There is nothing a runner hates more than being told not to run.
Unless you find a medical professional you can trust, it is hard to know whether it actually would be best to rest, or whether there is another treatment that is worth a try.
It seems every year there is a new type of treatment that emerges claiming to help injured runners get back sooner, but one that seems to be gaining a lot of momentum in the running world is dry needling.
Today we are going to look at what dry needling is (and how it is different to acupuncture), what research has found about how effective dry needling is for treatment, whether it is worth giving it a try for your running injury, and of course, the question we all want to know; just how bad does it hurt?
Curing a running injury by sticking needles into your skin might sound crazy, but it’s an increasingly popular treatment for many of the common ailments that distance runners suffer from.
The technique is called dry needling.
It’s quite similar to acupuncture in that it involves inserting several needles into your skin near the point of injury.
The proposed mechanism is a little murky, but many runners nevertheless swear by it.
What is Dry Needling and is it Safe?
Dry needling is an injury treatment performed by physical therapists and chiropractors who have been certified to treat myofascial injuries.
It arose partially out of scientific studies into acupuncture and injections of medication like cortisone, but has developed into its own area of treatment, and continues to grow in popularity.
Your therapist will use individually packaged, sterile needles for one site only, and very little, if any bleeding will occur due to the needles being around 1/4 mm thick.
The practice is very safe, especially as the therapist must undergo intense training to become certified in the practice of dry needling, and will already have vast knowledge of the anatomy of the body to know where to insert the needles.
How does trigger point dry needling work?
The therapist inserts needles through the skin into areas of muscle pain, known as trigger points, explaining the name trigger point dry needling, although the treatment is also called intramuscular manual therapy.
The name dry needling is used because there is no medication involved, and the solid filament needles are the same as the ones used in acupuncture, rather than the hyperdermic syringes that traditional injections use.
The number of needles inserted will vary depending on the size of the area in pain, and how often you are able to get treatment. Most treatments will involve 5-20 needles, which are removed just a few minutes after insertion.
What is the difference between acupuncture and dry needling?
This is one of the most common questions about the technique, and one that is still causing some friction between the two worlds.
Dry needling is part of a western medicine treatment technique that is supported by research, and used to target relief in specific areas. Acupuncture is based on traditional Chinese medicine, which treats the body as a whole, by creating balance within the body.
Therapists use dry needling to relieve pain by using the needles to release trigger points of specific muscles.
How much does dry needling hurt?
Dry needling can be painful, and the location of the injury affect the amount of pain experienced, but it usually manifests in two ways:
As the needle is inserted through the skin into the muscle, there may be a slight contraction or twitch within the muscle, that creates pain.
Although twitches in the muscles can elicit an initial (but brief!) painful response, twitches in the muscles are considered a good sign that the desired trigger point has been hit.
After the treatment itself, there may be some soreness in the area for up to 48 hours afterwards, but this is not considered a cause for concern, and should be expected for most patients.
If the pain is initially worse:
Don’t panic! Give the muscle 48 hours to calm down after treatment, and if it still feels bad, dry needling probably isn’t for you.
How Effective is Dry Needling?
We’ll have to look to the scientific research to find out.
Where did dry needling originate?
One way medical researchers test out treatments is to devise sham treatments to function as a control.
In traditional acupuncture, needles must be applied to specific locations on the body to achieve the intended effect.
To test acupuncture, researchers intentionally inserted needles into the “wrong” location to test whether the theory behind acupuncture holds any water.
Likewise, a “dry” injection (using a needle but injecting no medication) is sometimes used as a placebo treatment in studies on medical injections.
According to a review article by T. Michael Cummings and Adrian R. White, researchers first noticed that the needle itself seemed to have some therapeutic effect in the late 1970s.1
In one study published in 2002, for example, true acupuncture (with proper needle placement) was compared with sham acupuncture (wrong needle placement) in a group of patients with muscle pain.
Both treatment groups experiencing muscle pain noticed substantial improvement following treatment, but there was no difference between true and sham acupuncture!2
After this and other similarly surprising discoveries, researchers began to consider dry needling as a treatment in and of itself more closely.
By 2005, enough evidence had accumulated to allow for a review study.
A group of researchers led by Andrea Furlan at the Institute for Work & Health in Canada looked over the scientific literature on dry needling and acupuncture for low back pain in English-language journals as well as Chinese and Japanese databases (acupuncture being an understandably popular research topic in Asian medical research).3
Though Furlan et al. did not find the bulk of the evidence strong enough for a ringing endorsement of dry needling or acupuncture, the authors did have a different conclusion about back problems.
There is some evidence of an effect for both acupuncture and dry needling, and that dry needling functions best as an adjunctive treatment, not as a standalone solution.
Does dry needling help running injuries?
The scientific literature is more sparse when it comes to dry needling for athletic injuries, but there is some emerging evidence that it can be useful.
A 2010 report by Nichola Osborne and Ian Gatt described four elite female volleyball players with shoulder injuries who were successfully treated with dry needling treatments over the course of a month which included frequent competitions and tough training.4
Osborne and Gatt hypothesized that the needling treatments deactivated trigger points in the muscle, allowing the players to regain the ability to practice and compete while undergoing the treatment.
Likewise, a 2007 study by Steven James and colleagues published in the British Journal of Sports Medicine described how 44 patients were successfully treated for patellar tendonitis via dry needling and injection of the patients’ own blood into the tendon.5
In this case, the researchers used ultrasound imaging to insert a “dry” needle repeatedly into the degenerated area of the tendon.
This dry needling was followed by an injection of blood into the needled area.
Why Does Dry Needling Work?
Here’s the deal:
While all of these studies show promise, they highlight one major problem with dry needling:
We don’t know how it actually works.
Some scientists hypothesize that it manipulates a mechanism called “gate control”—by focusing your nervous system’s response on the acute pain caused by the needle puncture, the chronic pain from your injury goes away.
Others propose that endorphins, mood-stimulating chemicals released in response to a painful stimulus like a needle wound, are responsible for alleviating pain.
Still another theory is that the needle deactivates muscular trigger points when inserted into the right location, relieving tension and referred pain.
Finally, the approach used by James et al. tries to take advantage of the direct trauma of the puncture, using the acute, local damage from the needle to kick-start the body’s healing process (aided in this case by a direct blood injection).
Clearly, much more research is needed on this front.
It’s likely that all of these responses play some part in how dry needling works.
The proper way to use dry needling may well depend on the injury it’s being used to treat.
What injuries is dry needling most effective for treating?
A chronic, degenerative injury in tissue with poor healing capacity, like the Achilles tendon or the plantar fascia, might require the kind of repeated, direct trauma that was used in James et al.’s paper, possibly combined with external methods to boost healing, like autologous blood injections.
On the other hand, long-standing pain with nervous or muscular roots might benefit more from trigger-point targeted needling, or even just the rush of endorphins and redirection of pain that occurs in response to a needle wound.
Is dry needling available everywhere?
Dry needling is available worldwide, but a few states in the US do not currently allow physical therapists and medical professionals other than licensed acupuncturists to use dry needling. This is because of an ongoing battle between physical therapists and acupuncturists.
This includes:
California, Utah, New York, Idaho, Hawaii and Florida.
In the remaining 44 states of the US, the argument has been settled, but if you live in any of the above states, you may need to seek alternative treatment.
Just keep this in mind:
There is no Procedural Terminology (CPT) code for dry needling itself, and many insurance carriers will not cover the treatment, so you have to decide if it is worth paying out of pocket for.
What Does This Mean for the Injured Runner?
Here’s the bottom line:
Dry needling (or acupuncture) is best used as a tool to kick-start or speed up healing, not as a primary stand-alone treatment for running injuries.
You still need to get to the root of why you got hurt in the first place and how you can prevent that from happening again.
Further, it is best to seek dry needling from a medical professional you can trust with plenty of experience with the technique.
Even in the best case scenario, you can expect some significant soreness in the needled area, so you want to be sure the pain is worth it.
