What is dry needling?
Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissue for the management of neuromusculoskeletal pain and movement impairments. It is a technique used to treat dysfunctions in skeletal muscle, fascia, and connective tissue; to diminish persistent peripheral nociceptive input; and to reduce or restore impairments in body structure and function, leading to improved activity and participation (Source: www.apta.org/StateIssues/DryNeedling/ClinicalPracticeResourcePaper).
The dry needle used is very thin and there is no injectable solution. Inserting the needle can cause some pain, although this seldom occus when done by well-trained practitioners. Proper dry needling of a myofascial trigger point will elicit a local twitch response (LTR), which is an involuntary spinal cord reflex in which fibers of the affected muscle contract. The LTR indicates the proper placement of the needle in the affected area. Dry needling that elicits LTRs improves treatment outcomes.
Dry needling is different than acupuncture
Acupuncture practised by acupuncturists and dry needling performed by physical therapists differ in terms of historical, philosophical, indicative, and practical context. Dry needling performed by physical therapists is based on Western neuroanatomy and scientific studies of the musculoskeletal and nervous system. Physical therapists who perform dry needling do not use traditional acupuncture theories or acupuncture terminology. See this comparison overview between dry needling and acupuncture.
Why choose dry needling?
Musculoskeletal pains are not often explained from a muscle perspective. However, referred pain from muscle parts can mimic other musculoskeletal pains as shown in the image. These so called ‘myofascial trigger points’ are sources of persistent peripheral nociceptive input and their inactivation is consistent with current pain management insights.
Trigger points of the gluteus medius muscle and its possible referred pain patterns. Note the potential overlap with 'hip', 'SIJ’, ‘sacrum' or 'low back' pains.
In clinical practice, dry needling is performed once the physical therapy examination and evaluation are completed and clear therapeutic goals and objectives are established. Dry needling may be incorporated into a treatment plan when myofascial trigger points are present and possibly responsible for impairments in body structure, pain, and functional limitations. Dry needling is also indicated for restrictions in range of motion due to contractured muscle fibers or taut bands or to other soft tissue restrictions, such as fascial adhesions or scar tissue. The solid filament needle allows the therapist to target tissues that are not manually palpable.
Myofascial trigger points have been identified in numerous diagnoses, such as radiculopathies, joint dysfunction, disk pathology, tendonitis, craniomandibular dysfunction, migraines, tension-type headaches, carpal tunnel syndrome, computer-related disorders, whiplash-associated disorders, spinal dysfunction, pelvic pain and other urologic syndromes, post-herpetic neuralgia, complex regional pain syndrome, nocturnal cramps, and phantom pain.
Learning dry needling from a quality instructor
There is worldwide interest in dry needling supported by increasing scientific evidence. Dry needling is practiced around the world by Medical Doctors, Doctors of Osteopathy, Naturopaths, and Physical Therapists (PTs). The PTs account for the largest growth in recent years. Instructor Frank Timmermans has 37 years of experience as a Physical and Manual Therapist. He has published several articles on myofascial pain and dry needling and has instructed over 5,000 physical therapists. There is 1:4 teacher student ratio for optimal safety and didactics in the courses offered by Uplands Physio Clinic. You will receive specific course level information ( 10 hours study time per course) beforehand to review, such as videos, articles, anatomy and referred pain patterns.
Follow the three dry needling course levels to obtain a full dry needling certificate
Three dry needling course levels are offered and reflect increasing levels of dry needling skill. The introductory 3-day course on ‘Extremities’ covers the muscles in the arm and leg and teaches the basic knowledge and skills required to perform the technique. Videos (7 hours), articles (2 hours) and links for anatomy and referred pain patterns (1 hour) to review will be emailed beforehand. At the course you will receive a 185-page course manual, a Trail Guide anatomy/palpation book, and a trigger point poster. Practitioners must pass both theoretical and practical testing in this course and demonstrate safety and competency in order to receive a certificate of completion of level 1. A comeback day with a practical review (8 hours) will be offered one month after the level 1 course. Attendance and passing a practical exam are mandatory in order to be able to sign up for level 2.
The advanced 3-day level 2 course entitled ‘Spine’ can be taken after completion of the first level and following its comeback day. Videos (7 hours), articles (2 hours) and links for anatomy and referred pain patterns (1 hour) to review will be emailed beforehand. On the first morning, there will be an evaluation of the practical parts as taught in the first course ‘Extremities’. Particular time will be spent discussing adverse events and how to prevent and handle these when they occur. Afterwards, a presentation will show the muscles of the lower back and adductors of the hip with an emphasis on myofascial pain, specific tests, and dry needling techniques, followed by an anatomy test. In the afternoon, these tests and techniques will be practiced in small groups under the direct supervision of an instructor for optimal safety and didactics. On the morning of the second day, a presentation will show the erector spinae muscles with an emphasis on myofascial pain, specific spinal tests and dry needling techniques, followed by an anatomy test. For the rest of the morning these tests and techniques will be practised in small groups under the direct supervision of an instructor. After lunch, a presentation will show the muscles of the thorax with an emphasis on myofascial pain, specific tests and dry needling techniques, followed by an anatomy test. For the whole of the afternoon, these tests and techniques, as well as the ones from Day 1, will be practiced in small groups under the supervision of an instructor. On the third day, a presentation will show the neck muscles with an emphasis on myofascial pain, specific tests, and dry needling techniques, followed by an anatomy test. For the rest of the morning, these tests and techniques will be practiced in small groups under the direct supervision of an instructor. This practical session of the neck will continue after lunch and, for the rest of the afternoon these tests and techniques, as well as the ones from day 1 and 2, will be practiced in small groups under the direct supervision of an instructor. The course will conclude with a review and practitioners must pass both theoretical and practical testing in this course and demonstrate safety and competency in order to receive a certificate of completion of level 2. A comeback day with a practical review (8 hours) will be offered one month after this level 2 course. Attendance and passing a practical exam are mandatory in order to be able to sign up for level 3.
A 2-day third level 3 course concludes the full dry needling certication and this course relates to 'headaches' and 'temporomandibular' disorders. Videos (7 hours), articles (2 hours) and links for anatomy and referred pain patterns (1 hour) to review will be emailed beforehand. The relevance of interpreting the history and examination findings, with special attention to myofascial factors and red flags, will be pointed out. The afternoon of the first day will be practical with a dry needling review of the neck muscles including sternocleido-mastoid and sub-occipital muscles. On day 2 the evaluation of temporomandibular disorders (TMD) will be presented including a definition and diagnosis of TMD, sensitisation and biomechanical hypotheses and TMD assessment. Treatment options will be reviewed with special attention to myofascial and cervical spine influences. The afternoon of day 2 is filled with practical sessions such as assessment of TMD as well as dry needling of the masseter, temporalis and pterygoid muscles. The course will conclude with a review and practitioners must pass both theoretical and practical testing in this course and demonstrate safety and competency in order to receive a certificate of completion of level 3. A comeback day with a practical review (8 hours) will be offered one month after this level 3 course. Attendance and passing a final practical exam are mandatory in order to obtain a full and complete dry needling certificate.
Ongoing support after the courses
After completing the three course levels you will be registered on the website as a certified dry needling practitioner. Through the 'members only' section of the website, you will have access to a consent form, clinic brochures, dry needling safety overviews, as well as relevant publications. After the courses, you are encouraged to stay in close contact with your instructor in case you have any practical questions. Regular ‘refresher days’ will be organized to allow you to stay up to date with any new developments in this technique.
Feedback from participants
Level 1 course 'Extremities'
The focus on safety was very good.
I really gained valuable knowledge and skill from the seminar. Looking forward to the next!
You brought in an excellent team of knowledgeable physiotherapists that were great to help us with the techniques.
I really appreciated your attention to detail, the small group & hands on time, and the general environment of the class.
Level 2 course 'Spine'
This was a fabulous level 2 course. It supports the first one so much.
I really enjoyed it and appreciate the safe & comprehensive approach.
Love the verbal repetition for techniques and reinforcement for safety.
I especially appreciated the attention to detail and repetition regarding the safety issues.
I understand that you need to do the 2 courses in this order. There is no way I could have grasped it all in one course.
I am loving finding tightness and decreased ROM and then dry needling and then re checking. It is very satisfying.
I learned a more rounded approach to needling treatments and how it fits into an overall assessment and treatment plan.