“I’m referring you to a sports medicine doctor.”
For two years I’d been living with pain in my right calf muscle — unsure of the cause. I worked out six days a week so I initially thought it was just an overworked sore muscle. When the pain didn’t go away with rest, I scheduled an appointment with my doctor.
Now, my primary care doctor was suggesting that I see another specialist. Feeling skeptical and nervous about racking up medical bills, I was hesitant to follow her orders.
At this point, I had already been through two years of tests — blood tests, two MRIs, an ultrasound, and X-rays. My doctor had referred me to a rheumatologist, an orthopedic surgeon, and a physiatrist. I tried physical therapy for 12 sessions, but my pain never subsided and none of these specialists could deliver a diagnosis.
Ultimately, my primary doctor said it was OK for me to work out so my pain wouldn’t disrupt my life. Still, the pain bothered me enough after two years to try at least one more doctor.
I went to see Cheri Blauwet, a physical medicine and rehabilitation doctor at Brigham and Women’s Hospital. She thought my pain was a chronic muscle strain. She recommended stretching by wearing a splint while sleeping, along with more aggressive treatment with Philip Kidd, a physical therapist.
During physical therapy, Kidd recommended dry needle therapy. I had never heard of it, but was willing to try almost anything at this point. After only four physical therapy sessions, three of which included dry needle therapy, I had minimal calf pain. Within three months of ending physical therapy sessions — I continued it on my own — my calf pain was gone.
What is dry needle therapy?
Kidd explains that dry needling treats trigger points in muscles. Trigger points are dense, painful bands in the muscle. “I can manually work with my hands to treat trigger points, but I found dry needling to be more effective,” says Kidd.
The procedure is also faster than manual massage, less than 5 minutes compared to 30 minutes or more.
“When I perform the procedure, I use a thin, solid needle to penetrate into the trigger point to elicit a twitch response. The twitch is involuntary, much like a reflex in the knee when a reflex hammer is used. The twitch means I have found the correct spot. Then, I will try to repeatedly stimulate the muscle, ideally until it stops twitching. The local twitch response is uncomfortable, but if we can get to the point that the twitching stops, typically the treatment works,” says Kidd.
Kidd explains that his patients’ description of how dry needling feels varies on the size of the muscle and the location. Generally, people don’t report much pain at all from the needle and they often don’t know when the needle is inserted. The twitch response is what causes soreness or pain.
Kidd mentions, “I often tell people that the after effects of the procedure can feel like the delayed onset of muscle soreness from working out hard at the gym.”
The science behind dry needle therapy
“The science behind dry needling is not completely understood at this point, but there are many theories,” Kidd explains. “It’s possible that the needle deforms the muscle fiber or destroys a dysfunctional motor endplate.”
A trigger point usually develops due to muscle overload and overuse which is common with athletic injuries. “By using dry needling, you may be able to reduce the nociceptive input, increase the muscle activation, and improve the extensibility of the muscle,” says Kidd.
Blauwet explains that when athletes have biomechanical deficits, it can lead to taut bands in muscles. “The actual tissue density changes in the muscle itself and the area around the muscle. When that happens, it is hard for the muscle to release on its own. It becomes chronic and it is very hard to get better,” she explains.
She goes on to say that dry needling helps to jump-start a process in which you release that chronic tension, helping the tissue density and focal pH of that area to slowly improve.
She also stresses the importance of participating in physical therapy in conjunction with dry needle therapy. This way you can address the underlying reasons for why the muscle strain happened in the first place. “You can fix the trigger point but if you don’t fix the reason why the trigger point was there then it will just come back,” Blauwet says.
Do you need a prescription for dry needle therapy?
You don’t need a doctor’s prescription to receive dry needling therapy. “Some physicians I work with currently do prescribe it. I probably see this on referrals most often for patients with chronic headaches,” says Kidd.
The regulations for who can perform dry needle therapy vary by state. In some states, physical therapists can perform dry needling. “Some states do not allow it and there are many groups working to change that,” says Kidd.
Kidd explains that at Brigham and Women’s Hospital, only a physical therapist who participated in the full certification process can use the technique.
Are there any concerns people should be aware of?
There are some contraindications to consider before performing dry needle therapy.
Kidd mentions that people who have local skin lesions, such as cellulitis, psoriasis, and local or systemic infections, should avoid dry needling. Dry needling shouldn’t be done over areas of swelling, deep muscles in those with abnormal bleeding, or in areas of vascular disease, including varicose veins.
Those with compromised immune systems shouldn’t use dry needling. And it’s not possible to receive dry needling over areas of implants, such as in breasts, calves, or buttock.
“There is no evidence to support this but needling during the first trimester of pregnancy should be avoided,” says Kidd.
What’s the success rate?
Kidd has found that success rates vary. “I have been using this modality for about two years and some individuals with surprisingly long periods of pain can be significantly better after one or two sessions while others note modest improvements,” says Kidd.
Kidd says it’s rare that a patient finds no help from dry needling. “I think it is most effective when you can find a trigger point that, when palpated, reproduces the pain that the patient is having a problem with,” says Kidd. If there aren’t any trigger points, dry needling will be unsuccessful.
Dry needling can be added to physical therapy and medical treatments. Kidd also doesn’t recommend using dry needling therapy alone, but in conjunction with physical therapy and stretching.
“Dry needling is very effective for trigger points, but frequently [these aren’t the only] problem. I can have better long-term success if I can educate the patient on pain science and an exercise prescription. This last part is important because their success is not just in my hands. I want to give them the tools to empower them to self-manage. Dry needling is a means to help get them to that point.”
Blauwet says, “I really like dry needle therapy because overall, it’s so safe. It uses the mechanical effects of a needle as opposed to having to inject anything that might have side effects. Cortisone, for example, has its uses but you don’t want to put it in muscle if you don’t need to. Since you are not injecting cortisone or anything that has harmful side effects, you can repeat it.”
Blauwet doesn’t hear from all her patients about dry needling since they receive it during physical therapy, but she has heard feedback that it’s often helpful. She believes if it’s done in the right cases, it can be very effective.
One review study in 2016 examined previous research on dry needling and found that it was effective in reducing pain in the lower body and it’s recommended for other issues, such as myofascial pain. Another study found no difference for reducing short term pain when dry needling was used.
For over two years I experienced pain, but after only three dry needling sessions, my pain was greatly reduced. I think dry needling helped speed up the healing process for me, which meant less money spent on co-pays and less time visiting doctors.
The first physical therapist I saw did massage my calf, but it was extremely painful for 15 minutes and I never felt any improvements. The dry needling felt like a sharp pain for about 30 seconds and then my calf muscle felt more like a pulled muscle for about a day.
If necessary, I would try it again. If you think it might be a benefit for you, check for physical therapists in your state who are certified in dry needling.
Cheryl Maguire holds a Master of Counseling Psychology degree. She’s married and is the mother of twins and a daughter. Her writing has been published in Parents Magazine, Upworthy, “Chicken Soup for the Soul: Count Your Blessings,” and Your Teen Magazine. You can find her on Twitter.