For many people considering chiropractic treatment, manipulation is the first thing that springs to mind. They may have heard friends or family talking about it or seen videos online. But, is manipulation the only form of treatment that chiropractors offer?

The answer to that is dependent on the training that a chiropractor has received. Most chiropractic colleges include education on multiple modalities, and chiropractors often undertake post graduate courses in additional techniques, such as soft-tissue work, stretching, use of heat and/or ice, diet and supplementation, rehabilitation, laser and dry needling.

A number of studies have shown that these treatment techniques are highly effective for a variety of conditions or ailments and that, in combination, they provide a greater effect than any one method on its own.

For instance, the World Health Organisation (WHO) has recently released new guidelines* for managing low back pain, which include evidence-based recommendations of non-surgical interventions for managing this widespread, chronic problem. A recently published article** on these guidelines by the British Chiropractic Association (BCA) includes the assertion that:

‘Spinal manipulation was one of the physical therapies recommended for use in all patients, as well as physical therapies such as dry needling, a structured exercise program and massage.’

(You will find links to the WHO guidelines and BCA article at the foot of the page)

Understanding dry needling

Pain is a universal experience that can significantly impact a person's quality of life. Traditional approaches to pain management often involve medication, physical therapy, and other standard interventions. However, in recent years, a technique called dry needling has been recognised as a promising method for alleviating pain and improving overall well-being.

Unlike acupuncture, which is rooted in traditional Chinese medicine and focuses on balancing energy flow, dry needling is grounded in western medicine and targets the release of muscle tension and pain. It  involves the insertion of thin needles into specific muscle knots, medically known as trigger points, to relieve pain and improve muscle function.

These trigger points are localised areas of spasm within a muscle. They will often cause referred pain, which means it is felt in an area of the body away from the actual location of the trigger point. It can feel like the pain is inside a joint, bone, body cavity or even the head.

As you can imagine, identifying the connection between an area of referred pain and its root cause somewhere else in the body is a complicated process. A combination of anatomical knowledge and clinical skills, plus in-depth experience over time of identifying pain referral patterns is needed to make an informed diagnosis. At this point dry needling may be considered as a treatment option.

What does dry needling involve?

The area to be treated is first sterilised with an alcohol swab. The needles used are extremely fine and come in a variety of sizes, suitable for different areas. The appropriate needle is inserted into the localised muscle spasm. The increased excitability of this section of muscle causes it to react to the foreign stimulus of the needle by contracting harder around it. This spasm is recognised by the body as being ‘too much’, which in turn triggers a reflex relaxation of the spasm (a ‘twitch response’), thus relieving the trigger point.

Who can it help?

During my time in practice, I have noticed some impressive results with dry needling. Over the years there have been many cases where I have seen trigger point pain referral patterns overlap and be misdiagnosed as more serious conditions. I have included a few interesting examples below.

…I had a patient a number of years ago who presented with severe medial (inner side) knee pain. This had been so severe he had been to see the orthopaedic surgeon, who had done tests and diagnosed a medial meniscus tear. The patient had undergone surgery but, on waking, the pain had not changed. He tried to allow the problem to settle and went back to exercise therapy, which he had already done prior to the surgery, but to no avail.

Desperation brought him to our practice and after performing a thorough examination we found trigger points in a muscle called the Vastus Medialis Oblique (VMO for short) in the lower front part of his thigh, just above his knee.

We discussed the options and he agreed to try needling the trigger point. He was tender after the treatment, but the following week his pain was 80% better and within 3 treatments he was pain free for the first time in over a year.

More generally speaking, I find there can be a tendency for patients to be diagnosed with degeneration of the knee or shoulder joint as a cause of their pain. But, interestingly, no explanation is given as to why another person can have far more degeneration in their joints, but no associated pain.

One of the possible explanations for this is that the change in joint function in the individual with pain has led to the formation of trigger points. These, in turn, refer pain back into the joint. Needling of these trigger points around the joint will very often resolve the joint pain, even though the osteoarthritis or joint degeneration is unchanged.

Some of the common joints that we see involved are the TMJ (jaw), knee, shoulder, hip, elbow, ankle, and wrist.

…True sciatic pain is caused by irritation to the sciatic nerve or its roots. However, there is a very large overlap between the leg and buttock pain pattern caused by sciatic nerve irritation and that which is caused by trigger points in the buttock and lower back muscles. It is important to differentiate between these 2 causes of leg pain referral because the pain caused by trigger points is relatively easy to resolve.

Recently, a patient came in with history of a previous disc herniation (often referred to as a slipped disc), which had been bad enough to create a severe stenosis (narrowing of the spinal canal). As a result, 7 years previously, the patient had needed to have a surgical decompression and partial discectomy. This involved removal of the back part of the vertebra and a piece of the disc to reduce pressure on the Cauda Equina (the lower fibrous part of the spinal cord) .

His current complaint was of severe lower back, buttock and back of the thigh pain, which is commonly - and often mistakenly - referred to as sciatica.

In this instance, a few careful orthopaedic tests involving neural (nerve) provocation confirmed that the pain was not actually coming from compression of the sciatic nerve or its roots. This was enough to establish that the pain was not of a neural origin. By palpating (feeling and pushing) the gluteus-medius muscle we were able to confirm the presence of trigger points, which had pain referral patterns matching his pain pattern exactly.

We discussed the options for treatment and - because of the extent of his pain - we decided together that dry needling would potentially provide the quickest relief. We needled the trigger points and within ten minutes the patient’s presenting pain had completely resolved. He had some minor tenderness from the needling, but the excruciating pain which was limiting his movement and bothering him with every step, was gone.

…Often people can be diagnosed with a pinched nerve in the neck, when in truth they may have a trigger point in one of the many muscles associated with the shoulder girdle.

We frequently get patients complaining of severe shoulder pain and limited movement who have been clinically diagnosed as having a frozen shoulder, which is a tightening of the shoulder capsule around the joint that causes severe pain and limited movement.

However, there are a few trigger points around the shoulder that can present with the same symptoms. Two notable ones are the subscapularis muscle and the infraspinatus muscle trigger points. These 2 trigger points can also result in false positive tests for several other conditions, including tendonitis, adhesive capsulitis, and impingement syndrome.

On these occasions I will explain to a patient that they may indeed be experiencing these conditions, which frequently require more invasive medical therapies, including surgery. However, it might be worthwhile needling any of the active trigger points that they present with to see if the symptoms resolve. They often do improve, to such an extent that no further intervention is needed.

Benefits of Dry Needling:

Dry needling is emerging as a valuable tool in the field of pain management, offering numerous benefits for individuals seeking relief from acute or chronic pain. Its ability to target specific trigger points, provide rapid pain relief, and complement other interventions makes it a promising option for those looking to enhance their overall well-being, as detailed below:

• Pain relief: One of the primary benefits of dry needling is its ability to provide rapid and effective pain relief. When the needle used in the procedure stimulates the affected muscle, causing the twitch response, the reaction helps in breaking the pain cycle by reducing muscle tension, promoting blood flow, and releasing endorphins; the body's natural painkillers.

• Improved range of motion: Tight and knotted muscles can restrict joint movement and limit the range of motion. When the dry needling releases tension in the muscles, it allows for improved flexibility and enhanced joint mobility. This is particularly beneficial for individuals with chronic pain conditions or those recovering from injury.

• Improved muscle function and performance: By targeting trigger points and addressing muscle imbalances, dry needling contributes to improved muscle function. Athletes often use dry needling as part of their recovery and performance enhancement strategies, as it can help optimise muscle function and reduce the risk of further injuries.

• Reduced muscle spasm: A muscle spasm can be both painful and disruptive to daily activities. Dry needling helps to reduce muscle spasm by releasing tension in the affected muscle. This can be particularly beneficial for individuals with conditions such as chronic back pain or tension headaches.

• Complements other therapies: Dry needling can be used in conjunction with other approaches such as physical therapy, exercise, chiropractic manipulation and medication. Its versatility makes it a valuable addition to comprehensive pain management plans tailored to individual needs.

• Minimised side effects: Compared to some pharmaceutical interventions, dry needling generally has minimal side effects. Any temporary soreness or bruising at the needle insertion site is typically mild and short-lived.

So, is dry needling right for you?

Obviously, not every instance of pain is due to trigger points. Indeed, it is important to rule out the more serious causes of any presenting pain pattern. But, in the absence of significant evidence to the contrary, needling of trigger points can save a patient the trauma and stress of possibly far more invasive therapies. Even if there is evidence of a more serious issue, as long as it has been established that there is nothing to be lost by trying a conservative approach, needling can still be used to see if it alleviates the presenting symptoms.

As with any medical intervention, individuals should consult with healthcare professionals to determine the suitability of dry needling for their specific condition and health goals. For this reason, we do not offer dry needling as a separate appointment option. Rather, it can be employed as part of a patient’s overall chiropractic care, where deemed appropriate by the practitioner. It is then incorporated into a patient-centred approach to pain management, within a tailored treatment plan, based on individual needs, considering factors such as the nature of the pain, overall health and patient preferences.

If you would like to discuss the option of dry needling, you can speak to your practitioner at your next appointment. For further information, you can also call the practice on 01328 854325 or email us at info@creativechiro.co.uk

*To read the WHO guidelines in full, click HERE

**To read the BCA article about these new guidelines click HERE