Dry Needling
Dry Needling ( dry needles) is a relatively new form of therapy for the treatment of myofascial trigger points ( MTrP ) using sterile disposable acupuncture needles. Dry needling is practiced by physiotherapists and occupational therapists and applied as an effective adjunct to other therapies, and especially for manual trigger point therapy. The dry needling arose from clinical observations in MTrP injections, where it was found that the injectate is not responsible for the success of the trigger point treatment, but that it is the stitch in the MTrP in itself, which is effective. Patients with chronic or acute myofascial pain also often respond very well to the use of dry needling.
Dry- needling techniques
When Dry needling in principle between the so-called intramuscular stimulation (IMS ) and the superficial Afferenzstimulation (SAS ) is distinguished. The IMS is the "real " Dry needling, be sought in which the MTrP and dealt directly with the needle. In SAS, the needles are superficially inserted into the skin.
Intramuscular Stimulation ( IMS)
One of the first users of IMS was Chan Gunn. He developed the so-called Gunn Approach. It is not directly aimed at the trigger points, but treats the whole muscle, with the goal of general muscle relaxation. Later, the trigger point model of dry needling has evolved from the Gunn Approach, in which the clinical diagnostic criteria are applied by MTrP. These include:
- The taut band
- Local tenderness within the hard tensioning strand
- Pain transmitted from MTrP
- The local twitch response of the hard tension cable under mechanical stimulation
There are two different techniques, the dynamic and the static IMS in practical use.
Dynamic intramuscular stimulation
Here, the taut band is sought conical with the needle first. When this is found, the taut band is long dots, to the local twitch response subsides. Many patients find that as " good pain " and expectorant, similar to the feeling of cracking at a joint mobilization.
Static intramuscular stimulation
The difference to the dynamic IMS is that the needle, once the MTrP was found is left in place. Here, a spasmodic feeling (similar to that known from acupuncture Teh Chi ) arise. It is important, then so long as to leave the needle in a taut band, until the local seizure is released. Static IMS is suitable for so-called Strong responder, whereas the dynamic IMS is suitable for weak responder. This distinction and careful selection of the correct application of the intramuscular stimulation is particularly important because it may lead to overreactions otherwise.
Superficial Afferenzstimulation (SAS)
The superficial Afferenzstimulation based on the work of Peter Baldry. In this case, the needles are inserted a few millimeters above the MTrP into the skin and left for a few minutes. Before and after treatment, pain on pressure measurements can be made to measure the treatment outcome by means of a Druckdolorimeters. SAS is suitable for strong responders or to accustom the patient to the needles.
Possible mechanisms of action
The effect of IMS and SAS are not the same. There is scientific evidence that it through the local Zuckungsantworten triggered by the needle comes to a change of the local biochemical milieu of MTrP in the IMS. Mikrodialytische method showed that there is a reduction in the concentration of various vasoneuroaktiven ( phlogogenic ) substances by dry needling. The analgesic and consecutive tonussenkende effect of SAS based Baldry according to Gate Control Theory -like mechanisms.
Indications and contraindications
The indication of the IMS is the treatment of trigger points. The indication of the SAS is broader: trigger points, Ansatztendopathien, scar pain and other musculoskeletal pain. The contraindications include: blood thinners, local skin irritation, lymphedema, lack of patient compliance, hematoma, reduced general condition.
Possible complications
When dry needling is professionally applied by trained medical personnel, with above-average three-dimensional topographical anatomy knowledge and taking into account the contraindications and hygiene criteria, then dry needling is a safe, low complication manual therapeutic measure. Possible harmless complications include a small local hematoma, a similar treatment aching pain, which can last 3-5 days and very rarely vegetative reactions. Improper application may cause the following serious complications: pneumothorax, injury to other internal organs, injury to nerves and blood vessels and infection.
Application
Dry needling is primarily used by physiotherapists and occupational therapists, sometimes by doctors, chiropractors and dentists. Since dry needling is used frequently and regularly only since 2000, dry needling is not yet firmly anchored manual therapeutic constituent physiotherapeutic actions. In the following countries is dry needling official part in the rehabilitation therapy: Switzerland, Canada, Chile, Ireland, the Netherlands, South Africa, England, Spain, Australia and several U.S. states.