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As a physiotherapist, I often encounter patients who suffer from chronic muscle pain due to overuse, such as athletes or individuals with physically demanding jobs.
Take, for instance, a patient of mine who was struggling with persistent knee pain from repetitive strain. Our traditional soft tissue release techniques, while effective, are sometimes painful for the patient to endure.
This is where dry needling came in. It is a less painful yet highly effective alternative that provides quick relief by targeting the specific trigger points causing the discomfort.
Dry Needling is a therapeutic technique now widely practised by a range of healthcare professionals, including medical doctors, dentists, physiotherapists, veterinarians, and others who have undergone specific training. The discovery and development of dry needling as a distinct practice in Western medicine occurred much later than Traditional Chinese Medicine (TCM) acupuncture, but it has rapidly gained traction due to its effectiveness in treating various musculoskeletal conditions.
ORIGINS OF DRY NEEDLING
The origins of dry needling can be traced back to the use of injections of anaesthetic to treat painful musculoskeletal conditions. As early as the 1930s, practitioners began injecting irritated points in the muscles to alleviate pain. However, a significant turning point in the development of dry needling came in 1941 when a groundbreaking paper was published in the US. The research claimed that pain could be relieved by simple needling without the injection of any substance, which laid the foundation for the technique we know today.
The term “dry needling” was first coined by JD Paulett in the Lancet in 1947. This marked the beginning of a distinct approach within Western medicine, where needles are used not to inject any substance but to stimulate specific points in the muscles and surrounding tissues. The application of dry needling in physiotherapy practice began to take shape in the 1980s. Since then, it has become an integral part of the physiotherapist’s toolkit for managing pain and improving function in patients.
Dry needling was officially recognised as a subcategory of Western medical acupuncture in 2015. As physiotherapists, we specifically address this treatment technique as “dry needling” or “Western acupuncture” to differentiate it clearly from TCM acupuncture. This distinction is crucial to ensure that the unique methodologies and principles of each practice are understood and applied appropriately in clinical settings.
USES OF DRY NEEDLING
As physiotherapists, our application of dry needling focuses specifically on the musculoskeletal system, particularly targeting muscles and myofascial trigger points. This technique is primarily used for the treatment of pain, muscle tension and swelling, making it an effective intervention for musculoskeletal pain.
However, dry needling practitioners are not entitled to apply TCM concepts, such as theories of Qi, balancing the five elements, and Yin-Yang. Our approach is not intended to promote general wellness as does TCM.
Instead, dry needling is a targeted intervention designed to directly address specific musculoskeletal issues, grounded in Western medical understanding of anatomy and physiology.
EVIDENCE-BASED PRACTICE
In physiotherapy, our approach is grounded in evidence- based practice, ensuring that the selection of treatment techniques is guided by the best available scientific research. This approach prioritises the use of interventions that have been proven effective through rigorous studies and clinical trials, ensuring that our patients receive the highest standard of care.
Dry needling has been shown to be particularly effective for short-term pain relief in various musculoskeletal conditions. Research supports its use in alleviating back and neck pain, as well as knee pain associated with osteoarthritis. These findings make dry needling a valuable tool in managing pain and improving function in patients with these conditions.
Additionally, dry needling has demonstrated effectiveness in reducing limb spasticity in stroke patients. By targeting specific muscles and trigger points, dry needling can help to improve mobility and reduce discomfort in individuals recovering from a stroke, further expanding its applications within physiotherapy practice.
CLINICAL PRACTICE
In clinical practice, the application of dry needling begins with a thorough assessment of the patient’s complaints, often related to pain or discomfort. As physiotherapists, our first step is to identify the specific local structures that are causing pain. This is to ensure that the treatment is precisely targeted. We also take care to check all safety precautions and indications before proceeding, which includes obtaining informed consent from the patient.
The application of dry needling follows standardised procedures tailored to the individual needs of the patient. The duration of needling can vary, ranging from as short as one minute to up to twenty minutes. It depends on the condition being treated and the specific approach used. Patients often experience immediate pain relief following the procedure, which underscores the effectiveness of this technique.
However, in physiotherapy practice, dry needling is seldom used as a standalone treatment. It is most effective when combined with other therapeutic modalities such as manual therapy, electrotherapy and therapeutic exercises. This integrated approach not only provides short-term pain relief but also promotes long-term recovery and functional improvement, ensuring comprehensive care for the patient.
TRAINING REQUIREMENT
To practise dry needling safely and effectively, physiotherapists must undergo specialised training beyond their basic physiotherapy qualifications.
In Singapore, a trained Dry Needling physiotherapist should, first and foremost, hold a recognised physiotherapy qualification. In addition, the practitioner should have accredited certification or have completed courses in Dry Needling. These qualifications should align with the standards and recommendations set forth by Singapore Physiotherapy Association and International Acupuncture Association of Physical Therapists (IAAPT)
The IAAPT outlines specific training requirements to ensure safe and competent practice. A minimum of 80 contact hours is considered the basic requirement for safe acupuncture practice among physiotherapists. These 80 hours must include in-person teaching and supervised practice, excluding hours of self-directed learning or unsupervised practice.
For those seeking to advance their skills, the IAAPT recommends 200 contact hours, including the initial 80-hour introductory programme, as necessary for an intermediate-level programme. An advanced programme should consist of 300 or more contact hours to ensure a higher level of competency in Dry Needling.It is also essential for practitioners to follow local legal requirements and regulations regarding the practice of dry needling, ensuring that all treatments are conducted within the scope of the law and in accordance with professional standards.
BRING HOME MESSAGE
Dry needling has proven to be an effective tool in the physiotherapist’s arsenal, offering targeted relief for muscle pain and enhancing the body’s natural healing processes by modulating pain sensitivity, and promoting better blood flow and oxygenation to injured tissues.
So, the next time you find yourself struggling with an overuse injury or persistent muscle pain, consider consulting with your physiotherapist about whether dry needling might be a suitable, less painful, and more effective treatment option to help you get back on track.
