Functional dry needling, a pain management therapy, gaining momentum in SD

March 7, 2019

BELLE FOURCHE — On Aug. 1, 2018, a law in South Dakota became effective to approve physical therapists to practice functional dry needling, a therapy to manage musculoskeletal problems, and local physical therapists are seeing people seeking out the natural pain relieving treatment.

“These patients have usually learned about dry needling from a friend in a different state or from their own research to manage their pain. Since it is so new to our area, we have had to educate our patients and community on the effectiveness of dry needling,” Dr. Julie Wingen, a physical therapist at Pain & Movement Solutions in Belle Fourche, said. “Most of our patients have been very open and excited to have another treatment alternative to improve their pain and expedite their healing process. In other states where dry needling is more well-known, it is an expected part of physical therapy treatment due to its large popularity for good outcomes.”

Wingen said that many area physical therapists will receive their certifications for dry needling in the next year.

“I believe you will begin to see the popularity of this treatment grow rapidly in the next couple years,” she said, explaining that the technique has long been used in Europe, but it’s only been in the past 15 years that it’s risen in popularity in the United States.

“Our state physical therapy association advocated strongly last legislative session to approve dry needling for physical therapists, as our state was one of only six states left to approve this effective treatment technique,” Wingen said, voicing appreciation to state legislators.

She explained that the providers at Pain & Movement Solutions completed an intensive continuing education course to receive their Level 1 certification for Functional Dry Needling immediately once the law was passed and have been performing the technique since August.

Wingen said that the technique was introduced during her doctorate schooling for physical therapy and that research studies have found dry needling to be similar in effectiveness when compared to cortisone injections when treating trigger points.

“I have been waiting for dry needling to become an approved treatment in our state for over 10 years,” she said.

Wingen explained that the technique treats muscular tension and spasms produced by myofascial trigger points, which are painful “knots” in taut bands of impaired muscles that play a role in producing and maintaining a pain cycle.

She described that when an injury occurs from repetitive use or acute trauma, inflammation will be produced from the damaged tissues, which can go into a protective tension state or contracture to guard against further damage from utilizing the injured tissue leading to compression and irritation of nerves.

“Dry needling involves identifying the source of the pain and advancing thin, solid filament needles into the related muscles to stimulate underlying neural, muscular, and connective tissues,” Wingen said, describing that research shows that the strategic insertion of the needle creates a quick muscle twitch stimulating the body’s natural healing capabilities, increasing blood flow and oxygen circulation to the area, decreasing muscle contraction, reducing chemical irritation, and improving flexibility, pain and dysfunction. “This process essentially ‘reboots’ the muscle and the decrease in pain is related to the removal of muscular compression on joint, nerve, and vascular tissue.”

Wingen said the technique is a natural extension of hands-on physical therapy to decrease muscle dysfunction, but the muscle must then be retrained with appropriate exercises and motor control training to break the pain cycle.

She added that patients often ask how dry needling compares to acupuncture and that one of the main differences is that dry needling does not have the purpose of altering the flow of energy (“Qi”) along traditional Chinese meridians for the treatment of disease and is a modern, science-based intervention for the treatment of pain and dysfunction in musculoskeletal conditions by doctors of physical therapy with a thorough knowledge and understanding of a patient’s condition based on professional evaluations and assessments.

“Unlike acupuncture sessions, which can involve dozens of needles in several areas of the body, dry needling often utilizes just a few needles that are strategically placed along affected muscles,” she said. “Another way that dry needling differs from acupuncture is that it’s not considered curative on its own. It’s often part of a multi-technique physical therapy plan that may also include movement analysis, targeted exercises, and other interventions.”

Patients also ask about side effects, and Wingen said that there may be some soreness immediately after treatment in the area of the body treated that lasts between a few hours and 2 days, and there is occasional bruising.

“Typically it feels like you have had an intense workout at the gym, but a small number of patients report drowsiness, tiredness, or dizziness (1-3 percent),” she said, and soreness may be alleviated by applying ice or heat to the area and performing specific stretches for the treated muscle.

Patients also ask about how many sessions of dry needling are needed.

“We are looking to get improvements even from the first visit such as increased range of motion, ease of movement and decreased symptoms, but complete restoration of the muscle dysfunction is based on the chronicity and severity of your condition,” Wingen said. “We will only dry needle the same muscle group one time per week to allow for completion of the physiological response with dry needling.”

She added that the technique may not be for everyone, and the decision to implement treatment is based on the patient’s condition and interest for receiving dry needling.

The technique is considered a natural pain reliever that can reduce muscle tension, ease joint pain, improve blood flow, and oxygen circulation within the body, and desensitize irritated tissues in the body, which brings results for those who are trying to optimize sports performance, recover faster from injury, or prevent issues from becoming chronic, Wingen said.

She described that dry needling has allowed her to be more precise and definitive with her treatment strategy.

“I have seen great results for neck pain, headaches, and sciatica,” Wingen said, describing that she was excited when she utilized the treatment on a patient that was experiencing severe pain down his leg from an acute bulging disc. “He had failed typical treatments and was about to be referred to receive oral steroids to address the pain. He was agreeable to try dry needling and experienced an 85 percent reduction in his symptoms following and did not need any expensive medications or imaging to address his pain. I knew dry needling was effective, but I was blown away by the great results with some of the most difficult pains to treat.”

Wingen described that the technique is one tool that therapists can use to address myofascial pain and muscle tightness.

“In some cases, a therapist might do two to three treatments of dry needling in order to make subsequent movement therapies more effective,” she said. “For example, a runner with active trigger points in her hamstring would likely benefit from a few dry needling sessions before going through therapy that can improve her running gait.”

She added that it has been really exciting to be on the frontline of offering this new treatment for pain management in the state.

“We see a wide variety of patients and have been able to utilize it for new injuries vto chronic pains and everything in-between,” she said, adding, “Pain is a huge epidemic in our country and has currently led to a serious opioid problem.”

Physical therapists will continue to be at the frontline to address these issues in a conservative manner, Wingen said, adding, “Many do not realize that in our state all patients have direct access to physical therapy, meaning that you can come to PT without a physician referral. Research has proven over and over again that the sooner that you seek physical therapy, the better your outcomes will be.”

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