If you are an athlete that has been in Colorado for any amount of time you’ve probably heard about dry needling. It is a widely popular treatment strategy utilized by chiropractors and physical therapists alike. It has gained an especially strong following in the athletic community, mainly because of its dramatic results. Because it is such a new form of treatment, there are many different beliefs as to why it works. As such, there are a handful of methods, which is why a patient’s experience can vary widely depending on the practitioner and their methodology.
There are two basic methods to dry needling. First is a single stick, usually with multiple needles, where the needle is left in the body (usually with electrical stimulation attached) for a period of time. The second technique is where a single needle is placed into the trigger point & then ‘pistoned’ back & forth to increase the amount of sharp sensation in that trigger point.
I tend to piston the majority of cases, and here is why:
Sharp sensation, like a needle stick travels on a very specific pathway from the point of stimulation (where the needle is poked) to the brain. That pathway is called the spinothalamic path. This pathway is significant because it is one of the primary ways the brain receives, and therefore interprets noxious stimuli.
Once the signal is at the thalamus, it is relayed to either different parts of the body, or brain. The role of the thalamus is to process sensory information & delegate the response. The neuromatrix pain theory, developed by Dr. Ronald Melzack, is a novel new look at how the body, and brain, interpret pain. It essentially states that when a pain signal is created, it’ll take whatever pathway it is supposed to into the brain, and once at the brain, it can stimulate many different areas. This is why pain can cause/create a whole host of responses from ‘hurting (somatosensory cortex) crying/emotional (amygdala), passing out/syncope (thalamus) or cold sweats (hypothalamus), among other types of responses.
If an area is overstimulated with pain (sharp sensation in the form of sticking a specific body part/muscle with a needle), the brain will respond by re-evaluating how that particular structure works in conjunction with everything else around it. The goal of dry needling is to reset the way that structure is 1) viewed by the brain (thalamus) and 2) works with the surrounding structures.
If you view your nervous system like a computer, the analogy would be the long-term memory of the body is in the brain, while short term information is stored at the muscle (not exactly how it works, but close enough for this example). When a computer continues to do a task, over time it will begin to slow down and become unproductive. This is because the short-term memory has become overloaded & very inefficient. So, you have to reboot the system & clear that short term memory.
The issue was not that the computer was broken, just needed a reboot/reset. The body works the same way. The needling is the ‘reset/reboot’ button for that particular muscle or area and clears that short-term memory. This is also why post needling it feels like a Charlie horse or the dull achy sensation as the body resets how the needled structure should work within the system.
Because the body requires that sharp sensation stimulus is the reason, I choose to piston the needle vs. put the needles in & leave them (usually with electrical stimulation). It does not make the other ways wrong, just I personally believe if the goal is to use sharp sensation (thereby stimulating the spinothalamic tract), then use sharp sensation. If the goal was to use electrical stimulation to change the way the muscle tone works locally, you don’t need needles for that, just use e-stim pads & a good, quality stim machine.