Functional Dry Needling (FDN)

Functional Dry Needling is a specific technique that uses a solid filament needle to treat neuromuscular, movement, and function problems. The technique uses  a "dry" needle, one without medication or injection, inserted through the skin into areas of the muscle, fascia, and  alongside nerves for the management  of pain and dysfunction in neuromusculoskeletal conditions.

Other terms commonly used to describe dry needling, include trigger point dry needling, and intramuscular manual therapy.

A trigger point is a general term, but it is basically an irritable area your therapist can feel in a taut band of muscle fibers. Trigger points can be tender to the touch, and touching a trigger point may cause pain to other parts of the body. 

Trigger points play a role in producing and maintaining the pain cycle. Trigger points develop in muscle for various reasons including referred or local  pain, inflammation, tissue injury or other causes.

In addition to the trigger point model for dry needling, there are also other models. The radiculopathic model of dry needling highlights the importance of the spinal segment associated with the symptomatic area. The Functional Dry Needling model focuses on functional movement, while also including a combination of the trigger point model, and radiculopathic model. Treating the neuromuscular tissue that is not allowing or promoting  proper movement is the goal of Functional Dry Needling. When properly applied, pain quickly subsides and corrective movements are more easily adopted. Spasticity can also be addressed with Functional Dry Needling.

Functional Dry Needling involves a thin filiform needle that penetrates the skin and stimulates underlying muscle, fascia, connective tissue, areas alongside  nerves, associated spinal segments, and myofascial trigger points. The needle allows your physical therapist to target areas they cannot treat with just their hands. 

Physical therapists wear gloves and  appropriate personal protective  equipment (PPE) when dry needling,  consistent with Standard Precautions, Guide to Infection Prevention for Outpatient Settings, and OSHA standards. The sterile needles are disposed of in a medical sharps collector.

The mechanical stimulation of the muscle produces a local twitch and rapid depolarization of muscle fibers.  The muscle activity dramatically  reduces, resulting in relaxation, decreased pain and dysfunction. This is thought to restore circulation, increase blood flow, and oxygenation.  The decrease in symptoms is related  to the way your brain perceives pain,  as well as removal of muscular compression on joint, nerve and vascular tissue. 

Functional Dry Needling will not replace the hands-on approach to physical therapy. To be effective, dry needling should not be performed in isolation. It is a very specific tool to help reduce pain and dysfunction, allowing you to engage in therapeutic exercises and activities. 

Functional Dry Needling by a skilled therapist has a neurophysiological effect on the autonomic nervous system, pain processing, and can help with myofascial pain, headaches, neck pain, temporomandibular dysfunction, shoulder pain, elbow pain, carpal tunnel syndrome, back pain, knee osteoarthritis, plantar fasciitis, and other problems.

Electrical stimulation can elevate the outcomes of Functional Dry Needling and improve your experience as a patient. This technique involves insertion of an ultra-fine Functional Dry Needle, which probes into the muscle or soft tissues to electrically stimulate nerve fibers. This alters nerve activity through a targeted delivery of an electrical stimulus to specific neurological and neuromuscular sites in the body. It is also known as Neuromodulation, or Percutaneous Electrical Nerve Stimulation (PENS).

  The benefits include:

• Creating a healthy muscle pump action, also called a hemodynamic benefit
• Reducing post treatment soreness
• Stimulating deeper tissues

Emerging evidence-based research shows Functional Dry Needling with Electrical Stimulation improves:

• Pain modulation
• Neuromuscular changes (improving recruitment, sequencing, tone, and combatting atrophy)
• Athletic recovery
• Neural regeneration after peripheral nerve injury
• Spasticity
• Edema
• Lymphatic activation

There are currently two theories of how this works for pain modulation, from the bottom up and from the top down.  

From the bottom up, we are inhibiting pain signals to the brain by improving the function of something called an interneuron, which acts like a bouncer at a club and should only let a select few messages up to the brain that signal pain. Sometimes this interneuron lets too many messages up, but the electricity along with the functional dry needling helps to “reset” the interneuron.  

From the top down, we are activating balanced release of your body’s own opioids and other neurochemical compounds, like serotonin, noradrenaline, gamma aminobutyric acid (GABA), acetylcholine, and adenosine.  

The insertion of the needle should not hurt during Functional Dry Needling, these needles are very thin. Typically, patients feel short lived "ache" type of pain during the muscle twitch. The muscle twitch can also feel like muscle ache  or soreness for a day or two, like you worked out that muscle.

There may be soreness immediately after Functional Dry Needling treatment in the area of the body that was treated, this is normal but does not always occur. Sometimes this is delayed for a few hours or until  the next day. The soreness may vary  person to person and depending on the area of the body that was treated, but typically it feels like you had an intense workout at the gym. Occasionally patients will experience some minor bruising with this soreness. It is common to feel tired, nauseous,  emotional, giggly or “loopy”, or somewhat “out of it” after treatment.  This is a normal response that can last up to an hour or two after treatment. 

We go to great lengths to ensure safety during Functional Dry Needling. Doctors of Physical Therapy have all passed their necessary licensure and board exams and have an understanding of anatomy in excess. To truly be successful at this type of therapy, a physical therapist must first and foremost be a skilled manual therapist with excellent knowledge of anatomy. We apply OSHA standards, use personal protective high-quality equipment, and have a very high standard of safety.

The needle is similar, but the evaluation, application, and overall goals are very different. Functional Dry Needling is based on rehab and movement sciences. The physical therapy evaluation includes examination of the neuromuscular and movement systems. Insertion points are anatomy based, into areas of muscle, fascia, alongside nerves, myotomal spinal segments, and sometimes trigger points. The focus of Functional Dry Needling is the management of pain and to restore  functional movement in neuromuscular conditions, specifically based on neuromuscular anatomy.

Traditional acupuncture attempts to move qi along meridians and relies on diagnoses from traditional Chinese or Oriental Medicine. The acupuncture  evaluation may include examination of  the tongue, ear, and meridians based on traditional eastern medicine to balance energy within the body.  There is some overlap of trigger points and acupuncture points, but the goals of each technique are unique.

There is research on both dry needling and acupuncture for effective treatment in several conditions.  While we are advanced practitioners of Functional Dry Needling at Pinecone Physio, we don’t believe it is better or worse than acupuncture and both can be a part of your overall care.  We advocate for your overall health and encourage you to collaborate and coordinate your care across different professions to improve your experience as a patient. We encourage you to talk to a variety of qualified professionals about techniques that are uniquely best for you and are happy to help facilitate this on your behalf, at your request.

No. Functional Dry Needling is a part of a comprehensive treatment program. A full evaluation is needed, followed by therapeutic education, activities, and corrective exercises.

An average is 2-3 Functional Dry Needling sessions with one patient. We usually do not perform more than 5-6  sessions in a two month period except in rare circumstances.  

Best results are often when you see your physical therapist three times per week, but with only one of those sessions involving dry needling.

Functional Dry Needling is an add-on cost to your treatment time. The cost is $40 for up to 2 muscles, $60 for 3 or more muscles, plus the cost of your initial evaluation and treatment time. Additional recommended treatments may include therapeutic exercises,  neuromuscular re-education, and therapeutic activities. Health insurance often covers evaluations, therapeutic exercises, neuromuscular re-education, and therapeutic activities.

Dry needling is usually not covered by insurance.

We do not typically perform Functional Dry Needling at your first appointment unless you fit a classical “trigger point” presentation.  We may recommend it on day one and educate you on the  procedure, benefits, risks and possible side effects. We will then plan to use dry needling in future visits.

Yes we do. Please see references below:

1. Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: A literature review with implications for clinical practice guidelines. Phys  Ther Rev. 2014;19(4):252-265. doi:10.1179/108331913X13844245102034 

2. Sánchez-Infante J, Navarro-Santana MJ, Bravo-Sánchez A, Jiménez-Diaz F, Abián-Vicén J. Is dry needling applied by physical therapists effective for  pain in musculoskeletal conditions? A systematic review and meta-analysis. Phys Ther. 2021;101(3). doi:10.1093/ptj/pzab070 

3. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial trigger points then and now: A historical and scientific perspective. PM R.  2015;7(7):746-761. doi:10.1016/j.pmrj.2015.01.024 

4. Donnelly J. Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Lippincott Williams & Wilkins; 2018. https:// play.google.com/store/books/details?id=qYxjDwAAQBAJ. 

5. Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic effects of dry needling. Curr Pain Headache Rep. 2013;17(8):348.  doi:10.1007/s11916-013-0348-5 

6. Gattie E, Cleland JA, Snodgrass S. The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic  review and meta-analysis. J Orthop Sports Phys Ther. 2017;47(3):133-149. doi:10.2519/jospt.2017.7096 

7. Espejo-Antúnez L, Tejeda JF-H, Albornoz-Cabello M, et al. Dry needling in the management of myofascial trigger points: A systematic review of  randomized controlled trials. Complement Ther Med. 2017;33:46-57. doi:10.1016/j.ctim.2017.06.003 

8. Jafri MS. Mechanisms of myofascial pain. Int Sch Res Notices. 2014;2014. doi:10.1155/2014/523924 

9. Lázaro-Navas I, Lorenzo-Sánchez-Aguilera C, Pecos-Martín D, et al. Immediate effects of dry needling on the autonomic nervous system and mechanical  hyperalgesia: A randomized controlled trial. Int J Environ Res Public Health. 2021;18(11). doi:10.3390/ijerph18116018 

10.Navarro-Santana MJ, Gómez-Chiguano GF, Cleland JA, Arias-Buría JL, Fernández-de-Las-Peñas C, Plaza-Manzano G. Effects of trigger point dry  needling for nontraumatic shoulder pain of musculoskeletal origin: A systematic review and meta-analysis. Phys Ther. 2021;101(2). doi:10.1093/ptj/ pzaa216 

11.Kietrys DM, Palombaro KM, Azzaretto E, et al. Effectiveness of dry needling for upper-quarter myofascial pain: A systematic review and meta-analysis. J  Orthop Sports Phys Ther. 2013;43(9):620-634. doi:10.2519/jospt.2013.4668 

12.Vier C, Almeida MB de, Neves ML, Santos ARSD, Bracht MA. The effectiveness of dry needling for patients with orofacial pain associated with  temporomandibular dysfunction: A systematic review and meta-analysis. Braz J Phys Ther. 2019;23(1):3-11. doi:10.1016/j.bjpt.2018.08.008 

13.Liu L, Huang Q-M, Liu Q-G, et al. Evidence for dry needling in the management of myofascial trigger points associated with low back pain: A systematic  review and meta-analysis. Arch Phys Med Rehabil. 2018;99(1):144-152.e2. doi:10.1016/j.apmr.2017.06.008 

14.Navarro-Santana MJ, Sanchez-Infante J, Gómez-Chiguano GF, et al. Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal  origin: A systematic review and meta-analysis. Clin Rehabil. 2020;34(11):1327-1340. doi:10.1177/0269215520937468 

15.Liu L, Huang Q-M, Liu Q-G, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: A systematic review  and meta-analysis. Arch Phys Med Rehabil. 2015;96(5):944-955. doi:10.1016/j.apmr.2014.12.015 

16.Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, et al. Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: A  systematic review and meta-analysis. Phys Ther. 2021;101(5). doi:10.1093/ptj/pzab06