Needling the needy for pain erasure

Top 10 Dry needling researches in 2017-18

Dry needling is currently a well-recognized form of treatment in the management of musculoskeletal pain and dysfunction. Physical therapists all around the globe are increasingly showing interest in learning and using this technique. The clinical utility of dry needling is also broadening in terms of wide range of conditions that it can be used. Newer studies are showing the role of dry needling in spasticity and other neurological conditions. This has opened doors for further exploration of dry needling in various other upper motor neuron lesions. On the other side, numerous studies were published in other musculoskeletal conditions, showing the efficacy of dry needling. Conditions like greater trochanteric pain, entrapment neuropathies, golfers elbow, cervicogenic dizziness are a few to mention in which dry needling was used as an intervention. Even studies on abdominal wall pain, dysmenorrhea and pelvic floor pain using dry needling as a major intervention were published. Additionally systematic reviews and metaanalysis are done in shoulder pain, low back pain and temporomandibular joint dysfunctions. Systematic reviews and metaanalysis are possible now because more randomized controlled trials are available now unlike earlier times. The aim of this article was to review the top ten studies on dry needling that was published from April 2017 till August 2018.

1. Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Non inferiority Randomized Clinical Trial.

Brennan KL, Allen BC, Maldonado YM.
J Orthop Sports Phys Ther. 2017 Apr; 47 (4):232-239

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Greater trochanteric pain syndrome encompasses number of disorders involving the lateral hip, such as bursitis, gluteal tears, coxa saltans and trigger points in contractile tissues that cross the hip. The objective of this study was to compare the effects of dry needling as compared to cortisone injections. 43 patients with greater trochanter pain were divided in to dry needling and injection group. Dry needling was done over gluteus maximus, medius, minimus, piriformis and tensor fascia lata. Outcome measures used were numerical pain rating scale (NPRS) and Patient specific functional scale (PSFS). With 1, 3 and 6 weeks follow up, the results showed that dry needling was no inferior to cortisone injection. Given the potential risks involved in cortisone injection, dry needling can be a better, safe and cost effective alternative in greater trochanter pain.

2. Effectiveness of trigger point dry needling for plantar heel pain: a meta-analysis of seven randomized controlled trials.

He C, Ma H.
J Pain Res. 2017 Aug 18; 10: 1933-1942.

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Plantar heel pain affects 10% of the general population and it is characterized by heel pain and tenderness centered around medial tubercle of the calcaneus especially on weight bearing. Presence of Myofascial trigger points (MTrPs) over the plantar muscles play a role in plantar heel pain. So this meta-analysis, which followed PRISMA guidelines was done to find the efficacy of dry needling in plantar heel pain. Out of 395 relevant titles that were screened, seven RCTs were chosen for analysis. The quality of evidence for outcome measures was evaluated using GRADE approach. The result of this meta-analysis indicated that MTrP needling effectively reduces plantar fasciitis heel pain. The improvements of pain relief was maintained throughout the 12 month follow-up, which showed the long-term effects of dry needling.

3. Effectiveness of dry needling versus a classical physiotherapy program in patients with chronic low-back pain: a single-blind, randomized, controlled trial.

Tüzün EH, Gıldır S, Angın E, Tecer BH, Dana KÖ, Malkoç M.
J Phys Ther Sci. 2017 Sep; 29(9):1502-1509.

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In this single blinded randomized controlled trail (RCT), thirty four subjects aged between 35 to 70 years, who had low back pain (LBP) for at least 3 months were included. Both groups were evaluated and palpated for the presence of MTrPs. The patients were randomly assigned into study group (that received dry needling) and control group (received conventional treatment like hot pack, TENS, Ultrasound and exercises). The study group received dry needling to the erector spinae, multifidus, quadratus lumborum and gluteus medius. Post needling the both group received Swedish massage to the back area. The outcomes were measured using Mcgill pain questionnaire, number of MTrPs and its sensitivity and Tampa kinesiophobia scale (TKS). The results showed that Dry needling is superior to conservative care that is measured by all the above mentioned outcome parameters.

4. Dry needling in lateral epicondylitis: A prospective controlled study.

Uygur E, Aktaş B, Özkut A, Erinç S, Yilmazoglu EG.
Int Orthop. 2017 Nov; 41(11):2321-2325.

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Lateral epicondylitis is a common yet difficult condition to manage especially if the pain is lasting for more than 3 months. This study aimed to find the efficacy of dry needling as a first line of treatment in lateral epicondylitis. 92 patients who were diagnosed with lateral epicondylitis were divided in to dry needling group (N=51) and control group (N=41). Dry Needling was performed in lateral epicondyle region by needle twisting technique for three to four times in a span of 10 minutes. The control group received anti-inflammatory medications and wrist brace. Both the group was followed-up for 6 months. Patients who received dry needling showed greater improvements in pain relief as measured by Patient rated tennis elbow evaluation. Some patients were analyzed by ultrasound before and after needling and it was found that the tendon thickness was improved after needling.

5. Evidence for dry needling in the management of myofascial trigger points associated with low back pain: A systematic review and meta-analysis.

Liu L, Huang QM, Liu QG, Thitham N, Li LH, Ma YT, Zhao JM.
Arch Phys Med Rehabil. 2018 Jan; 99 (1):144-152.

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Dry needling has become an increasingly popular nonsurgical treatment method for relieving low back pain (LBP) and improving functional disability. Dry needling targets the MTrPs, which disrupt the dysfunctional neuromuscular activity in the muscles, decrease muscle tone, and normalize the neurochemical pathways of muscles. This systematic review and meta-analysis was conducted according to PRISMA guidelines. Out of 784 article published on low back pain dry needling, 11(pooled n = 802) RCT articles were found eligible for analysis. The result of this systematic review provided a moderate quality of evidence recommending dry needling over other treatments to relieve pain intensity in LBP. When dry needling is combined with other treatment, the efficacy is more than used alone. It did not show any evidence for long term effects.

6. The use of dry needling as a diagnostic tool and clinical treatment for cervicogenic dizziness: a narrative review & case series.

James Escaloni, Raymond Butts, James Dunning
Journal of Bodywork and Movement Therapies, 17 February 2018

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This article is a combined narrative review and case series that discussed the diagnostic tools and treatment for cervicogenic dizziness. Smooth pursuit neck torsion test, joint position error test and cervical flexion rotation tests are commonly used to test the cervicogenic dizziness. But it insisted that there should be a cluster of test to be used to diagnose the cervicogenic dizziness. Myofascial trigger points in the upper cervical spine was found to be causing dizziness. Dry needling the muscles like obliquus capitis inferior shown to be helpful. Three patients that had cervicogenic dizziness was needled over their obliquus capitis inferior. This muscle is located between C2 spinous process and C1 transverse process. Needling was done between these two points, angulating it antero-medially and slightly inferiorly. This is the recommended method of needling without disturbing the neurovascular structures. Leaving the needle in situ for 10 minutes would be beneficial according to the author. Dizziness handicap inventory was the outcome used and all three patients reported significant reduction in their dizziness post needling. It was concluded that dry needling would be a useful tool in the diagnosis and treatment of cervicogenic dizziness.

7. The effect of dry needling on spasticity, gait and muscle architecture in patients with chronic stroke: A case series study.

Hadi S, Khadijeh O, Hadian M, Niloofar AY, Olyaei G, Hossein B, Calvo S et al.
Top Stroke Rehabil. 2018 Apr 23:1-7.

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This study aimed to identify the effect of dry needling in post stroke spasticity, gait and muscle shape. Six stroke patients received dry needling over the medial and lateral gastrocnemius and soleus. The outcome measures were Modified Modified Ashworth Scale, Timed up and Go test. A single session of dry needling was done to the patients. Needling was done on the mid bulk of the muscle as the criteria of taut band does not apply in spasticity needling. Ultrasound examination of the pennation angle and muscle thickness was measured in the muscles post needling in all patients. The result concluded that a single session of dry needling decreased the pennation angle of the muscle and reduced the muscle thickness. A reduction in resistance while stretching the plantar flexors were also observed after calf needling. There was a reduction in spasticity, improvement in gait after needling. This is the first study, which explored the muscle architecture and its structural changes in spasticity needling.

8. Periosteal electrical dry needling as an adjunct to exercise and manual therapy for knee osteoarthritis: a multi-center randomized clinical trial.

Dunning J, Butts R, Young I, Mourad F, Galante V, Bliton P, Tanner M, et al.
Clin J Pain. 2018 May 28.

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This is a randomized single blinded multi-center parallel group trail compared two treatment protocol in knee osteoarthritis patients. First group (n=117) received manual therapy and standard exercises while the second group (n=118) received additional periosteal electrical dry needling. This is a first study done to compare the effect of periosteal electrical dry needling in arthritis patients. Needling was performed for 8-10 sessions over 9 points around the knee to reach the periosteum to elicit a sensation of aching, heaviness etc. After that, electrical stimulation was given over the needles for 20-30 minutes. Patients that received dry needling were 1.7 times more likely to have stopped pain medications. Similarly, benefits were identified in pain, stiffness and function that were shown in WOMAC and NPRS. Needling over bone is believed to enhance cartilage repair, limiting inflammation and inhibiting osteoclastic activity.

9. Effectiveness of dry needling of rectus abdominis trigger points for the treatment of primary dysmenorrhea: A randomized parallel-group trial.

Gaubeca-Gilarranz A, Fernández-de-Las-Peñas C, Medina-Torres JR, et al.
Acupunct Med. 2018 May 2.

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This study is a randomized parallel group controlled trail that compared the effect of dry needling in primary dysmenorrhea patients. 56 patients were randomly allocated in to dry needling group (n=19), placebo needling group (n=18) and no needling group (n=18). A single session of dry needling over the rectus abdominis MTrPs was performed. The needling was done 2 weeks prior to their menstrual cycle. Outcomes measured were NPRS and SF-36. The results concluded that a single session of dry needling into active TrPs of the rectus abdominis muscle combined with a stretching exercises was more effective than placebo needling. Since rectus abdominis trigger points refer pain to hypogastrium, deactivation of the point was attributed to pain reduction. Adding to that, reduction of somato-visceral convergence to spinal cord, after dry needling was also considered as one of the reasons for improvement.

10.The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis.

Vier C, Almeida MB, Neves ML, Santos ARSD, Bracht MA.
Braz J Phys Ther. 2018 Aug 22.

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Myofascial orofacial pain is the second most recurrent type of orofacial pain. It is assumed that myofascial pain related to temporomandibular dysfunction (TMD) may originate from the trigger points in the orofacial muscles that can cause pain and reduce movements of the jaw. This study aimed to investigate the effects of dry needling on orofacial pain of myofascial origin in patients with TMD. After identification, screening and eligibility check, seven studies (pooled n=199) were included for analysis. All studies measured the NPRS and maximal mouth opening (MMO) as outcome measures. Three studies used pressure pain threshold (PPT) using pressure algometer as an outcome. Grade system was used to analyze the studies. The results showed that dry needling is better than sham needling for PPT and dry needling was better compared to other interventions for pain intensity in the short term but the quality of evidence is very low due to lack of insufficient data.

Dry needling in chronic abdominal wall pain of uncertain origin.

Pandurangan Rajkannan, Rajagopalan Vijayaraghavan
Journal of Bodywork and Movement Therapies, Feb, 2018.

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This is a special mention of an article that was published by us this year. For the first time across the globe, dry needling was researched in patients with chronic abdominal wall pain. In this case series, 12 patients with chronic abdominal wall pain of more than 3 months duration were included. All previous medical and surgical treatment failed to resolve their pain and hence they were referred for dry needling. Abdominal muscles like rectus abdominis and external oblique were palpated to locate the MTrPs. Dry needling as a standalone treatment was performed on these subjects. LTRs was elicited in most of the patients during the procedure. No other treatment was given during this period. All patients were followed up to 6 months and the result concluded that dry needling over the abdominal muscles was effective in pain reduction. Some patients got improvement in dysmenorrhea, urinary frequency and loose stools, which indicates that needling can positively influence the visceral structures through the somato-visceral connections.


Pandurangan Rajkannan, Rajagopalan Vijayaraghavan
Journal of Bodywork and Movement Therapies, Feb, 2018.

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In this review article we have chosen top ten researches, in which dry needling is used as a primary intervention. The studies were chosen based on its quality, novelty and clinical utility. Out of 60 studies that were published during this period, we have picked up ten studies for this review. We did not analyse the methodology of these studies but simply narrated the study results. As expected, most of the studies found that dry needling is effective compared to sham or other interventions. Since all the studies were done by a certified dry needling practitioners, there could be a potential bias, though few studies used blinding protocols to minimize it. In most of the studies long term follow up was missing, which was rightly pointed by couple of systematic reviews. It is not easy to conduct a proper double blinded RCT with homogeneous population, with a long term follow up. It is especially true for chronic neck and back pain as the condition itself is a complex manifestation of multiple aetiology with significant psychosocial contribution. This article conveys that dry needling can be effective in variety of neuromusculoskeletal conditions after a good assessment and clinical reasoning. Dry Needling in chronic abdominal wall pain, dysmenorrhea and stroke is found to be promising, which implies the expansion of the dry needling intervention to non-musculoskeletal pain conditions. We hope that future studies will be able to provide more insights into the neurophysiological mechanism of dry needling, which is currently lacking.

Dr. Rajkannan. P, PT

Chief Physiotherapist - RMV Hospital, Bangalore

Founder President – Dry Needling Association

Director- APTER Institute, INDIA