1) Why does dry needling hurt?
The insertion of an acupuncture needle into the muscle causes minimal discomfort. If the
needle hits a trigger point there is a twitch response. The twitch response is uncomfortable
and difficult to explain. The twitch response is also something desired by the practitioner as
it is associated with better outcomes.
Theoretically an active trigger point undergoes constant repetitive contraction. This causes
a build up of metabolic waste. A twitch response will allow the metabolic waste to dissipate
into the muscle. This creates an acidic environment, thus for 6-48 (96 hrs in extreme cases)
hrs post treatment there will be some residual soreness that could be compared to delayed
onset muscle soreness (DOMS) post work out.
2) How long do the effects of dry needling last? And what should the frequency of
treatment be?
If the dysfunction or pain is associated with myofascial tension, then dry needling should
have significant effects with one treatment. Usually only 2-3 sessions over a month is
needed for this type of client. More complex pain patterns, ie whiplash or repetitive
strain/desk job, are harder to predict. A reduction of symptoms is expected but full
resolution through dry needling alone should not be expected. A multi-focal treatment with
focus on exercise should be used with this type of client. If dry needling provides relief but
for only a couple of days it indicates that the trigger point is the result of some other
dysfunction, usually the neck or back.
3) Are there certain activities that should be avoided post dry needling?
Post needling movement is better than no movement. If the pain has been present for
longer than a month there will be a tendency for a rested muscle to creep back to the
hypertonic state. Movement provides feedback to the central nervous system of restore
muscle length and tone which helps with maintenance of outcomes. If the post needling
soreness is enough to make a person avoid movement, a day of rest is ok. I would not
recommend deep tissue massage within 24 hrs of dry needling. Effleurage like massage
would likely be beneficial.
4) Can dry needling be combined with other modalities and/or therapies?
Dry needling can be combined with all other modalities and therapies, with caution of
deep tissue massage 24 hrs post. Anecdotally, massage therapists have reported easier
ability to release tension and chiropractors have reported more success of
manipulations when combined with dry needling. A recommended spacing of 48 hrs in
between dry needling and massage or chiropractic treatments is satisfactory.