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  • Dr. Najarian, PT, DPT

Not all needling is created equally


What is dry needling, and why do I love to turn my patients into pin cushions?


Not all needling is created equally. I am obviously bias towards Integrative Dry Needling (IDN), for it fits my paradigm of how the human body operates. We are nervous system driven beings. Our brains weigh a mere 3 pounds, yet those 3 pounds carry colossal weight with regards to our physiology and function.


Before I continue, let me make this clear; dry needling is not acupuncture. I previously studied medical acupuncture and was accepted to a Traditional Chinese Medicine program to pursue another doctorate prior to stumbling upon IDN. From the knowledge I gained, I can confidently tell you that there are similarities. The likeness is due to neurology. It’s no wonder that in acupuncture, the L14 acupuncture point (top Left) is coincidentally the same location that the superficial radial nerve homeostatic point is (top Right) in IDN; the pad between the thumb and first finger. The same goes for the SP6 acupuncture point (bottom left) and the tibial nerve homeostatic point (bottom right), both are about 2 inches above the ankle.


Reverting back to “western medicine”, most dry needling techniques focus on trigger points. I like to explain trigger points to patients as being hypersensitive, localized points in muscle tissue, and in layman’s terms, referenced as “knots”. On the contrary, IDN utilizes homeostatic points, which I typically explain to patients as neurological “hot spots” on the body. Homeostatic points are further defined as… “key neurological areas in the body that have stronger therapeutic signaling to the CNS (central nervous system) and are present in reproducible locations and patterns. The innervation zones of homeostatic points are extensions of major peripheral nerves that are present in consistent locations around the body based on the predictable anatomy of the peripheral nervous system. This is in stark contrast to locating the highly variable myofascial trigger points.”(1) Furthermore, homeostatic points are present in everyone, in close to identical places, and on both sides of the body. Whereas, trigger points can be in any muscle, are not predictable, and are not necessarily bilateral.


So why all this talk about homeostatic points?


Homeostatic points are the starting points for treatment of any condition with IDN. There are 47 homeostatic points on the body, and by needling these points along the nerve pathway, you essentially get the most therapeutic response. No matter the injury, pain location, or disfunction, I always begin with needling 1-2 homeostatic points on a patient.


The needles used in IDN are identical to acupuncture needles, and these tiny metal filaments are extraordinary, powerful tools. By inserting a needle into the skin, a teeny tiny cut is created, and an inflammatory response is prompted; blood flow and microcirculation occurs. The surrounding tissue begins to therapeutically change and inflammation is normalized as the needling encourages the body to self heal, returning to homeostasis. Stasis refers to a standstill, so a better explanation would be that needles truly encourage a "dynamic-balanced" state, for our bodies are constantly in flux. Puncturing the skin and creating lesions also aids in pain relief, via the gate control theory. This is a blog in itself, and I'll spare you the details. Just know that needling = pain relief.


With injury, inflammation also occurs; muscle, connective tissue, and even nerves have inflammation responses. There is also pain, decreased circulation, and endogenous muscle inhibition. Due to this effect, muscles can feel tight and knotted. To better explain this, observe patients with low back pain whose glutes and hamstrings are completely shut down. The brain first registers back pain from an injury, local muscle guarding manifests and the posterior chain (glutes and hamstrings) become inhibited; meaning the muscles don't fire appropriately. Needling not only alleviates local back pain and releases muscle tension, it can help to “wake up” the inhibited muscles again. Thus, in this case, waking up the posterior chain to support the low back.


Another reason why IDN resonates with my practice is that it's a comfortable intervention. Other trigger point methods may simply locate a painful trigger point, insert a needle, and piston it to stimulate a muscle twitch getting the "knot" to release. While it may be effective, I don’t believe it's optimal or maximizes the full potential of needle use. Trigger point needling is local. IDN is local, regional, AND systemic. Instead of just needling one point of pain, why not impact an entire nerve path from cervical spinal root all the way down to fingertips? This is how IDN works.


Our body’s are incredible, dynamic machines. I’d like to believe that medicine is beginning to shift towards treating these miraculous machines with a whole body, multi-system approach. Evidence of this is the increasing popularity of the gut/brain connection in the medical community. It’s exciting and necessary to see the body from every angle, every system, and to treat accordingly. Likewise, IDN supports a “whole-istic” methodology which I am so passionate about. It’s time to reinvent mainstream physical therapy..


(1) Gargano, Dr. Frank. (Sept, 2018) Advanced Neurologic Dry Needling for Pain Management & Performance Enhancement course notes