Training Center: Explaining dry needle therapy

Can dry needle therapy help with knee tendonitis?

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Explaining dry needle therapy

Dear BCSM,
Can you explain the theory behind dry needle therapy? I’ve got a tendinitis issue in my knee and someone recommended it to me. Am I a good candidate? What are the ideal injuries for such a treatment, and lastly, is there any science behind it that proves it works, including studies?
— Bret

Great questions! Dry needle therapy, which is formally known as Trigger Point Dry needling (TDN), is a technique that uses small monofilament needles to treat trigger points within muscles. Active trigger points develop due to injury, musculoskeletal dysfunction, overuse issues such as an improper training progression, and other abnormal stresses such as a poorly fit bicycle. When muscles develop trigger points, they often become shortened and can create compression on the structures around them, which can be perceived by the body as pain. An active trigger point impairs an individual’s ability to lengthen and or contract a muscle.

One of the theories behind TDN is that trigger points are known to have abnormal electrical activity and are surrounded by numerous chemicals known to cause inflammation. Research has shown that when a needle is successfully inserted into a trigger point and causes a local twitch response, it can return the electrical and chemical environment within the muscle to its normal state and the muscle “lets go.” Deactivated trigger points draw white blood cells and plasma cells into the area and create a healing response. In addition, trigger points are known to exhibit an altered PH and altered rate of neurotransmitters. Following dry needling, the PH and the rate of transmission of neurotransmitters becomes more normalized. While there are no double-blind studies to support dry needling, there is some scientific evidence that supports the above theory. Clinically, after dry needling we see improved muscle length, flexibility, and a corresponding decrease in client-reported pain.

As far as your knee tendonitis goes, patellar tendonitis can occur for many reasons: biomechanics, over-training, and muscle tightness/imbalance issues. The effectiveness of TDN depends on which of these factors are contributing to your current problem. If muscle tightness issues are the primary cause, then you would be a good candidate for dry needling. A physical therapist would be able to complete an evaluation and determine if you would benefit from the technique. Factors that would be taken into consideration are muscle length, bony alignment issues, muscle imbalances, and biomechanics. There are many other problems that you may encounter as a cyclist that would benefit greatly from TDN. Treatment of acute or chronic strain/sprains resulting from a crash or race related injury and/or treatment of chronic neck pain and back pain from a poor bike fit are fine examples where TDN would be effective. It is important to note that TDN is not a cure all. TDN is most effective when it is used as an adjunct to other physical therapy techniques and treatments that specifically address your issue.

Good luck!
— Cathy and Sue

Editor’s Note: Cathy Fraser PT and Sue Nakaoka PT are physical therapists at the Boulder Center for Sports Medicine. They specialize in manual therapy and TDN. Sue is currently training to be a teaching assistant for TDN courses. Cathy is an Australia-trained manual therapist.

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