Should you be asking your physiotherapist for dry needling to cure all of your stubborn ailments?
Dry needling has become an extremely popular treatment method for physiotherapists and other allied health professionals treating musculoskeletal pain conditions. It is thought to help by relaxing or ‘releasing’ tight spots in the targeted muscles, but is it really effective in improving musculoskeletal pain conditions?
All health professionals should understand and use evidence based assessment and treatment methods
Anyone seeking help for a musculoskeletal pain condition should have peace of mind that their chosen health professional will act in their best interest by delivering best practice treatment methods. When deciding whether a treatment method should be used, three key considerations should be made:
The Available Evidence: What does the scientific evidence tell us? This includes both scientific studies and the clinician’s experience. The quality of evidence should be evaluated based on its methodology and risk of bias. Considering all available evidence helps make the best judgment on a treatment’s efficacy and effectiveness.
Synthesis of Evidence: This involves the therapist critically thinking about how the available evidence applies in their treatment room.
Patient Values and Circumstances: As the patient, you should be the primary decision-maker in your treatment. After your therapist explains the rationale behind their recommended techniques, including dry needling, using sound evidence and reasoning, the final decision should be yours.
These three steps can be thought of as a sequential process of narrowing down information to decide whether a treatment method is worthwhile. The picture below depicts this ‘funnel’ analogy:
So, with this in mind, is dry needling based on sound evidence-based principles?
Let's analyse dry needling using the important principles of evidence-based practice described above:
Is there scientific evidence for dry needling?
Numerous studies have investigated the effectiveness of dry needling for various ailments. Unfortunately, most research conducted is of poor methodological quality, making it difficult to draw firm conclusions. Currently, the general consensus is:
Dry needling is effective at reducing pain in many conditions, but whether it’s more effective than ‘sham’ dry needling treatments is still unproven. In some cases, it may be no more effective than a placebo, but even this placebo effect can offer temporary relief of symptoms.
Dry needling alone is unlikely to improve functional outcomes when used in isolation, but it may improve outcomes when combined with other physiotherapy treatment methods such as exercise prescription.
What does clinical expertise tell us?
Most consensus statements from experts in the field, based on summaries of all available evidence, do not include dry needling as a first-line treatment for any musculoskeletal conditions. When they do, the supporting evidence is of very low quality. Synthesizing the available evidence should guide therapists to use dry needling in combination with other treatment methods rather than as a stand-alone treatment.
What are your values?
What type of treatment do you feel you need? Do you prefer hands-on deep tissue massage, stretches, therapeutic ultrasound, or exercise advice? Do you believe dry needling will work? Your beliefs will likely be influenced by personal experience, what you’ve heard from family and friends, and what your physiotherapist has told you. These beliefs can influence how you respond to any treatments used, including dry needling.
Our Recommendation?
As mentioned, current evidence is mostly of low quality, making it difficult to draw clear conclusions. A critical eye might lead us to conclude that dry needling may be no more effective than a placebo. However, there is strong anecdotal evidence from therapists and patients that it has a positive effect on pain and function. Emerging evidence of varying methodological quality continues to explore its effectiveness in various musculoskeletal conditions, though debate and lack of clarity on the underlying mechanisms remain.
So, do we still recommend and use dry needling? It is our belief that you should be presented with all available information to make an informed decision. Many people come to us firmly believing that dry needling will benefit them due to past experiences, while others are unsure and rely on us for an unbiased view. Provided you are treated first with methods of proven efficacy and effectiveness (whenever possible), the addition of dry needling often provides additional benefit when applied by an experienced therapist.
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