Dry needling

Dry needling, also known as myofascial trigger point dry needling, is the use of either solid filiform needles (also referred to as acupuncture needles) or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. Dry needling is sometimes also known as intramuscular stimulation (IMS). Acupuncture is a broad category of needling practices with solid filiform needles. Modern acupuncture notably includes both traditional and Western medical acupuncture; dry needling is arguably one subcategory of western medical acupuncture.

Chinese style tendinomuscular acupuncture relies on careful palpation of what are called "Ah Shi" points, which often correspond to both trigger points and/or motor points in the myofascial tissue. Chinese style tendinomuscular acupuncture tends to use lower gauge (thicker) needles necessary for puncturing contraction knots with a high degree of precision. On the other hand, lighter styles of acupuncture, such as Japanese style, and many American styles, may tend towards very shallow insertions of higher gauge (thinner) needles. Most acupuncture styles, especially those with lighter techniques, require a detailed knowledge, not only of anatomy but also of the channel networks and connections. Thus, while some forms of acupuncture are not at all the same as dry needling, the term dry needling can refer quite specifically to what is now called Myofascial Acupuncture, Tendinomuscular Acupuncture, or some version of Sports Acupuncture.

The origin of the term “dry needling” is attributed to Janet G. Travell, M.D. In her book, 'Myofascial Pain and Dysfunction: Trigger Point Manual', Dr. Travell uses the term "dry needling" to differentiate between two hypodermic needle techniques when performing trigger point therapy. However, Dr. Travell did not elaborate on the details on the techniques of dry needling; the current techniques of dry needling were based on the traditional and western medical acupuncture. The two techniques Dr. Travell described are the injection of a local anesthetic and the mechanical use of a hypodermic needle without injecting a solution (Travell, Simons, & Simons, 1999, pp. 154–155). Dr. Travell preferred a 22-gauge, 1.5-in hypodermic needle for trigger point therapy and used this needle for both injection therapy and dry needling. Dr. Travell never used an acupuncture needle. Dr. Travell had access to acupuncture needles but reasoned that they were far too thin for trigger point therapy. She preferred hypodermic needles because of their strength and tactile feedback: “A 22-gauge, 3.8-cm (1.5-in) needle is usually suitable for most superficial muscles. In hyperalgesic patients, a 25-gauge, 3.8-cm (1.5-in) needle may cause less discomfort, but will not provide the clear “feel” of the structures being penetrated by the needle and is more likely to be deflected by the dense contraction knots that are the target… A 27-gauge needle, 3.8-cm (1.5-in) needle is even more flexible; the tip is more likely to be deflected by the contraction knots and it provides less tactile feedback for precision injection” (Travell, Simons, & Simons, 1999, p. 156).

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