By Brian Rog and Charles Matt Huey, PT, MPT, Cert. MDT, CMTPT for ATI Physical Therapy
Often times, the inevitable postsurgical pain and discomfort following a procedure like a total knee arthroplasty (commonly known as a knee replacement) is a mystifying variable we cannot seem to escape – even with the inclusion of opioids. However, what if we told you, that this pain could be lessened considerably without medication, would you believe us?
Major advancements in technology have allowed the operational side of procedures to go as seamless as possible; however, the short- and long-term effects of post-surgery pain still appear to be unavoidable. Well, that was the original belief. Thanks to research, a lesser known, yet growing in popularity, practice called myofascial trigger point dry needling or dry needling, is playing a vital role in minimizing post-surgery pain when it is most severe. Data suggests that patients who undergo dry needling prior to a total knee replacement endure less pain after intervention as compared to those who do not.
Before we take a closer look into these findings, it is important to understand what exactly dry needling is, its role in helping to mediate knee injuries, how dry needling differs from acupuncture, and what conditions it is most appropriate for treating.
But first, let’s brush up on the origins of knee pain as this will help draw a better connection to dry needling and knee pain.
Trigger points and knee pain
Most patients undergoing knee replacement surgery have endured some form of pain through the process, or experience decreases in their functional abilities. Because of this, simple activities like walking or standing become troublesome, so people tend to do less of both thinking they will be better off. Unfortunately, this inactivity attributes to several physiology responses such as decreased endurance, stamina, weakness and loss of motion. There may also be a change in gait pattern, which can cause the muscle fibers to shorten or over-lengthen, leading to trigger points.
Herein lies the problem. These trigger points then begin to harvest pain due to the sarcomeres (functional unit of striated muscle) moving closer together, causing a decrease in blood flow and oxygen saturation, which makes the muscle area very acidic. And when there is an acid build-up in the muscles, you’ll experience knots, fatigue and muscle burn.
Since most researchers’ efforts zero in on the causes of the pain, like bone-on-bone contact in the knee, these trigger points, which have a large role in the resurrection of pain, often go unnoticed. It is at this moment that we start to understand the value of techniques like dry needling.
What is dry needling?
Dry needling is a technique for the treatment of myofascial pain (contraction knots) and dysfunction in musculoskeletal areas where muscles are typically denser. Due to the sensitive nature with treating areas of deep tissue, dry needling helps target these areas without the discomfort or bruising commonly experienced through hands-on techniques. The goal of dry needling is to help the body relax and increase blood flow at locations of discomfort. By doing this, the muscles will contract, which will allow for improved functionality and decreased pain.
Some of the more common conditions dry needling helps to remedy deal with sprain/strain injuries, chronic pain conditions, chronic tension-type headaches, pressure build-up in the muscles, and nerve compression conditions.
Differences between dry needling and acupuncture
Like dry needling, acupuncture uses similar anatomically specific (non-injection) filiform needles to help reduce pain. However, the approach and ideologies of the procedures are where we start to see the similarities fade.
Dry needling involves the insertion of a needle into soft tissues with the aim of decreasing muscle tissue tension and improving musculoskeletal function.
Acupuncture, on the other hand, uses needles to manipulate the balance and flow of the body’s energy meridians. Doing this stimulates the body to produce its own pain-relieving endorphins, which help to promote healing and restore health.
Dry needling and post knee replacement surgery pain
Earlier in the story, we talked about a study that suggests dry needling can help lessen post-surgery pain in total knee replacements. Fascinating, right?
Here’s what we know, the study observed 40 patients undergoing a total knee replacement. The 40 subjects were unknowingly randomized to a ‘true’ dry needling group or to a ‘sham’ group where the procedure mimicked a dry needling intervention, but was not true dry needling. Each of the participants were examined for myofascial trigger points by an experienced physical therapist 4–5 hours before surgery. Immediately following anesthesiology and before surgery started, subjects in the ‘true’ group were dry needled in all previously diagnosed trigger points, while the ‘sham’ group received no treatment in their myofascial trigger points. This is where it gets good. The results concluded that subjects in the ‘true’ group had less pain after their surgery and showed significant differences in the need for immediate post-surgery opioids. So that begs the question, why isn’t dry needling more commonly recommended to individuals undergoing a total knee arthroplasty? The answer is simple. Awareness!
Muscles after surgery
Using knee replacement cases as our example, dry needling is beneficial as it helps to reduce trigger points that either developed prior to the surgery or afterwards. During the surgery, tissue is pulled and moved around which can be traumatic to the tissue. It will then respond by shortening and becoming painful. The patient may also not want to start moving again right after the surgery due to pain or other complications from the surgery. Again, lack of activity will cause decreased strength, shortening of the muscles, reduced endurance, etc., ultimately leading to trigger points. The patient’s body mechanics may have changed as well causing the muscle to fire and move in incorrect patterns, which also lead to trigger points.
Dry needling and long-term opioid use
As compared to opioids, dry needling is a safe and effective alternative to controlling musculoskeletal pain especially in chronic pain patients. Opioids have a long list of side effects and can lead to spiraling dependencies. Opioids work by binding to receptors in the brain and body, however, there are limits to the number of receptors that can be utilized. Once every receptor has something bound to it, any additional increase in dosage has no effect. By steadily increasing the dosage level means that the medication is not working and other options need to be explored.
Studies have found longer relief of pain is best managed through dry needling as compared to wet needling (lidocaine injections) and medication. The use of dry needling is just one component in controlling pain. A skilled therapist will use needling to remove any painful trigger points but also direct the patient in a beneficial exercise program to continue to decrease and control pain.
Does ATI Physical Therapy offer dry needling treatment?
Dry needling is currently offered at select ATI Physical Therapy locations across our more than 750 clinics nationwide. To see if dry needling is available to your area, we recommend calling your nearest ATI clinic for more information.