Dry needling involves the application of very fine sterilised acupuncture needles into muscle and surrounding tissues to assist in the release of myofascial trigger points, reduce tightness and spasm, improve muscle function and relieve pain. It is commonly used as an adjunct to physiotherapy and myotherapy techniques to improve treatment outcomes.
There are two types of Dry Needling, the first called Superficial Dry Needling (SDN) works by inserting the needle only 5-10mm under the skin. Secondarily is Deep Dry Needling (DDN) where the needle is inserted to the depth required to penetrate the targeted myofascial trigger point.
How does it work?
Myofascial trigger points are hyper-irritable, taut bands within muscles, which are painful to touch and can contribute to muscle shortening, weakness and pain (both locally and referred). They often develop following muscle, joint or nerve injury and sometimes persist well after the initial tissue injured has healed. This leads to persistent pain and discomfort.
Dry needling releases these trigger points by encouraging local blood flow to the trigger point and by modulating nerve pathways that erroneously cause them to persist. The needling also stimulates your body’s own endorphin system to provide pain relief and help allow the muscle to relax.
Dry needling can be extremely effective in the treatment of:
Needles used in dry needling are much thinner than those you receive when you see your GP for an injection and so usually cause much less discomfort. This does vary depending on what techniques your therapist uses. You may also experience the very satisfying response of the muscle twanging and releasing quickly. A sure sign of a successful trigger point release.
The initial treatment is conservative to determine the patient’s response. This varies from person to person. It is expected that there will be some post treatment soreness during the first 24-48hrs and sometimes minor bruising is experienced.
What sorts of conditions can Dry Needling be beneficial for?
Dry needling can produce excellent results as an adjunct to standard physiotherapy and manual therapy treatment. It can be used in both acute and chronic painful conditions.
Dry needling can be extremely effective in the treatment of:
Back, neck and shoulder pain
Hand and wrist pain
Tendinopathy pathologies i.e. Tennis elbow, Achilles pain
Many other musculoskeletal injuries (You can discuss dry needling with your therapist to see if it may be useful for your condition)
What is the difference between Dry Needling and Acupuncture?
Dry needling revolves around Western Medicine philosophy and involves inserting needles into muscular trigger points palpated by your therapist and consistent with your area of pain.
Acupuncture is based on ancient Eastern Medicine, with needle placement over specific points along meridian lines or ‘energy’ lines which are thought to associate with particular illness and disease.
Exercise therapy is as effective as surgery for middle aged patients with a common type of knee injury known as meniscal tear (damage to the rubbery discs that cushion the knee joint), finds a study in The BMJ this week.
The researchers suggest that supervised exercise therapy should be considered as a treatment option for middle aged patients with this type of knee damage.
Every year, an estimated two million people worldwide undergo knee arthroscopy (keyhole surgery to relieve pain and improve movement) at a cost of several billion US dollars. Yet current evidence suggests that arthroscopic knee surgery offers little benefit for most patients.
So researchers based in Denmark and Norway carried out a randomised controlled trial to compare exercise therapy alone with arthroscopic surgery alone in middle aged patients with degenerative meniscal tears.
A randomised controlled trial is one of the best ways for determining whether an intervention actually has the desired effect.
They identified 140 adults (average age 50 years) with degenerative meniscal tears, verified by MRI scan, at two public hospitals and two physiotherapy clinics in Norway. Almost all (96%) participants had no definitive x-ray evidence of osteoarthritis.
Half of the patients received a supervised exercise programme over 12 weeks (2-3 sessions each week) and half received arthroscopic surgery followed by simple daily exercises to perform at home.
Thigh muscle strength was assessed at three months and patient reported knee function was recorded at two years.
No clinically relevant difference was found between the two groups for outcomes such as pain, function in sport and recreation, and knee related quality of life. At three months, muscle strength had improved in the exercise group.
No serious adverse events occurred in either group during the two-year follow-up. Thirteen (19%) of participants in the exercise group crossed over to surgery during the follow-up period, with no additional benefit.
“Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term,” say the authors. “Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.”
How did this situation — widespread practice without supporting evidence of even moderate quality — come about, ask two experts in a linked editorial? “Essentially, good evidence has been widely ignored,” say Teppo Järvinen at the University of Helsinki and Gordon Guyatt at McMaster University in Canada.
“In a world of increasing awareness of constrained resources and epidemic medical waste, what we should not do is allow the orthopaedic community, hospital administrators, healthcare providers, and funders to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence,” they conclude.
1.Nina Jullum Kise, May Arna Risberg, Silje Stensrud, Jonas Ranstam, Lars Engebretsen, Ewa M Roos. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ, 2016; i3740 DOI: 10.1136/bmj.i3740
Nearly all of us experience knee pain at some point in our lives for various different reasons. Knee pain is mainly caused by overuse of muscles, arthritis, or excessive foot pronation amongst other reasons, with knee arthritis the leading cause of chronic disability for US residents over 65. The good news is, chronic knee pain is actually avoidable, and there are several steps you can take for knee pain treatment.
Recently the New England Journal of Medicine published research suggesting physical therapy and exercise are just as good as surgery when it comes to knee pain treatment for arthritis. Taking good care of our knees by strengthening and stretching the key supporting muscles can prevent knee pain.
With that in mind, here are five useful methods you can try to help reduce your knee pain.
Stretch Your Muscles
We all know that sitting on our butts all day isn’t good for us. When our muscles begin to atrophy or grow imbalance due to this sitting fest, our inner thigh muscles (hip adductors and hamstrings) end up working overtime which often means extra pressure on our knee joints. Taking the time to stretch out our support muscles will lessen the chance of them tightening and causing any muscle imbalances. So, stretch your supporting muscles, and also strengthen weak muscles like your glutes (more about that below).
Strengthen Your Butt
Who thought knee pain treatment would involve your butt? Well, it does. In fact, many knee injuries are actually caused when your hip muscles are weak; this is especially true for Anterior Cruciate Ligament (ACL) tears. Weak butt muscles can cause your pelvis to drop and your femur to fall inward, creating extra stress from your hip right down to your knee and ankle!
A way to combat this is by doing hip extensions in order to help you strengthen up those glutes.
Tone Your Core
Weak core and abdominal muscles are another reason for your pelvis to tip forwards, but they can also cause other health problems and affect areas such as balance. There are plenty of ways to strengthen your core, such as stomach crunches, ab ball exercises, yoga, kickboxing or pilates.
Maintain a Healthy Weight
Being overweight greatly increases your risk of developing knee osteoarthritis (fives times more likely for men, four for women). Research has shown that just a 10 per cent decrease in weight can provide you with an impressive 28 per cent increase when it comes to knee function. How’s that for a fair trade? If you’re suffering from knee pain, try low-impact cardio such as a cross trainer, stationary bike, or water aerobics.
Wear the Right Shoes
Wearing high heels can increase compression on those knee joints by as much as 23 per cent, as well as encouraging tight muscles in your calves; another source of knee pain. Wear shoes that are comfortable and practical when possible, or at least go for a smaller heel when walking is involved.