I’ve been fortunate enough to learn dry needling from the authority of dry needling, Jan Dommerholt, and have been using dry needling with a lot of success. Additionally the physio edge blog just wrote about some ideas that improve outcomes for his patients after needling. I was glad to see this post because recently I've heard of a lot of local therapist just needling and I just don't think that's the best plan for the patient. Personally, my best experiences with dry needling is when it is used as an adjunct to the overall plan of care including other manual and neuromuscular re-ed techniques. This is likely due to the fact that trigger points (TrP) are symptoms of a movement (be it overuse of misuse) or postural dysfunction. Yes, the TrP may be the sole cause of the pain (see research on that here) and can be the cause of the limited mobility and motor control (see that here), but not the cause of the overall noted deficit. And I think with a simple analogy I can explain why ( I hope). Our body works a lot like an engine, or rather an engine works a lot like our human physiology. In that, like our body an engine has a lot of components and they all need to run in the correct sequence. Each part relies on the other for overall success.
And only one part, say the spark plug, goes out it can prevent the engine from running optimally. Similarly, only 1 hypertonic, tight, latent trigger point muscle may lead to dysfunction and pain. So what do you do; you replace that broken part. Now with needling we can release or restore that specific muscle just like buying a new spark plug. But going to an auto shop and buying a spark plug isn't enough, you have to install it. Installing a spark plug can be complicated like having the right gapping, having the correct tension on the wrench, connecting the right cables (truth be told i don't know anything about engines). This is where additional manual techniques come in after needling, like a mulligan techniques for example to improve the proprioception of the new range and teach correct arthrokinematics.
After the spark plug is installed obviously you need to run the car and ensure it is running at optimal performance. Same for the body, we need to reload or retrain the muscle. this is where I like using PNF techniques or sometimes simply teaching a correct hip hinge, or utilizing the 4x4 SFMA matrix. The choices for retraining are endless. But put simply, if we can treat the patient like a spark plug by replacing, installing, and driving; I bet we can get some pretty amazing results.
