When is dry needling appropriate?

Stim current about to be applied to a needle in the left lumbar multifidi

Answer:  For a huge number of conditions.  Maybe a better question would be when is dry needling NOT appropriate.   

When thinking about if dry needling could be useful for you it’s necessary to know what it’s often used for. The goal of dry needling is to create a very controlled local trauma to an area not getting good blood flow.  These areas often manifest as muscle knots, trigger points, or other pain generators.  The currency of healing is blood flow…there is no second currency.   You have many important biochemicals in your body relating to the exact science of how tissue is healed but none of them can get to the damaged tissue without blood flow!  Surgeons can’t perform surgery if they can’t get to the hospital!  All exercises, modalities, prayers, seances, (whatever you’ve got going on) are considered to be physically successful if they bring blood flow effectively to an area.   

So, if you have an acute injury, surgery, post intensive lift, or any condition where the body already has a natural high flow of blood to an area you are unlikely to benefit from this aspect of dry needling.   In a similar vein if you’re already successful getting blood flow to an area with massage, hot pack, etc. you likely won’t see an appreciable benefit from dry needling for this specific function.    

Enter the second major benefit; turning on/retraining a malfunctioning/nonfunctioning muscle.  This is maybe the best tool physical therapists have in their toolbox for this specific problem.  It’s the only modality that gets below the skin (electrical current the exception, but even this is not specific).  There are some extraordinary therapists out there who can use their hands to do some amazing things.  But they are limited by having to push through the skin, fascial layers and any superficial muscles before they can impact any deeper muscle tissue.  Often times simply getting the needle into the right area is all you need before the muscle ‘wakes up’ and starts responding to targeted exercise.  

Once you have the muscle turned on and well supplied with blood put it to work!   All good dry needling sessions are followed by use of the muscle in question.  Doesn’t have to be heavy lifting, but you’ve now got blood flow and a very awake muscle primed for movement.