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Inflamed areas of muscle are known as myofascial trigger points or trigger points. They often feel like small knots underneath the skin, and if you've ever had them, you know they can be a real pain. 

One of the ways we treat trigger points is a physical therapy technique called dry needling. We typically incorporate dry needling into a more comprehensive physical therapy treatment plan. 

With dry needling, a therapist gently inserts thin needles through the patient's skin directly into the affected muscle.  The extremely fine needles are either hollow-core hypodermic needles or solid filoform needles, such as those used in acupuncture. They do not contain medication or injection, hence the term "dry." 

Sometimes we add electrical stimulation or e-stim, an electrical current transferred through the dry needle that can help accelerate the pain-relief process.  

H-Wave® technology is one form of e-stim we use for our dry needling patients. On low frequency, the H-wave helps stimulate smooth muscle fibers to increase blood flow, which helps heal specific muscles or areas of inflammation more quickly.

It’s important to know that not all physical therapists can perform dry needling, and those who do must be certified according to state guidelines. 

Here are some of the most frequently asked questions about dry needling:

What conditions can be treated with dry needling?

Dry needling can treat an enormous range of conditions, from muscular pain to carpal tunnel, to lateral epicondylitis, plantar fasciitis and much more.

What are the benefits of dry needling?

Dry needling is a minimally invasive PT technique that is, at its core, instrument-assisted manual therapy. It has been shown to be powerfully effective in decreasing muscle tension and tone (the muscle's resistance to passive stretching during a resting state). This can improve a patient's range of motion and relieve pain.

What are the benefits of dry needling with e-stim?

Dry needling on its own can be extremely effective as a treatment. The addition of e-stim acts as an adjunct to enhance the treatment's pain-relieving effect. E-stim helps to stimulate blood flow and provide analgesic effects to help numb the pain, often providing long-term relief.

How does the e-stim itself work?

Electrical stimulation helps treat pain by stimulating larger nerve fibers that supersede the smaller nerve fibers that are causing pain. The larger nerves travel faster to override the smaller nerves, similar to if you were to rub a sore spot -- you would feel the rubbing instead of the pain.

How many dry needling sessions are needed?

The number of treatments is a case-by-case basis. Usually, a patient will see results or improvement after only the first or second session.

Tyler Brady, PT, OCS, is a dry-needling-certified physical therapist with OrthoCarolina University Physical & Hand Therapy.

This article was originally published on September 6, 2016, and has been updated on November 9, 2020.

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