Dry needling, or trigger point dry needling, targets trigger points, or tiny knots that dry needling practitioners say develop in muscles when they are injured or overworked.
“Trigger point therapy has been around for a really long time, but we used to use our hands a lot [instead of needles]. Then it was discovered that if you actually put a needle deep into the muscle you can get a really good response,” said Christine Bell, a Boulder-based physical therapist. Dry needling practitioners use the same needles that acupuncturists use; they tap the needle into the trigger point in the hopes that the muscle will loosen, eventually reducing pain and tightness.
“What happens with a shortened or tight muscle is that it is continually firing,” Bell said. “A chemical is continually released into the motor end plate of the muscle [the spot where nerve impulses are transmitted to the muscle], which makes it fire and keeps the muscle short. That’s a dysfunctional muscle. It can’t contract properly. Dry needling will get rid of the chemical substances in the muscle by producing a twitch response [the release of the trigger point], and it also helps to realign the muscle fibers to restore a more normal length and tension balance. Then it can contract normally, and then you can strengthen it. The muscle not only feels better instantly, but then when you go out and exercise you can actually do it, so you can get stronger.”
Widely practiced in Canada, Australia, New Zealand and Europe, dry needling is rapidly gaining popularity and acceptance in the United States. Roughly a dozen states currently allow physical therapists and chiropractors to dry needle (following proper training), and proponents of the technique are attempting to increase this number.
While most of the evidence in favor of dry needling is anecdotal, case studies cite improvement in a variety of conditions including chronic muscle tightness, piriformis and hamstring issues, patellar tendonitis, Achilles tendonitis and rotator cuff injuries.
One of the earliest studies of dry needling in the treatment of chronic muscle pain was published in 1979 by Karel Lewit, a physician from the Czech Republic and a pioneer of the technique. Lewit reported that of 241 patients and 312 sites treated, immediate relief was felt in nearly 87 percent of locations needled. That is, while some patients experienced no change, the majority felt pain relief ranging from several days to several weeks to permanent improvement.
Ironman champion and Arizona-based triathlete T.J. Tollakson, for example, believes that dry needling helped him recover quickly from recent hip surgery. “One of the drawbacks of the surgery is a super sensitive hip flexor group,” Tollakson said. “[My physical therapist] recommended I try dry needling along with my current rehab and strengthening routine—I’m a huge fan. I believe it aided in an increased healing process of my hip flexor group and allowed me to get back to full training sooner.”
Anyone interested in dry needling should note that the process can be painful.
“The needles pushed through my IT band tended to be some of the most painful ones, along with needles in my psoas and iliacus,” Tollakson said. “I would leave each session walking with a slight limp from being so sore and I developed a few quarter-sized bruises in different injection sites, though most of the needles left no bruising.”
Tollakson said he was quite sore immediately after each session, but improved over the next few days.
Ins & Outs of Dry Needling
BEST FOR | Muscular tightness or imbalance; soft-tissue injuries; back or pelvic misalignment
BENEFITS | Restores proper muscle function, flexibility and range of motion; decreases pain
WHAT TO EXPECT | Sensations range from unnoticeable to painful, depending on the individual, the location needled and the condition of the muscle
RESPONSE TIME | Some degree of immediate improvement; complex or chronic conditions require longer-term treatment
SIDE-EFFECTS | Temporary soreness lasting a few hours to a day or more; occasional bruising
CONTRAINDICATIONS | People taking anticoagulants; people with infection or road rash (needling dramatically increases blood flow); pregnancy (in some instances)
COST | Comparable to a physical therapy office visit
TIPS | As with deep-tissue massage, post-treatment drink plenty of water and avoid being completely sedentary in order to increase circulation and flush out released toxins
FIND A PRACTITIONER | Physical therapy website Kinetacore offers dry needling education and provides a link to certified therapists nationwide: Kinetacore.com
SCIENCE SAYS | Several studies of dry needling find the technique effective in the treatment of muscle trigger points; however, the consensus is that controlled trials would be necessary to determine whether the results are conclusive or a placebo effect.
Extracorporeal Pulse Activation Technology
“It feels like a million bee stings!” said professional triathlete and Ironman champion Linsey Corbin of extracorporeal pulse activation technology (EPAT). “It’s almost like a jackhammer, but it has a blunt end.”
EPAT is a therapeutic treatment in which sound waves are delivered to the injury or pain site through the skin with a hand-held applicator. Its origin is in extracorporeal shockwave therapy, or ESWT, a common practice used by urologists. According to practitioners, EPAT breaks up scar tissue, stimulates the metabolism, increases circulation and fast-tracks the body’s natural healing process.
“ESWT has been available since the early 1980s for the treatment of renal stones and biliary stones [kidney and gallstones],” said John Ball, a chiropractor based in Phoenix who administers EPAT. “The shock waves break up solid structures into smaller fragments and allow for the spontaneous passage of the stones.”
EPAT is believed to work in a similar fashion on the scars and calcium deposits that develop after an injury. “EPAT disrupts these calcific deposits and scarring. It loosens the soft tissues and promotes reabsorption of calcium, thereby decreasing pain and improving function,” Ball said.
Because EPAT is an emerging technology, there’s still much to research on its optimal dosages, response times and overall effectiveness.
What is known, however, is that elite athletes from all over the country travel to Phoenix to visit Ball and receive treatments using EPAT.
These athletes include Ironman champion Chris Lieto, who had an Achilles injury that Ball says he treated successfully; 2012 elite cross-country national champion Sara Hall, who received therapy for hamstring and hip issues; professional triathlete Rachel Joyce, who saw Ball for hip and groin injuries; two-time 5,000 meter national champion Lauren Fleshman, who received treatment for a foot injury; and Ironman champion Linsey Corbin, who saw Ball for a hamstring injury.
“I ran around like crazy trying to find a solution. I tried acupuncture, dry needling, crystals, PT, ice, rest, natural supplements, strength imbalance work. I saw an osteopath, a naturopath, people in Oregon, Tennessee, Montana—you name it. Nothing was working for me,” said Corbin, who lives in Montana but trains in Tucson when the weather is particularly cold.
She eventually found Ball through a referral from Olympic marathoner Ryan Hall. Whereas previous practitioners had focused on Corbin’s lower hamstring where she felt the pain, Ball went straight to her hip and gluteal region.
“Basically his theory is that as athletes, we’re building up scar tissue over time,” she said, “layering Band-Aid upon Band-Aid upon Band-Aid, but what we want is to have our muscles smooth like putty. He went in with the EPAT machine to clear up all the junk and scar tissue built up in my hip area, which immediately released the tension on my hamstring. It was like I was a free woman again!”
She says he had her running pain-free within a day.
“I stayed in Phoenix for a week on my first visit in June [last year]. I would see him a few times a day,” said Corbin. “I’d go for a run, tell him where I had pain, he’d treat me and I would leave. I’d run, he would evaluate what was tight or restricted, treat the area and I would leave. Again—run, treat, repeat.”
Corbin returned home to her regular training routine, yet paid a follow-up visit to Ball in July 2011, this time for four days, to address lingering scar tissue. She spent an additional three days working with him prior to the 2011 Ironman World Championship 70.3, where she placed third.
“After that I was back to 100 percent of my range of motion and health,” Corbin said.
Ins & Outs of E.P.A.T.
BEST FOR | Treatment of soft-tissue injuries including plantar fasciitis, numerous forms of tendinosis and acute and chronic muscle pain
BENEFITS | Disrupts scar tissue, stimulates metabolism, increases circulation and accelerates healing of injured tissues, resulting in increased range of motion and decreased pain
WHAT TO EXPECT | May feel moderately unpleasant or uncomfortable
RESPONSE TIME | Most conditions respond within 3–4 treatments spread at one-week intervals; chronic conditions may require more intensive treatments, whereas intermittent treatment can aid recovery
SIDE-EFFECTS | Potential for temporary local tenderness or mild swelling
CONTRAINDICATIONS | People with uncorrected bleeding disorders or bone tumors; pregnancy; recent use of steroid injection
COST | Varies depending on treatment and type of medical office, ranging from $95 per single treatment to $750 for three-pack series
FIND A PRACTITIONER | Approximately 500 M.D.’s, D.O.’s, D.P.M.’s and D.C.’s nationwide currently use EPAT; contact CuraMedix directly for referral to a practitioner near you: Curamedix.com
SCIENCE SAYS | Research in support of ESWT (and ESWT-derived techniques such as EPAT) as a treatment for musculoskeletal conditions is limited and primarily focused on plantar fasciitis and chronic tendinitis.