By John Quintner

John Quintner - 12.3.12

John Quintner

In a truly remarkable editorial, Dommerholt et al. [2019] wonder whether there is any point to the practice of dry needling (DN).

They draw attention to the popularity of this form of “therapy” throughout the world, as well as to its relative safety, but concede that many fundamentally important questions remain unanswered:

  • Is DN more effective than other treatment options?
  • Does DN induce clinically meaningful changes?
  • Which method of DN is preferred? If any?
  • Is it necessary to elicit local twitch responses?
  • What constitutes DN practice?
  • Which patient populations may benefit the most from DN?
  • Is DN contraindicated for patients with certain medical diagnoses?
  • What is the best dosage of DN for various conditions?

It seems impossible to reconcile this huge gap in scientific knowledge with the fact that physical therapists (PTs) are already using DN to target trigger points, tendons, entheses, periosteum, scar tissue and fascia.

To make matters worse, Dommerholt et al. [2019] note that PTs believe, without any evidence, that DN can “lessen spasticity, reduce local and referred pain, eliminate neural entrapments, increase range of motion, and normalize muscle activation patterns”.

Is it any wonder that DN has attracted scathing criticism from some PTs (and other clinicians), who question whether the practice should be part of the scope of therapists of all persuasions (including PTs, occupational therapists, chiropractors and athletic trainers).

Dommerholt et al. [2019], who are DN advocates, appear to distance themselves from this disastrous situation (which could well be termed “needle mania”) when they conclude:

“While it is conceivable that the act of DN offered within a therapeutic context may be sufficient to facilitate a positive response by evoking brain activation in reward-related brain areas, these characterizations do not seem to match the current state of affairs.”

Indeed, the sorry state of affairs that Dommerholt et al [2019] outline in their editorial may reflect the opinion of one astute commentator:

“DN is an utter fool’s errand wrought with placebo – induced by maximal ritual effect, novel and exciting stimulus as well as an injection of hope for those desperate enough to allow someone to stab them with a needle”.*

Ouch!

Reference: Dommerholt J, Fernández-de-las-Peñas C, Petersen SM. Needling: is there a point? Journal of Manual & Manipulative Therapy 2019; 27(3): 125-127, DOI: 10.1080/10669817.2019.1620049

About Australian Pain Society

The Australian Pain Society is a multidisciplinary body aiming to relieve pain and related suffering through leadership in clinical practice, education, research and public advocacy.

2 responses »

  1. Jodie Lyons says:

    When reading this blog I couldn’t help but feel miffed that acupuncture wasn’t even mentioned as the real source of needling and that practitioners qualified with degrees (4years full time study & the hecs debt) do exist to administer needling safely and with in depth understanding of the indications, contraindications, point dynamics, prescription and safe needling technique. Dry needling is simply one of many acupuncture techniques which would closely align with needling what we call an ‘ahshi’ point with a particular needle technique (of which there are many).
    Why are people and this profession not protected from under trained people administering it? I do like the fact that you at least mention ‘scope of practice’ as it is clearly the issue. It simply is not possible to cover enough to qualify one to needle in a weekend or evening course. If it’s not ok for a podiatrist to do neck adjustments why is it ok for a physio to do needling which is in fact acupuncture.
    I agree that any practitioner practicing needling without an acupuncture degree should attract scathing attention as it really is outside their scope of practice.

    • jqu33431quintner says:

      Jodie, thanks for your comment.

      The reason why acupuncture was not mentioned in my blog is that the political status of “dry needling” in the USA differs from that in Australia.

      The American Physical Therapy Association (APTA) went to great lengths to distinguish between the Western philosophy of “dry needling” (which it supports) and that of traditional Chinese medical acupuncture. I first ventured into this arena some 5 years ago: http://nationalpainreport.com/to-needle-or-not-to-needle-8824782.html

      Since then, fiercely contested turf wars over physical therapists’ scope of practice have been fought in some state jurisdictions. Questions of patient safety were fully aired, as well as the time allocated for training the respective practitioners. Sad to say, the Courts were not asked to rule on the therapeutic efficacy of the different needling procedures.

      In this country, the Australian Physiotherapy Association (APA) decided to lump together Western and Eastern needling practices. The APA offers discounts to its members wishing to undertake continuing professional education by attending approved courses related to either of them: https://australian.physio/membership/national-groups/acupuncture-and-dry-needling

      It appears to me that Australian physiotherapists can legally choose to employ whatever technique they prefer when poking their patients with stainless steel needles. However, they cannot call themselves acupuncturists.

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