Dry needling at myofascial trigger points mitigates chronic post-stroke shoulder spasticity

Post-stroke spasticity is associated with restriction in the range of motion of the shoulder.Reducing muscular dystrophy may help relieve muscular dysfunction in patients with post-stroke shoulder spasticity.Dry needle therapy is a method of needling the trigger points using a syringe needle without the use of a drug.Dry needle therapy is commonly used for pain at the shoulder,neck,waist,and back.In this case study,a 62-year-old male patient affected with cerebral hemorrhage of the right frontal lobe had received rehabilitative treatment for 12 years.However,he still experienced shoulder spasticity.The patient received daily dry needling at the trigger points of infraspinatus,teres minor,posterior deltoid,and pectoralis major on 9 days.After the first and ninth treatment,the Modified Ashworth Scale and the passive range of motion of the shoulder was used to assess the effect of the treatment.The spasticity and range of motion of the shoulder showed obvious improvement.These results indicate that dry needling at the myofascial trigger points can effectively treat chronic poststroke shoulder spasticity.

Traditional Chinese acupuncture manipulations and “dry needling”

In this paper, the authors studied the manipulation of ＂dry needling＂, reviewed Chinese ancient and modern literature of acupuncture-moxibustion, and found that ＂dry needling＂ is very similar to triple needling, superficial needling, joint valley needling, surround needling, and other traditional Chinese acupuncture- moxibustion manipulations; even if in modern China, before and after the invention of ＂dry needling＂, some unique therapies, such as oblique insertion therapy at Ashi point, sliver needling, Fu＇s subcutaneous needling, and long-round needling, were also invented. It can be seen that ＂dry needling＂ therapy is actually a kind of differentiation of traditional Chinese acupuncture- moxibustion in the international communication. The spread of traditional Chinese acupuncture-moxibustion in the West is the basis for the invention of ＂dry needling＂ therapy, and ＂dry needling＂ therapy develops and enriches traditional Chinese acupuncture-moxibustion.

Dry needling:a de-meridian style of acupuncture

Recently, the educators OT ury Neeclllng （DN） in tne West ofterl proctaime that DN is not acupuncture, and thus DN practitioners do not need to have the same training as acupuncturists. Their primary reason is that DN does not use the meridian theory of traditional Chinese medicine （TCM）. in this paper, the authors refuted this claim. Through a systemic review on the global ＂Acupuncture Fever＂, there are several different manifestations of ＂De- Meridian＂ phenomena （meridian theory is not required for acupuncture and other related modalities）. Although De-Meridian has played a positive role in the development of acupuncture, it does not mean ＂De-Acupuncture＂ （modaiities derived from but different from acupuncture）. Given the clear definition of acupuncture by WHO, even though DN has certain attributes of De-Meridian that is similar to other forms of novel needling therapies, all of them belong to acupuncture. DN is a style of contemporary acupuncture, also called Trigger points （TrPs） acupuncture. This is because not only these myofascial TrPs stimulated by DN have always been acupoints, the needles and techniques used in DN are no different than acupuncture. Moreover, the mechanisms of DN and acupuncture are one in the same. The development of modern DN theory and its application are closely associated with the clinical trials and research of acupuncture. On the other hand, researches and clinical applications on myofascial TrP have highlighted the importance of stimulating reflex points in the clinic. However, as it refuses to inherit the theory and experience from thousands of years of acupuncture practice, it has shown obvious shortcomings in clinical applications.

Discussion about the training or education for“dry needling practice”

Dry needling is one style of acupuncture, therefore, practitioners of dry needling should abide by laws of the Food and Drug Administration （FDA） and acupuncture boards in the U.S.. Along with following the laws of practice should be included basic acupuncture education requirements. The education or training requirements regarding regulations for practicing acupuncture among different professionals in the U.S. were investigated for this article. The facts are, in the U.S., licensed acupuncturists are required to attain a minimal of 1 905 educational or training hours via an accredited （such as the Accreditation Commission for Acupuncture and Oriental Medicine, ACAOM） school or program before they apply for a license. The physician or medical acupuncturists are required to get a minimum of 300 educational hours in a board （American Board of Medical Acupuncture, ABMA） approved acupuncture training institution and have 500 cases of clinical acupuncture treatments to get certified in medical acupuncture. Some physical therapists （PTs） receive only 20-30 hours of acupuncture training in the form of dry needling in weekend continuing education classes and want to be able to practice acupuncture. For the sake of public safety, they should get a formal education in an accredited acupuncture school or program.

Effectiveness of dry needling on reducing pain intensity in patients with myofascial pain syndrome： a Meta-analysis

OBJECTIVE: To summarize the literature about the effectiveness of dry needling(DN) on relieving pain and increasing range of motion(ROM) in individuals with myofascial pain syndrome(MPS).METHODS: Papers published from January 2000 to January 2013 were identified through an electronic search in the databases MEDLINE, Dialnet, Cochrane Library Plus, Physiotherapy Evidence Database(PEDro) and Spanish Superior Council of Scientific Research(CSIC). The studies included were randomized controlled trials written in English and/or Spanish about the effectiveness of DN on pain and ROM in individuals with MPS.RESULTS: Out of 19 clinical trials that were potentially relevant, a total of 10 were included in the Meta-analysis. Regarding pain intensity reduction when measured before and immediately after the intervention, DN achieved improvement compared with the placebo treatment [d =-0.49; 95% CI(-3.21, 0.42)] and with the control group [d =-9.13;95% CI(- 14.70,- 3.56)]. However, other treatments achieved better results on the same variable compared with DN, considering the measurements for pre-treatment and immediately after [d = 2.54;95% CI(-0.40, 5.48)], as well as the pre-treatment and after 3-4 weeks [d = 4.23; 95% CI(0.78, 7.68)].DN showed a significantly increased ROM when measured before the intervention and immediately after, in comparison with the placebo [d = 2.00;95% CI(1.60, 2.41)]. However, other treatments achieved a significant better result regarding ROM when it was measured before the intervention and immediately after, as compared with DN [d =-1.42;95% CI(-1.84,-0.99)].CONCLUSION: DN was less effective on decreasing pain comparing to the placebo group. Other treatments were more effective than DN on reducing pain after 3-4 weeks. However, on increasing ROM,DN was more effective comparing to that of placebo group, but less than other treatments.

Evidence and Expert Opinions:Drying Needling versus Acupuncture(Ⅰ)--The American Alliance for Professional Acupuncture Safety(AAPAS)White Paper 2016

In the last twenty years, in the United States and other Western countries, dry needling （DN） became a hot and debatable topic, not only in academic but also in legal fields. This White Paper is to provide the authoritative information of DN versus acupuncture to academic scholars, healthcare professional administrators, lawmakers, and the general public through providing the authoritative evidence and experts＇ opinions regarding critical issues of DN versus acupuncture, and then reach consensus. DN is the use of dry needles alone, either solid filiform acupuncture needles or hollow-core hypodermic needles, to insert into the body for the treatment of muscle pain and related myofascial pain syndrome. DN is sometimes also known as intramuscular stimulation, trigger points （TrP） acupuncture, TrP DN, myofascial TrP DN, or biomedical acupuncture. InWestern countries, DN is a form of simplified acupuncture using biomedical language in treating myofascial pain, a contemporary development of a portion of Ashi point acupuncture from Chinese acupuncture. It seeks to redefine acupuncture by reframing its theoretical principles in a Western manner. DN-like needling with filiform needles have been widely used in Chinese acupuncture practice over the past 2,000 years, and with hypodermic needles has been used in China in acupuncture practice for at least 72 years. In Eastern countries, such as China, since late of 1800s or earlier, DN is a common name of acupuncture among acupuncturists and the general public, which has a broader scope of indications, not limited to treating the myofascial pain.

Evidence and Expert Opinions:Drying Needling versus Acupuncture(Ⅱ)--The American Alliance for Professional Acupuncture Safety(AAPAS)White Paper 2016

In the United States and other Western countries, dry needling has been a topic in academic and legal fields. This White Paper is to provide the authoritative information of dry needling versus acupuncture to academic scholars, healthcare professionals, administrators, policymakers, and the general public by providing the authoritative evidence and expertise regarding critical issues of dry needling and reaching a consensus. We conclude that Dr. Travell, Dr. Gunn, Dr. Baldry and others who have promoted dry needling by simply rebranding（1） acupuncture as dry needling and（2） acupuncture points as trigger points（dry needling points）. Dry needling simply using English biomedical terms（especially using ＂fascia＂ hypothesis） in replace of their equivalent Chinese medical terms. Dry needling is an over-simplified version of acupuncture derived from traditional Chinese acupuncture except for emphasis on biomedical language when treating neuromuscularskeletal pain（dry needling promoters redefined it as ＂myofascial pain＂）. Trigger points belong to the category of Ashi acupuncture points in traditional Chinese acupuncture, and they are not a new discovery. By applying acupuncture points, dry needling is actually trigger point acupuncture, an invasive therapy（a surgical procedure） instead of manual therapy. Dr. Travell admitted to the general public that dry needling is acupuncture, and acupuncture professionals practice dry needling as acupuncture therapy and there are several criteria in acupuncture profession to locate trigger points as acupuncture points. Among acupuncture schools, dry needling practitioners emphasize acupuncture＇s local responses while other acupuncturists pay attention to the responses of both local, distal, and whole body responses. For patients＇ safety, dry needling practitioners should meet standards required for licensed acupuncturists and physicians.

Short-term effectiveness of high-and low-intensity percutaneous electrolysis in patients with patellofemoral pain syndrome:A pilot study

BACKGROUND Unilateral patellofemoral pain syndrome(PFPS)is the most frequently diagnosed knee condition in populations aged<50 years old.Although the treatment of myofascial trigger points(MTrPs)is a common and effective tool for reducing pain,previous studies showed no additional benefits compared with placebo in populations with PFPS.Percutaneous electrolysis is a minimally invasive approach frequently used in musculotendinous pathologies which consists of the application of a galvanic current through dry needling(DN).AIM To evaluate changes in sensitivity,knee pain perception and perceived pain during the application of these three invasive techniques.METHODS A triple-blinded,pilot randomized controlled trial was conducted on fifteen patients with unilateral PFPS who were randomized to the high-intensity percutaneous electrolysis(HIPE)experimental group,low-intensity percutaneous electrolysis(LIPE)experimental group or DN active control group.All interventions were conducted in the most active MTrP,in the rectus femoris muscle.The HIPE group received a 660 mA galvanic current for 10 s,the LIPE group 220 mA×30 s and the DN group received no galvanic current.The MTrP and patellar tendon pain pressure thresholds(PPTs)and subjective anterior knee pain perception(SAKPP)were assessed before,after and 7 d after the single intervention.In addition,perceived pain during the intervention was also assessed.RESULTS Both groups were comparable at baseline as no significant differences were found for age,height,weight,body mass index,PPTs or SAKPP.No adverse events were reported during or after the interventions.A significant decrease in SAKPP(both HIPE and LIPE,P<0.01)and increased patellar tendon PPT(all,P<0.001)were found,with no differences between the groups(VAS:F=0.30;η2=0.05;P>0.05;tendon PPT immediate effects:F=0.15;η2=0.02;P>0.05 and tendon PPT 7-d effects:F=0.67;η2=0.10;P>0.05).A significant PPT increase in rectus femoris MTrP was found at follow-up in both the HIPE and LIPE groups(both,P<0.001)with no differences between the groups(immediate effects:F=1.55;η2=0.20;P>0.05 and 7-d effects:F=0.71;η2=0.10;P>0.05).Both HIPE and LIPE interventions were considered less painful compared with DN(F=8.52;η2=0.587;P<0.01).CONCLUSION HIPE and LIPE induce PPT changes in MTrPs and patellar tendon and improvements in SAKPP,and seem to produce less pain during the intervention compared with DN.

从干针崛起看古典针灸传承与创新的必要性

By reviewing the historical background and the current state of dry needling(DN),including the"AntiDN Independence"movement by the acupuncture profession in the west,this paper emphasizes that DN is acupuncture,or more precisely,a"de-meridian"style of acupuncture.Clinical applications of DN and its modern studies have seen a tremendous growth spurt during the past two decades,which suggests that the meridian theory of traditional Chinese medicine(TCM)may not be the exclusive theory to guide acupuncture.Even certain high-quality DN trials may serve as good examples for acupuncture research,such as refining the stimulation targets in acupoints,recognizing the reflex properties of acupoints known as acu-reflex points(ARPs),or establishing standardized indicators of stimulus amount while objectively assessing the needling efficacy.Like any other therapies,DN has its shares of drawbacks or limitations,which reminds that while innovating classical acupuncture,it is still necessary to inherit the valuable experience of classic acupuncture and the rational core of meridian theory.This is crucial for enhancing the efficacy of clinical acupuncture intervention including DN to broaden the treatment scope and indications of acupuncture.

The historical source of “Trigger Points”:classical Ashi points

Our research began with a consideration of the etymological origins of the terms Ashi and the Ashi point. We used both original source texts and textual criticism to trace the original meaning of the phrases, ＂take the tender spot as the point＂ and ＂use the Ashi method.＂ Linguistic theory informed our discussion of three similar terms and our analysis of them. We show that Ashi points are in theory similar to regular acupuncture points in terms of their definition and function. Furthermore, we can use the concept of ＂c/i-pathway （Qi./ie）＂ to expand our understanding of the clinical use of Ashi points. Ultimately, the main purpose of our research was to clarify that the classical Ashi point and modern, western concept of the trigger point are in fact quite similar. The two concepts have been described in different languages primarily due to cultural differences.

The evolving conception and practice of acupuncture-moxibustion

With the emergence of the modified forms of acupuncture-moxibustion such as dry needle,the discipline acupuncture-moxibustion faces significant opportunities and challenges.The concept and treatment of acupuncture-moxibustion need to combine with modern medicine to consolidate the effectiveness and apply the research results to guide clinical treatment.By reviewing the brief history of acupuncture-moxibustion in the Western countries and summarizing the definitions,this article was to propose the trend and development strategies of this discipline in the future.