Dry Needling Gets a Boost

Fortunately, the answer to that last question just got a boost. In the recent Journal of Orthopedic & Sports Physical Therapy, Dr. Kietrys and colleagues published a systematic review and meta-analysis of dry needling for myofascial pain in the upper quarter. In the article, the authors conclude that dry needling,when compared to sham or placebo,has a significant and positive impact on upper quarter pain immediately after treatment. Trigger point dry needling is similar to acupuncture in the use of the needle which is placed into the site of a myofascial trigger point. There are ways in which dry needling are not similar to acupuncture, and you can find some of those differences explainedhere. The mechanism of the treatment effect, and the reason for the "twitch response" that is often elicited during the needle placement is still debated.

How does research about the upper quarter help pelvic rehab providers? Efficacy of dry needling has been described in other excellent research reports, including this free, full-text case report about a patient with low back pain. Pelvic rehab providers apply similar strategies when treating myofascial pain regardless of the site of dysfunction: education for pain theories and management of chronic pain, manual therapies, modalities, muscle lengthening and strengthening as appropriate, body mechanics, adaptations for work and leisure activities. Any research about dry needling that supports pain relief and improved function for patients assists our understanding of how to apply the modality. As pointed out by the authors of the systematic review on dry needling, further research with high quality study design are needed in general.

Pelvic pain providers who are trained in dry needling can contribute to the body of research.

For answers to some of the other questions above, we can look to the American Physical Therapy Association (APTA) resource page about dry needling. Therapists are encouraged to bill the "manual therapy" code as the intervention addresses myofascial trigger points. Each practitioner needs to check state practice acts to find out if the technique is supported for your particular profession, and attending a specific training course is required. One of the course providers, Kinetacore, lists each state recommendations.

You may recall this blog postfrom the 2011 International Pelvic Pain Society Meeting that highlights a presentation from Dawn Sandalcidi, PT, and Nel Gerig, MD, about dry needling for pelvic pain. Dawn teaches the pediatric incontinence and pelvic floor dysfunction courses for the Institute, and she also lectured at the last Combined Sections Meeting of the APTA about dry needling for pelvic pain. (The next pediatric course happens in October in California if you would like to expand your practice to pediatrics.) As pelvic rehab continues to advance in the development of both evaluation and treatment techniques, therapists who use dry needling for pelvic pain have an exciting opportunity to offer patients another valuable tool.