Dry needling, also known as trigger point dry needling and intramuscular stimulation, is a treatment technique used by various healthcare practitioners, including physical therapists, physicians, and chiropractors, among others. Acupuncturists usually maintain that dry needling is adapted from acupuncture, but others consider dry needling as a variation of trigger point injections. It involves the use of either solid filiform needles or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. Dry needling is mainly used to treat myofascial trigger points, but it is also used to target connective tissue, neural ailments, and muscular ailments. The American Physical Therapy Association defines dry needling as a technique used to treat dysfunction of skeletal muscle and connective tissue, minimize pain, and improve or regulate structural or functional damage.
There is conflicting evidence regarding the effectiveness of dry needling. Some results suggest that it is an effective treatment for certain kinds of muscle pain, while other studies have shown no benefit compared to a placebo; however, not enough high-quality, long-term, and large-scale studies have been done on the technique to draw clear conclusions about its efficacy. Currently, dry needling is being practiced in the United States, Canada, Europe, Australia, and other parts of the world.
Origin
Etymology and terminology
The origin of the term dry needling is attributed to Janet G. Travell. In her 1983 book, Myofascial Pain and Dysfunction: Trigger Point Manual, Travell uses the term dry needling to differentiate between two hypodermic needle techniques when performing trigger point therapy. However, Travell did not elaborate on the details on the techniques of dry needling; the current techniques of dry needling were based on the traditional and western medical acupuncture.
Initial techniques
The two techniques Travell described are the injection of a local anesthetic and the mechanical use of a hypodermic needle without injecting a solution. Travell preferred a, 1.5-in hypodermic needle for trigger point therapy and used this needle for both injection therapy and dry needling. Travell never used an acupuncture needle. Travell had access to acupuncture needles but reasoned that they were far too thin for trigger point therapy. She preferred hypodermic needles because of their strength and tactile feedback: "A 22-gauge, 3.8-cm (1.5-in) needle is usually suitable for most superficial muscles. In hyperalgesic patients, a 25-gauge, 3.8-cm (1.5-in) needle may cause less discomfort, but will not provide the clear feeling of the structures being penetrated by the needle and is more likely to be deflected by the dense contraction knots that are the target... A 27-gauge needle, 3.8-cm (1.5-in) needle is even more flexible; the tip is more likely to be deflected by the contraction knots and it provides less tactile feedback for precision injection".
Development and regulation in the United States
The solid filiform needle used in dry needling is regulated by the FDA as a Class II medical device described in the code titled "Sec. 880.5580 Acupuncture needle is a device intended to pierce the skin in the practice of acupuncture". Per the Food and Drug Act of 1906 and the subsequent amendments to said act, the FDA definition applies to how the needles can be marketed and does not mean that acupuncture is the only medical procedure where these needles can be used. Dry needling using such a needle contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or corticosteroids to the same point.
The founder of Integrative Systemic Dry Needling (ISDN), Yun-Tao Ma, has been spearheading the "dry needling" movement in the United States. Ma states, "Although ISDN originated in traditional Chinese methods, it has developed from the ancient empirical approach to become modern medical art rooted in evidence-based thinking and practice." Ma also states that, "Dry needling technique is a modern Western medical modality that is not related to traditional Chinese acupuncture in any way. Dry needling has its own theoretical concepts, terminology, needling technique and clinical application."