I was a 26-year old wide-eyed, green-horn physical therapy student on clinical rotation at Keesler Air Force Base in Biloxi, Mississippi. A patient came into our clinic with stubborn shoulder pain that had been unsuccessfully treated over the past several years. My clinical instructor pulled out a long, thin needle & inserted it into the patient’s posterior deltoid (back of shoulder) causing the patient’s muscle to powerfully twitch – something I had never seen or heard of in my schooling! The patient sat up, half startled, half excited & to his surprise moved his arm freely with no pain. “Not bad…” I thought to myself.
Since the great state of Idaho allowed Functional Dry Needling (FDN) to be practiced at Physical Therapy clinics there has been a lot of confusion (understandably so) about what FDN is, what it does, and what sort of patient benefits most. This is my attempt to bring clarity to this interesting procedure.
FDN is a progressive, orthopedic technique in which a very thin needle (similar to an acupuncture needle) is inserted into myofascial tissue, often at the site of a trigger point (a painful, neuromuscular “knot”). The inserted needle produces a neuromuscular twitch which facilitates a host of changes such as:
- Reduction of pain & stiffness
- Normalization of neuromuscular functioning
- Changes to muscle & nervous system biochemistry.
A common misconception is that this technique is similar to, or related to acupuncture. Although the needle is very similar to that used in acupuncture, the implementation & results are quite different. The needle is typically positioned much deeper into the soft tissue, eventually making contact with the underlying bone. Or it can be “threaded” through the entirety of the myofascial tissue. After insertion, there are several ways to manipulate the tissue in order to achieve maximal effect. In “mechanical pistoning” the needle is physically moved up & down throughout the tissue to activate the telltale neuromuscular twitch. Another method is to apply electrical stimulation (as in the pic below) through the needle(s) so that the tissue experiences an exogenous rhythmic, heartbeat-like sensation.
I know what you’re thinking . “YIKES, this sounds painful!” Well, you wouldn’t be entirely wrong. Some people experience a strange deep, twitchy, achy pressure. This makes perfect sense because the tissue being treated (deep, protected neuromyofascial tissue) is not accustomed to direct stimulation. Interestingly enough though, many others will feel little to nothing when the needle is inserted – lucky folks!
Currently there are over 200 high-quality, peer-reviewed clinical trials demonstrating the efficacy, effectiveness & safety of FDN. These studies examine (bear with me here…): general pain, spinal & extremity pain, temporomandibular (TMJ) pain, pelvic floor (men’s & women’s health) dysfunction, neurologic dysfunction (hypertonia, spasticity, stroke, spinal cord injury), post-surgical pain, stiffness & weakness, electric stimulation with FDN, dry needling vs. injection therapy, as well as describing the nitty-gritty ways in which dry needling works.
FDN is a powerful technique – but very likely there’s more to the story! It’s important to remember that the fundamental cause of your specific symptoms is likely related to underlying dysfunction, some less obvious than others, which must be addressed. For this reason, it is often essential that FDN is coupled with other treatments: corrective therapeutic exercise, soft tissue & joint manipulation, biomechanical training, pain neuroscience education, & myofascial release. This powerful combination of treatments ensures that the underlying dysfunction, not just the symptoms, is eliminated.
Due to the wide-spread, multi-faceted effects of FDN, it has the capacity to treat a plethora of diagnoses, pathology & dysfunction. Although it is typically used for standard diagnoses involving pain, stiffness & weakness, one of the most exciting frontiers for FDN is its ability to address specific impairments in patients with abnormal, unique, or formidable issues.
A few such cases that I have had the pleasure of treating include: re-establishing neuromuscular activation (power, strength & stability) in an athlete with severe traumatic lower extremity nerve damage, decreasing spasticity & tension in a patient with cerebral palsy, reducing sleep apnea-induced peripheral neuropathy & even eliminating deep scar adhesions from an old machete wound. As earlier mentioned, FDN is handsomely equipped to address more than just your typical hamstrings strain!
Do you have an injury or issue that might be a good candidate for FDN treatment? Feel free to contact Jerrod for more information at 208-375-5511 or email at jerrodackermandpt@gmail.com. For more about Jerrod, visit Jerrod Ackerman (rockandarmor.com).