TDN | knowyourphysio

Traditional Dry Needling

No, it's not accupuncture! But it does use the same type of needle. The term "dry needling" was first coined by Janet Travel in the 1940's and is a procedure where monofilament needles are inserted through the skin to the target tissue to bring about a therapeutic effect. Medical needles that are used for injections or drawing blood are referred to as 'wet' needles. Because these needles do not deliver medication and merely separate the skin, they are referred to as 'dry' needles. Traditional Dry Needling (TDN) may also be referred to as Intramuscular Stimulation (IMS), Trigger Point Dry Needling (TrP DN), and medical acupuncture - a hybrid between accupuncture and dry needling.

Several medical professionals are able to perform dry needling including PTs, MDs, DCs, dentists, and FNPs.

Physical therapists practicing TDN should follow OSHA Blood Borne Pathogens Standards as well as guidelines established by the APTA and VPTA.

Why dry needle?

For the treatment of pain of myofascial origin and spasticity! Myofascial pain develops from trigger points which can result in a motor and/or sensory abnormality. People can develop these trigger points directly as a restult of acute overuse, repetitive strain, acute overstretching, or direct trauma. Trigger points may also develop indirectly as a result of activation of MTrP in a different area, somatogenic reflexes, visceral somatogenic reflexes, peripheral nerve entrapment, typertonus due to stress, cold-wet climates or other extreme factors, and metabolic factors such as a lack of vitamin B. In doing a microdialysis of trigger points, Dr. Shah found that the trigger point contained increased levels of pH and decreased levels of Substance P, CGRP, bradykinin, TNF, and interleukins. These are factors that can increase pain, vasodilation, and inflammation. Theoretically, accurately placing a needle on this trigger point to provide a localized stretch to the conctracted tissue of the taut band facilitates a restoration of normal sacromere resting length and returns the afformentioned factors to more regular levels.

Clinical Presentation of Trigger Points

Motor Dysfunction
- Weakness of involved muscle
- coordination loss
- altered recruitment patterns
- Decreased work tolerance of muscle
- Weakness occurs from reflex inhibition
Sensory Dysfunction
- Pain/tenerness locally and referred to a distant site
- Peripheral sensitization - decreased excitation threshold, increased nociceptive response
- Central sensitization - same as above in CNS
Autonmoic Dysfunction
- Vasoconstriction
- Vasodilation
- Lacrimation
- Piloerection

Diagnostic Criteria for Trigger Points

Taut band
Exquisite spot tenderness
Patient's recognition of current pain
"Jump Sign"
B-mode 2D US, shear wave elastography
Decreased ROM of muscles with MTrP
Decreased muscle strength
Autonomic signs (sweating, dizziness, nausea)

Be familiar with contraindications before dry needling

If the patient has been cleared for contraindications, than move on to....

Rules and mechanics of Needling

Review the Safety Policy
Wear gloves, use alcohol wipes
position patient comfortably in supine, prone, or side-lying position
Find Anatomical landmark, taut band, trigger point
Remove the tube (with needle insitu) from the wrapper
Release the needle by removing the colord tab on the top while pressing the top of the needle against the tube to keep it in the tube
Place the tube on the patient over the trigger point
Let the needle drop down onto the skin
Briskly tap the top of the needle to get it through the skin
After tapping the needle into the skin, place the tube between the fingers or where it can otherwise be kept tract of
Needle with a straight in and out motion
Elicit a local twitch response (though you don't need to get this to get an effect)
Draw needle back to skin and redirect to other trigger points
Place the needle back in the tube with the beck end first while keeping one finger/thumb at the bottom of the tube to prevent the needle from falling through the tube
Discard the needle in a medical waste sharps container
Always practice universal precautions

To learn how to dry needle specific muscles, refer to David G Simmons Acadomy: Top 30

Adverse Effects

Pneumothorax
- Sharp chest pain during breathing/coughing, SOB, tight chest, fatigue, tachypnoe, tachnycardia
Infections
- HIV/AIDS, advanced diabetes, drug abuse, region of any prostheses
Soreness
- at the site of needling
Local Bleeding
- at the insertion site
Autonomic symptoms
- Dizziness and vertigo, sudden and excessive perspiration, fainting
Broken/Lost needles

Complications

Allergic reactions
Vasodepressive syncope
Hematoma
Nerve injury
Vascular injury
Trauma to brainstem of spinal cord
Penetration to visceral organ
Infection
Increased spasm and pain
Muscle edema

Reasons for Failure

Diagnostic error
Incomplete management of perpetuating factors
Trigger point missed
Referral zone needled, not primary trigger point
Inadequate post needling care