• Katie O'Bright, DPT

The Deal With Dry Needling

Video insert is something I found off youtube! Just a demo - but it's fairly spot on with the treatment that I do.

When I first moved to Pittsburgh in June 2019, many of my patients had questions about dry needling. Most had no idea what it even was. I was surprised by this, but it made sense after I realized that hardly anyone practices dry needling in the state. After scouring the practice act and a lot of back and forth with the state board, the PPTA and legal counsel, I found out that the issue was a matter of the practice act being 'silent'. After using the modality for 5 years, I made the decision to keep it in my practice and I'm really glad that I did!

Dry needling, especially electrical dry needling (which is what I use that majority of the time), has proved to be fairly effective for the patients I have treated. There is a decent literature base on dry needling, but a lot of it is a wash, ie. the studies show that its not superior to other treatments most of the time. But electrical dry needling (EDN) - now we're talkin'.

Dunning et al (2018; e-mail me for full text) wrote a nice article about EDN in the treatment of plantar fasciitis. I liked the descriptions that he used in the rationale for EDN, particularly this one. At the end of this blog post is a direct quote from Dunning's article - some may want to read it, but I'll warn you - it's not going to be easy to understand! This is more for the other PTs or other professional who might be reading this. The bottom line is - the addition of the electrical stimulation with the needling seems to provide a superior effect from a neurochemical and vascular standpoint, especially in chronic tendon and osteoarthritis conditions. I have found this to be true in my practice, so I continue to utilize it.

With that being said - dry needling is just a small part of the treatment that I provide and it certainly isn't for everyone. The vast majority of my intervention is going to be educating the patient in their condition, building their confidence in recovery (prognosis depending) and finding strategies to get them moving comfortably and safely again. I do this with specific exercises and helping the patient come up with strategies to improve the other contributing factors, like sleep, stress, and what I like to call 'behavior optimization'.

Questions on dry needling or my approach to therapy? Send me a message or email me directly at katie@redefineptpittsburgh.com.

Excerpt from Dunning et al 2018. Full reference below:

Electrical dry needling vs. manual dry needling

Electrical dry needling (i.e. electroacupunture) has been found to cause the release of substance-P and CGRG predominantly from non-neural structures, facilitating a negative feedback loop to neural and neuroactive components of the target tissue.[108, 109] In the case of periosteal needling, this may lead to decreased inflammation of the densely innervated periosteum—i.e. at the proximal attachment of the plantar aponeurosis at the medial tubercle of the calcaneus which is most frequently reported by patients as the origin of symptoms and the site of greatest discomfort. Notably, CGRP in high quantities causes inflammation, but the concurrent release of substance-P combined with electric stimulation in the vicinity of the periosteum may provide sustained, low levels of CGRP required for a potent anti-inflammatory and therefore anti-nociceptive effect.[110–113] CGRP also initiates a cascade of events mediated by protein kinase A (PKA) in vascular smooth muscle, leading to vasodilation.[114] Moreover, PKA stimulates nitric oxide synthase, increasing the production of nitric oxide, thereby exaggerating the vasodilation effect.[114] The improved vasodilation may improve the microcirculation within the plantar foot, resulting in increased opioid delivery and decreased inflammatory factors in the vicinity of the plantar aponeurosis.[115, 116] Mechanical and electric needle Electrical dry needling and plantar fasciitis

PLOS ONE | https://doi.org/10.1371/journal.pone.0205405 October 31, 2018 16 / 24

stimulation close to the periosteum of bone may be particularly advantageous, as acupuncture has been shown to reduce IL-6 mRNA expression in bone marrow, thereby limiting inflammation,and inhibiting myelogenic osteoclast activity driving degeneration.[117] Additionally, and although for a different chronic musculoskeletal condition, a recent meta-analysis[118] and a separate secondary analsyis that pooled data from the Cochrane review[119, 120] concluded that electroacupuncture is superior to manual acupuncture in knee osteoarthritis.

Dunning J, Butts R, Henry N, Mourad F, Brannon A, Rodriguez H, Young I, Arias-Buría JL, Fernández-de-Las-Peñas C. Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial. PLoS One. 2018;13(10):e0205405. doi: 10.1371/journal.pone.0205405. eCollection 2018. PubMed PMID: 30379937; PubMed Central PMCID: PMC6209187.

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