Photo by Sunlight19/iStock / Getty Images

Dry needling

Trigger point dry needling (TDN) is a treatment technique used to alleviate pain or muscle dysfunction associated with myofascial trigger points. It uses fine, solid filament needles with or without the application of electrical stimulation.  In Virginia, dry needling treatment requires a physician's order.   This can be obtained verbally at first, but must be followed by a written order.  Primary Solutions will obtain these orders for patients who see us without a physician referral.  Dry needling is not billed separately, but will be included, when needed, in the plan of care as part of physical therapy follow-up visits.

Primary Solutions Physical Therapy uses sterile, single use, disposable needles and maintains a clean and safe environment. Only physical therapists who have been trained in the proper use of trigger point dry needling and meet the Commonwealth of Virginia Board of Physical Therapy requirements perform this treatment. The needles are inserted through the skin into the underlying tissues and muscles at specific points known as myofascial trigger points. When a twitch response is obtained, the trigger point is released. Trigger point dry needling is typically most effective as an adjunct to other manual therapy techniques and exercise.

Trigger point dry needling is NOT a form of acupuncture. It is generally a safe method of treatment, but it may have side effects, including bruising, post-treatment soreness and discomfort, and in rare cases, dizziness or fainting. While the risk of trigger point dry needling is small, there have been very rare instances reported of pneumothorax when treating around the rib cage.

How will I feel after a session of TDN?

Response to treatment can vary significantly from one individual to another.  It is common to feel sore and stiff immediately after treatment in the area of the body that was treated, similar to the muscle soreness one experiences after an intense workout at the gym.  This is normal but does not always occur.  For some individuals it will take a few hours or the next day before soreness occurs.  Soreness typically lasts less than 24 hours but may last up to 48 hours.  If soreness continues beyond this, please contact your provider.

 

What are the potential side effects?

It is common to have bruising after treatment; some areas are more likely than others. Some common areas are shoulders, base of neck, arms and legs. Large bruising rarely occurs, but can. Use ice to help decrease the bruising and if you feel concern, please call your provider.  It is also common to feel tired, nauseous, or “loopy” after treatment.  This is a normal response that can last up to an hour or two after treatment. If this lasts beyond a day, contact your physical therapist as a precaution. While it is uncommon, there are times when treatment may actually make your typical symptoms worse. If this occurs, please inform your physical therapist so your treatment plan can be adjusted as necessary.  Trigger point dry needling may still be indicated for your condition.

 

What should I do after treatment, what can I do, and what should I avoid?

It is highly recommended that you increase your water intake for the next 24 hours following treatment to help decrease post treatment soreness.  Soaking in a hot bath or hot tub can help avoid post treatment soreness.  After treatment, it is recommended you continue with your normal routine, which may include:

- Work out and/or stretch

- Jog

- Massage the area

- Use a heating pad

- Avoid ice unless you are icing a bruise

- Take Tylenol, Ibuprofen/Motrin, aspirin etc.

If you feel like any of these activities is exacerbating your symptoms, discontinue them until you follow up with your physical therapist.

If you are feeling light headed, having difficulty breathing, having chest pain or any other concerning symptoms after treatment CALL your therapist immediately. If you are unable to get in touch your therapist, call your physician or REPORT TO THE CLOSEST EMERGENCY ROOM.  Be sure to tell the staff there that you recently received dry needling, and the area(s) in which you were treated.