all the hype about this treatment called dry needling? Since dry needling (DN) is a technique I commonly use in my PT practice, I thought a blog to answer some of the questions would be beneficial. I have had a lot of patients and friends curious as to what dry needling actually is….followed by: “Does it hurt? What does it actually do? Does it feel like getting a shot? Is it like acupuncture?” While the science behind it can be fascinating, it would also keep you reading this for much longer than you’d probably like. So rather than offering you a trip back to a science college lecture, I’ll do my best to summarize in laymen’s terms :)



In short, DN is a treatment to get rid of trigger points — the knots in your muscles that cause you pain and tightness. There are other forms of trigger point therapy that use massage, deep manual pressure, or tools. I have found within my clinical practice that all of these methods used in conjunction with DN seem to provide the greatest outcomes for patients.


DN technique uses small, solid filament type needles which are inserted into myofascial trigger points (the painful knots in muscles) to stimulate a healing response with the goal of reducing pain and dysfunction. It has been shown that our bodies can develop areas of hypersensitivity and tightness as a response to various stresses i.e. postural, repetitive movements, intense exercise, psychological, emotional etc.

Ever had a stressful day at work and feel like your traps are glued to your ears? Or how about the pitcher who threw a high pitch count game and feels like their shoulder muscles are trashed. Or the CrossFit athlete who did high volume dead lifts and their back and hamstrings feel like rocks (and not in a good way haha). I bet you those muscles are FULL of active trigger points.



When trigger points are present, they cause the muscles they are in to neurologically tighten which serves to further disrupt the normal functioning of that muscle due to increased pain and local compression of vascular structures and nerves (aka you’re muscles are tender to touch, tight, your recovery is slowed, and you’ve decreased ability to produce power to the affected muscle group). PTs use dry needling to treat these tissues because it is a very effective way to decrease those trigger points and allow our muscles and nervous system to return to baseline…and decrease pain/dysfunction, which is what makes everyone happy at the end of the day.


Why is it called “dry” needling?

It is called "dry" needling because no solution is injected into the tissue, as is the case with an injection with a hypodermic needle. The needles we use are acupuncture needles which are solid point, stainless steel, one-time use needles (definitely no garage tattoo needles ;)



Is dry needling like acupuncture? This is a question I get asked often. With DN, we actually do use acupuncture needles. Other than that, the two techniques are very different. DN is based on Western medical research and principles, whereas acupuncture is based on Traditional Chinese Medicine in which the purpose is to alter the flow of energy ("Qi") along traditional Chinese meridians for the treatment of diseases. So needles are placed at precise points along these interconnected pathways that map the whole body, including your head, trunk and limbs. The goal of placing needles into acupuncture points is to direct the flow of vital energy to trigger your body's healing response and restore physical, emotional and mental equilibrium.

Dry needling gets to the source of your pain — the myofascial pain caused by restrictions of your muscle tissue or the fascial layer of connective tissue that surrounds and supports the muscle. PTs identify the knots or taut bands that are causing you problems and place needles with the intent of producing a local twitch response (LTR). It's the LTR that leads to the resolution of this trigger point and therefore the reduction of your pain.



Does dry needling hurt?


Each patient describes the processes of being needled differently depending on what tissues are being treated, pain tolerance, and degree of dysfunction. Most patients describe DN as a “deep ache, burn, and/or occasionally sharp” depending on the amount of active trigger points in their tissue. Typically, patients report not feeling the needle actually penetrate the skin and to most, the treatment is not very painful at all. I am not just saying that to try to sway you. As a certified dry needling practitioner, I have been dry needled from head to toe with many different techniques. I have been needled in every single muscle I have learned how to needle, and I personally get my shoulder dry needled as needed because of the great outcomes it provides in relieving tissue restrictions, restoring mechanical function and performance, and pain relief. Now let me clarify, to some it definitely hurts. Once the needle has been inserted into the skin/muscle, the therapist will work the needle around trying to get the muscle to twitch. As mentioned above, these twitches are called the “local twitch response” (LTR) and means that we are positively affecting the desired tissue. These twitches can be sudden, startling, and sharp but are what the therapist is hoping to see. The twitch is what releases the muscle and retrains it to fire correctly. The twitches will probably hurt and will not be pleasant. But are they worth it? Absolutely.


If you have copious amounts of twitches, you may be more sore than if you did not have any at all. I typically tell patients that it will feel like you just worked out really hard or that you got “frogged” in the treated muscle.




How does dry needling work and what does the needle actually do?


The BIG question that I love to answer but can sometimes become hard to explain without making it too “sciencey.” Here is the watered down version:

When dry needling, we are looking to elicit that twitch response (LTR) of the muscle. This LTR is a quick contraction reflex of the muscle that can be both diagnostic and therapeutic. Research has shown that when the LTR is elicited, the tissue will have a decreased muscle spasm, reduced chemical irritation, improved flexibility and can provide short term pain relief. This can often immediately improve range of motion, improve function and decrease or eliminate pain. Eliciting a LTR is not imperative and often will not occur when performing needling aimed at other structures in the body besides muscles and trigger points. That is worth writing a WHOLE OTHER BLOG, but in short…needles can also be placed into other tissues including tendons, ligaments, around scars or near nerves. Depending on the patient's particular pathology, the aim of DN may be different and therefore the desired physiological response is also different.


What type of pain does dry needling treat?


For myofascial pain, the technique is used to treat a number of areas. The most common trigger points lead to these issues (there are many more not listed): Neck/Scapular Pain

Sciatica Low/Mid Back Pain

Headaches & Migraines Pain in your Shoulders, Hips, Knees, Ankles, etc. (joints)

Golfer's or Tennis Elbow Tendonitis Bursitis Plantar Fasciitis Achilles tendonitis Stress induced or postural induced muscle tension



What should I expect after dry needling therapy?


Soreness is common after a dry needling session. It’s similar to the soreness you feel after a hard workout. The soreness typically resolves within 24-48 hours. You can help reduce it with heat, proper hydration, massage, and gentle stretching. You can continue to exercise but note you may feel weaker or more sore if you workout within the same day of being dry needled. ALWAYS consult with your therapist about the logistics of returning to your exercise/sports routine after being dry needled.

If dry needling is something you feel that may be beneficial to help decrease your pain, improve function, and return doing the things you love, please call Dr. Jodi Hierholzer, PT at (325) 261-0043 for a free phone consultation or email at jodi@bodyworx-pt.com.




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