Should you be asking your physiotherapist for dry needling to cure all of your stubborn ailments? There is no doubt that the use of dry needling has become an extremely popular treatment method for physiotherapists and other allied health professionals treating musculoskeletal pain conditions. They are 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 treatment of a musculoskeletal pain condition should have peace of mind that their chosen health professional will be acting in their best interest by delivering best practice treatment methods. When making a decision on whether a treatment method should be used, three things should be considered:
The available evidence for the treatment of choice. What does the evidence tell us? This includes scientific studies and as well as the experience of the clinician. Evidence should be weighted and judged on its methodology (how well designed was the scientific study, was there a high risk of bias?). Considering all the available evidence should allow us to make the best judgement on its effectiveness.
Synthesis of Evidence. This refers to your therapist critically thinking about how the available evidence applies and works in their treatment room.
Your values/circumstances. You, the patient should be the decision maker! After your therapist explains to you the available evidence and how it is likely to apply to you, the ultimate decision should rest in your hands.
These three key steps can be thought of as a sequential process of narrowing down information to make a decision on whether a treatment method is worthwhile using. 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:
1. Is there scientific evidence for dry needling?
Numerous studies have investigated the effectiveness of dry needling for a range of different ailments. Unfortunately, most research conducted is of poor methodological quality, therefore it is difficult to draw 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 not yet to be proven. Put simply, the jury is still out due to poor quality evidence. It may be no more effective than a placebo in some cases, but at the very least this placebo can offer temporary relief of symptoms
Dry needling alone is unlikely to improve functional outcomes when used in isolation, but may improve outcomes when stacked with other physiotherapy treatment methods such as exercise prescription.
2. What does clinical expertise tell us?
Most consensus statements (the opinion of experts in the field based off a summary of all available evidence) fail to include dry needling as first line treatment in any musculoskeletal conditions, and if they do, the backing evidence is of very low quality. Synthesis of the available evidence should guide therapists to using dry needling at least in combination with other treatment methods rather than as a stand-alone treatment.
3. What are your values?
What type of treatment do you feel you need? Do you feel like you need hands-on deep tissue massage, stretches, therapeutic ultrasound, advice about what exercise to do? Do you believe dry needles will work? Your own beliefs will probably be influenced by your personal experience with dry needles, what you've heard from family and friends, and what your physiotherapist has told you about them. And these beliefs will likely influence how you respond to any treatments used, including dry needling.
What is our recommendation?
As mentioned, current evidence is mostly of low quality therefore it is difficult to draw clear conclusions. A critical eye might lead us to the conclusion that dry needles may be no more effective than placebo, however there does seem to be strong anecdotal evidence from therapists and patients that they have a positive effect on pain and function. There is continuously emerging evidence (of varying methodological quality) of its effectiveness in various musculoskeletal conditions, however there is still debate and lack of clarity on the underlying mechanisms of action.
So, do we still recommend and use them? It is our belief that you should be presented with all the available information so that you can make an informed decision. Many people come to us for treatment with a firm belief that dry needles will benefit them due to their previous experiences, while others are unsure and will rely on us for an unbiased view to inform their decision. Provided you are being treated first with methods which have proven efficacy and effectiveness (whenever possible), then the addition of dry needles often provides some additional benefit if applied by an experienced therapist.
