🦀 PT Crab Issue 99 - Dry Needling, Hokey Pokey? Nopey Nopey.

This week we’re doing a whole big thing on dry needling. I’ve been asked about it a bunch and decided that it is time to settle it now and for now. Because it’s not once and for all, that’s how research works. But now and for now, here’s what we know.

P.S. if DN isn’t allowed in your state, isn’t something you do, or you’re an inpatient therapist (ick, poop), sorry! But more coming for you in future.

Also, this issue covers plantar fasciitis, shoulder pain, and headaches. If you’re interested in the effect on all MSK pain, post-stroke pain and spasticity, and TMJ pain, become a supporter of the Crab for just $5 per month and join the 98 people who keep it going strong. Thanks!

With that, let’s dive in!

Plantar Fasciitis? Not bad.

The Gist - This systematic review and meta-analysis published in the journal Pain Medicine in March 2021 dug around for RCTs that gave DN to trigger points associated with plantar heel pain. They checked outcomes related to pain and disability. 6 trials were eligible, showing low-quality evidence that DN reduces pain in the short term (-1.77 points on 0-10 scale, with 0.8 being the MCID there). There was moderate quality evidence that it improved pain (-1.77) and disability in the long term as compared to control groups.

Those control groups were all either “sham dry needling, no intervention, or another intervention such as manual therapy or corticosteroid injections.”

I want more details. Get ‘em here.

How to Heal.

PT Crab is brought to you this week by How to Heal Co, the company that sells positive mental health apparel that comes with free therapy. Yes really.

Check out this amazing “The Earth Has Scars Too” shirt modeled by the amazing Soko.

Learn more about the company, their mission, and their clothes over at HowToHealCo.com. They’re really quite amazing.

Tension, Cervicogenic, Migraine Headaches? Pretty Good.

The Gist - This systematic review and meta-analysis from PTJ in February 2021 looked at 11 RCTs in the qualitative synthesis and 9 in the meta-analysis for reducing pain from these types of headaches when compared to “physical therapy interventions, pharmacological interventions, injections with different substances, and sham or control groups.” The researchers found very low quality evidence that dry needling is not better at improving headache pain the short term in people with tension-type and mixed headaches. It “provided significantly greater improvement in related disability in the short term in patients with TTH and CHG”.

“The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH.”

But this one comes with some caveats. The studies they had to include were largely low quality, heterogenic, and the needling methods they used were sometimes questionable. Still, the authors felt good enough to make a strong conclusion and that works for me. But do your own look through to verify the deets.

I wanna look! Enjoy.

Shoulder Pain? Yeah man.

The Gist - This piece from PTJ looked into dry needling for non traumatic shoulder pain and pulled together 6 RCTs to get data from. Overall, there was moderate quality evidence that “dry needling reduces shoulder pain intensity with a small effect (mean difference = −0.49 points).” There was also low quality evidence that it improves disability with a large effect (mean difference = -9.99 points). You know they really did the math because they didn’t just round it up to 10. On the downside, the effects on pain were only short term and (as usual) heterogeneity in the studies reigned.

What we do know from this one is that it probably needs to be applied at least three times to have a real effect, so keep that in your pocket.

I want details! Have them.

I didn’t go through looking specifically for systematic reviews that showed that DN works. But I do I have positive publication bias, and journals have positive publication bias. There are probably plenty of papers out there showing that DN doesn’t work that haven’t been published and that’s sad. But the data that we do have available for these things is published above. That’s what we know right now. The heterogeneity sucks, I know. We need more standardized protocols in needling research and practice and we need it now. And you yourself (yes, you) need to double-check the effect sizes, techniques, and information from the individual papers to make sure it actually fits your clinical practice. But you do that every week, right? Lol.

Anyway, that’s all I have this week. Aside from once again thanking you for being a supporter and letting you know that next week is both Issue 100 and the introduction of a brand new thing where you can get paid to recommend the Crab to people. Wouldn’t that be nice? Share something you love, help me, make a bit of dough as long as they subscribe, win win win. Win. Win. WIN.

And check out How To Heal Co. Here.

Anyway, have a great week,

Luke

Here’s the bibliography:

• Llurda-Almuzara, L., Labata-Lezaun, N., Meca-Rivera, T., Navarro-Santana, M. J., Cleland, J. A., Fernández-de-las-Peñas, C., & Pérez-Bellmunt, A. (2021). Is Dry Needling Effective for the Management of Plantar Heel Pain or Plantar Fasciitis? An Updated Systematic Review and Meta-Analysis. Pain Medicine, 22(7), 1630–1641. https://doi.org/10.1093/pm/pnab114
• Navarro-Santana, M. J., Gómez-Chiguano, G. F., Cleland, J. A., Arias-Buría, J. L., Fernández-de-las-Peñas, C., & Plaza-Manzano, G. (2021). Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis. Physical Therapy, 101(2), pzaa216. https://doi.org/10.1093/ptj/pzaa216
• Pourahmadi, M., Dommerholt, J., Fernández-de-Las-Peñas, C., Koes, B. W., Mohseni-Bandpei, M. A., Mansournia, M. A., Delavari, S., Keshtkar, A., & Bahramian, M. (2021). Dry Needling for the Treatment of Tension-Type, Cervicogenic, or Migraine Headaches: A Systematic Review and Meta-Analysis. Physical Therapy, 101(5), pzab068. https://doi.org/10.1093/ptj/pzab068