What You Need to Know About Dry Needling as a Physical Therapist

There are things to consider if you’re thinking of implementing and using dry needling in your physical therapy practice.

As a physical therapist (PT), there are many different techniques to choose from when it comes to effectively treating your patients. There are soft tissue mobilization exercises, joint mobilization movements, and a variety of other strategies you can utilize during treatment sessions, all of which are designed to improve your patient’s rehabilitation and healing process.

There is one additional technique that some physical therapists have begun to use in their practices as well called dry needling. However, there are some things you should know about this therapy if you’re considering implementing it into your practice as well.

What dry needling is and how it works

Physiopedia explains that dry needling is an invasive procedure which involves inserting an acupuncture needle into the skin and muscle at specific myofascial trigger points. It can either be inserted superficially (only going in 5-10 mm) or deep tissue, the second of which is sometimes referred to as trigger-point dry needling.

Dry needling is thought to work in a twofold method: First, insertion of the needle into the muscle can cause a local twitch response, an involuntary contraction of taut muscle fibers, creating an analgesic effect which reduces pain and improves function in the affected area. Second, insertion of the needle is also thought to improve healing by creating a small lesion that triggers the body to better repair the already damaged area.

Conditions dry needling may help treat

Research has found that dry needling can be effective in treating a number of physical issues. For instance, a 2017 systematic review and meta-analysis published in the Journal of Orthopaedic and Sports Physical Therapy indicated that dry needling has the potential to “decrease pain and increase pressure pain threshold” for individuals experiencing some type of musculoskeletal pain.

A study on shoulder pain specifically found positive results in this area, especially for older patients. This piece of research was published in the Journal of Geriatric Physical Therapy and involved 20 participants aged 65 or older. After just one dry needling session, the 10 individuals in the experimental group experienced “statistically significant differences” in their pressure pain thresholds. They also reported moderate relief in the intensity of their pain.

Research has also found that dry needling can potentially help with headaches. One such study was published in The Journal of the Canadian Chiropractic Association and involved a patient who had been battling stabbing neck pain and headaches for four years. After four sessions of dry needling delivered over the course of two weeks, there was “meaningful improvement” in both her neck pain and headaches.

Dry needling risks

Since dry needling is invasive, it does come with some risks according to research published in the International Journal of Sports Physical Therapy. Though small, some patients have experienced post-needling soreness, needling site hemorrhages, syncopal responses, acute cervical epidural hematoma, and damage to the central nervous system.

There have also been a small number of cases of pneumothorax (a collapse of the lung due to presence of air or gas between the lungs and chest wall) reported in the International Journal of Sports Physical Therapy as a result of dry needling four of these cases resulted in death.

There is also a concern that inserting needles into the skin can potentially result in the development of a serious bacterial skin infection, which has also led to death in dry needling patients. However, increasing safety precautions such as one-time-use needles, wearing latex gloves, and regular handwashing during treatments have helped minimize this particular risk.

Physical therapist practice considerations

Before deciding whether to offer dry needling in your practice, it’s important to know that not all jurisdictions view this therapy as legal and within the scope of physical therapy offerings.

An article published in Physical Therapy Reviews reports that many state-level physical therapy boards have a very limited definition of dry needling, complicating the issue of whether PTs in those areas can practice this particular treatment method and to what extent. Additionally, each one seems to have a slightly different definition of what this type of therapy actually entails to be considered legal on a physical therapy level.

It’s important to check with the board in your state to discover the parameters of using dry needling in a physical therapy setting. This will tell you whether you can use this therapy at all and, if you can, in what instances it is legal for you to do so.

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