Why I Love Dry Needling

by Mitch Hauschildt, MA, ATC, CSCS

Dry needling has been around for several years and has been the source of a fair amount of controversy due to state regulations, insurance company pushback, and turf battles.  There has also been a lot of confusion amongst providers and the public as to who, how and when needles should be used and how it differs from acupuncture.  One thing is clear in my mind, however.  It works.

Due to a lot of the factors listed above, I held off on getting trained in dry needling for several years to allow some of the legal battles to get resolved and the education process to be refined.  While I believe that I made a good decision in not being an early adopter to the dry needling practice, I also believe that I made a great decision in pushing forward to get trained and start offering this game changing modality, because that’s what it is…a game changer.  

To be clear, dry needling isn’t for everyone.  It isn’t legal in every state and many states allow some clinicians to needle and not others.  It is also invasive and carries with it some inherent risks such as infection and if you don’t have a strong grasp of anatomy, odds are pretty good you will end up placing a needle somewhere where you don’t want to be (mistakes can be very, very dangerous).  And, if you’ve cleared all of those hurdles, you have to have patients who are interested in this modality.

On a high level, I view dry needling as a neurological reset.  It allows me to introduce a stimulus to tissue deep beneath the skins surface in ways that I can’t do with my hands or soft tissue tools. At the end of the day, I am not changing function, posture or motor patterns, which are usually the underlying driver for their pain or dysfunction, but I am resetting the nervous system.  That means that this modality on its own may lead to temporary relief, but long term solutions for most people includes corrective exercise and a combination of therapies.

This unique neurological reset does several things for my patients.  First, it usually breaks the pain-spasm cycle.  We were all taught in school about this cycle that many people find themselves in…pain causes spasm and spasm causes pain and it continues until somehow the cycle is broken.  I find that needling allows me to get right into the hypertonic tissue and begins to break that cycle.  This manual intervention immediately decreases tone and it opens a window of opportunity to train in.

Dry needling can also be a great way to reduce pain.  It may seem counterintuitive to use a needle to reduce pain, but it does a great job of pain reduction.  Aside from changing tone (which often results in decreased pain), introducing needles into tissue shines a “kinesthetic flashlight” to the area, making the brain more aware of the dysfunction and remapping a painful part of the body.  This increased awareness in the mind’s eye can result in a heightened sense of safety and control, the driving factor for pain control.

Lastly, I do believe that needles can play an important role in improving tissue slide and glide.  Pushing a tiny needle through tissue likely won’t mechanically deform that tissue enough to “break up adhesions”, but I don’t really believe that we are doing much of that anyway with any of our manual techniques (another topic for another day).  What I believe is more likely going on with “stuck” tissue is that it is densified and usually needs either more Hylaruanic Acid (HA) introduced to the area or an improvement in the viscosity of HA.  There is some limited data becoming available that the nervous system is able to both introduce HA into specific areas of the body as needed and change the viscosity of that HA.  This nervous system response can improve tissue slide and glide between the various layers under the skin, making it move the way it was supposed to move to start with. 

Dry needling has changed the rehab game for me, and many others.  I don’t like it as a stand alone modality and should be coupled with other things like kinesiology tape, exercise, cupping, IASTM and so on to make long term improvements.  But, in the right situation with the right patient, it is an absolute game changer.  

If it is legal for you to needle in your state and you have been sitting on the fence as to whether or not to get trained and integrate it into your clinical practice, I encourage you to get off the fence and start dropping needles into tissue.  You will see fast and impressive results.