Hey everyone,

I hope this finds you well. Here are some thoughts about dry needling combined with joint manipulation to fix, or at least significantly improve erectile dysfunction (ED). Let me know if anyone has any questions about anything. I am planning to write a handful of articles on this topic. Needling, thoughtfully performed, especially when combined with joint manipulation, stimulates amazingly rapid, positive results.

Enhanced Blood Perfusion (the primary mechanism necessary to achieve erection)

One of the best objectively observed effects of needling is the awesome vasodilation and increased microvascular blood perfusion stimulated. Luckily for us, this is the primary mechanism needed to achieve erection. Studies have been performed all over the body using various forms of technology and numerous needling strategies to measure blood flow through muscles, veins, venules, arteries, arterioles, carpal tunnel, etc. Much of the research indicates needling stimulates around a 20x increase in blood perfusion. Not 20%. 20 times the blood flow. The really cool thing about this is that depending on the location, needling increases and normalizes blood flow locally, but also, and probably more importantly, in the brain.

Homeostatic effects on abnormal electrical activity are also strong in both the peripheral and central nervous system, secondary to needling. Remember, our body works on electricity, along with a lot of other stuff. However, without electricity, we are dead. So, it would make sense that having a homeostatic electrical system is super important. Thoughtful needling has a neuroplastic effect on the brain and body and can stimulate amazing neurophysiologic responses, even after years of impairment.

Related: Click here to read my blog on "Dry Needling & Spinal Manipulation to Maximize Pelvic Health & Function"

There is little research concerning needling to specifically improve sexual function, however, there is some. Mostly acupuncture research, which all needlers should read. It really opens your mind to thinking in different ways. There is no reason to believe that needling the pelvic floor and surrounding structures wouldn’t significantly increase blood perfusion and muscle function, as it does everywhere else in the body, almost without fail. Aside from that, I treat people for ED and other sexual impairments on a weekly basis, male and female, and consistently see wonderful results. One of the other things I see all the time is people who have tried non pharmacological, standard ED treatment for years, including medical professionals, with little to no result. Then they try needling, and in a few treatments, the dysfunction is completely resolved. Happens all the time. Needling oftentimes eliminates the need for medication, as it addresses the cause of the problem, not just the symptoms.

The disparity in results from typical non-pharmacological treatment to needling is profound. Oftentimes, this has nothing to do with the quality of the prior treatment. It has everything to do with the magical effect thoughtful needling has on the human mind and body. I am amazed by it all the time, and I see these results on a regular basis. It seems like the magic I read about all the time in my fantasy books (the only other thing I read aside from science stuff). The speed and efficacy of treatment is often stunning, watching decades of impairment disappear in mere days or weeks. A lot of the time you see baffling results after just the first treatment. Like I said, magic.

Primary Muscles for Erection

The bulbospongiosus and ischiocavernosus are muscles located at the base of the penis and are the primary muscles involved in male erection. Many other muscles need to function properly to facilitate maximum sexual function, like the multifidus, however, the bulbospongiosus and ischiocavernosus are the most important. Both are innervated by the perineal branch of the pudendal nerve (S2-S4, parasympathetic-dominant portion of the autonomic nervous system (ANS)), and are located at the base and to the sides of the penis, respectively. These 2 muscles are vitally important in creating an erection and are easily treatable with needles (again, this is totally counterintuitive, but this is one of the most comfortable areas of the body to be needled).

T10 to T12 spinal segments are typically the roots of the sympathetic fibers involved in erection. The sympathetic chain ganglia cells transmit signals to the penis and are located in the sacrococcygeal region. Therefore, technically, any spinal and or muscular deviation from T10 down to the coccyx could easily cause both sympathetic and or parasympathetic impairment. Impairment in either of these portions of the ANS, at certain levels, will disable and hinder erectile function and sexual performance. This holds true for both men and women.

Again, the bulbospongiosus and ischiocavernosus are important for both sexes, however, let’s stick to males for this article. If these muscles have knots (trigger points) in them, which is extremely common, or are dysfunctional in another way, they are going to be shortened and or stretched. Shortened is way more typical. If the pelvis is significantly deviated, out of place, the pelvic floor neuromuscular system will dysfunction. Remember, joints don’t move themselves, muscles and other external forces do. Needling combined with joint manipulation is the fastest method that exists on planet earth to regulate these muscles and joints to neutral, along with pushing the ANS toward homeostasis, allowing for normal sexual function, both mechanically and neurologically. This includes regulating the brain toward homeostasis. Without healthy brain function and a homeostatic ANS, nothing works properly.

Dry needling, especially when combined with joint manipulation, addresses the symptoms of ED, and more importantly, the underlying causes. Mainstream medicine just addresses the symptoms and never addresses or resolves the cause. When thoughtfully performed, these techniques have powerful, awe-inspiring, regulatory effects on our neuromusculoskeletal systems, leading to improved health and function in all aspects of daily living, both physical and mental.

Thanks for reading. Let me know if anyone has any questions about anything.

Jason

References

Blood Perfusion

• Ding, N., Jiang, J., Xu, A., Tang, Y. and Li, Z., 2019. Manual acupuncture regulates behavior and cerebral blood flow in the SAMP8 mouse model of Alzheimer’s disease. Frontiers in neuroscience, 13, p.37.
• Leszczynska, A., Ramm, L., Spoerl, E., Pillunat, L.E. and Terai, N., 2018. The short-term effect of acupuncture on different ocular blood flow parameters in patients with primary open-angle glaucoma: a randomized, clinical study. Clinical Ophthalmology (Auckland, NZ), 12, p.1285.
• Su, Z., Yuan, Y., Yu, M., Liu, Y., Klein, J.D. and Wang, X.H., 2018. Electrically stimulated acupuncture increases renal blood flow through exosome-carried miR-181. American Journal of Physiology-Renal Physiology, 315(6), pp.F1542-F1549.
• Pecchio, O., Martinelli, M., Lupi, G., Giardini, G., Caligiana, L., Bonin, S., Scalese, M., Salvetti, O., Moroni, D. and Bastiani, L., 2021. Acupuncture Effects on Cerebral Blood Flow during Normoxia and Normobaric Hypoxia: Results from a Prospective Crossover Pilot Study. Technologies, 9(4), p.102.
• Lee, H.K., Moon, S.K., Jin, C., Cho, S.Y., Park, S.U., Jung, W.S., Park, J.M., Ko, C.N., Cho, K.H. and Kwon, S., 2021. Effects of GV14 Acupuncture on Cerebral Blood Flow Velocity in the Basilar and Middle Cerebral Arteries and CO2 Reactivity during Hypercapnia in Normal Individuals. Evidence-Based Complementary and Alternative Medicine, 2021.
• Huang, A.C., Yeh, K.Y., Cheng, Y.Y., Dubey, N.K., Chiu, A.W. and Tsai, T.H., 2018. Investigation of interactive activity of electro-acupuncture on pharmacokinetics of sildenafil and their synergistic effect on penile blood flow in rats. International journal of molecular sciences, 19(8), p.2153.
• Venturini, M., Piacentino, F., Coppola, A., Recaldini, C., Pacetti, S., Fontana, F. and Vannucci, V., 2021. Early Increase in Retinal Arterial and Venous Blood Flow Velocities on Color Doppler Ultrasound after Acupuncture. Ultraschall in der Medizin-European Journal of Ultrasound.
• Zhang, L.L., Wang, Y.H., Song, X.L., Fan, X.N. and Wang, S., 2019. Effects of acupuncture on carotid intima-media thickness and cerebral blood flow velocity in patients with mild-to-moderate hypertension. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 39(7), pp.703-707.
• Wang, H., Zhao, M., Zhang, J., Yan, B., Liu, S., Zhao, F., Guo, J. and Wang, F., 2022. The Efficacy of Acupuncture on Patients with Erectile Dysfunction: A Review. Evidence-Based Complementary and Alternative Medicine, 2022.

Muscle Contraction

• Stojanovic, B., Svicevic, M., Kaplarevic-Malisic, A., Gilbert, R.J. and Mijailovich, S.M., 2020. Multi-scale striated muscle contraction model linking sarcomere length-dependent cross-bridge kinetics to macroscopic deformation. Journal of Computational Science, 39, p.101062.
• Senneff, S. and Lowery, M.M., 2021. Effects of extracellular potassium on calcium handling and force generation in a model of excitation-contraction coupling in skeletal muscle. Journal of Theoretical Biology, 519, p.110656.
• Carter, S. and Solomon, T.P., 2019. In vitro experimental models for examining the skeletal muscle cell biology of exercise: the possibilities, challenges and future developments. Pflügers Archiv-European Journal of Physiology, 471(3), pp.413-429.
• Michailowsky, V., Li, H., Mittra, B., Iyer, S.R., Mazála, D.A.G., Corrotte, M., Wang, Y., Chin, E.R., Lovering, R.M. and Andrews, N.W., 2019. Defects in sarcolemma repair and skeletal muscle function after injury in a mouse model of Niemann-Pick type A/B disease. Skeletal muscle, 9(1), pp.1-15.
• Stern, M.D., Pizarro, G. and Ríos, E., 1997. Local control model of excitation–contraction coupling in skeletal muscle. The Journal of general physiology, 110(4), pp.415-440.
• Rebbeck, R.T., Karunasekara, Y., Board, P.G., Beard, N.A., Casarotto, M.G. and Dulhunty, A.F., 2014. Skeletal muscle excitation–contraction coupling: who are the dancing partners?. The international journal of biochemistry & cell biology, 48, pp.28-38.
• Gong, G., Liu, X. and Wang, W., 2014. Regulation of metabolism in individual mitochondria during excitation–contraction coupling. Journal of molecular and cellular cardiology, 76, pp.235-246.
• Qaisar, R., Bhaskaran, S., Premkumar, P., Ranjit, R., Natarajan, K.S., Ahn, B., Riddle, K., Claflin, D.R., Richardson, A., Brooks, S.V. and Van Remmen, H., 2018. Oxidative stress‐induced dysregulation of excitation–contraction coupling contributes to muscle weakness. Journal of cachexia, sarcopenia and muscle, 9(5), pp.1003-1017.
• Hernández-Ochoa, E.O. and Schneider, M.F., 2018. Voltage sensing mechanism in skeletal muscle excitation-contraction coupling: coming of age or midlife crisis?. Skeletal muscle, 8(1), pp.1-20.
• Squire, J.M., 2016. Muscle contraction: Sliding filament history, sarcomere dynamics and the two Huxleys. Global cardiology science & practice, 2016(2).
• Rassier, D.E., 2017. Sarcomere mechanics in striated muscles: from molecules to sarcomeres to cells. American Journal of Physiology-Cell Physiology, 313(2), pp.C134-C145.
• Powers, J.D., Malingen, S.A., Regnier, M. and Daniel, T.L., 2021. The sliding filament theory since Andrew Huxley: multiscale and multidisciplinary muscle research. Annual review of biophysics, 50, pp.373-400.
• Nishikawa, K., Dutta, S., DuVall, M., Nelson, B., Gage, M.J. and Monroy, J.A., 2020. Calcium-dependent titin–thin filament interactions in muscle: observations and theory. Journal of Muscle Research and Cell Motility, 41(1), pp.125-139.

Pelvic Floor

• Ferri-Morales, A., 2018. Posterior tibial nerve stimulation in the treatment of fecal incontinence: a systematic review. Rev Esp Enferm Dig, 110(9), pp.577-588.
• Liu, B., Liu, Y., Qin, Z., Zhou, K., Xu, H., He, L., Li, N., Su, T., Sun, J., Yue, Z. and Zang, Z., 2019, January. Electroacupuncture versus pelvic floor muscle training plus solifenacin for women with mixed urinary incontinence: a randomized noninferiority trial. In Mayo Clinic Proceedings (Vol. 94, No. 1, pp. 54-65). Elsevier.
• Wang, Y., Zhishun, L., Peng, W., Zhao, J. and Liu, B., 2013. Acupuncture for stress urinary incontinence in adults. Cochrane Database of Systematic Reviews, (7).
• Itza, F., Zarza, D., Serra, L., Gomez-Sancha, F., Salinas, J. and Allona-Almagro, A., 2010. Myofascial pain syndrome in the pelvic floor: a common urological condition. Actas Urológicas Españolas (English Edition), 34(4), pp.318-326.
• Kalichman, L. and Vulfsons, S., 2010. Dry needling in the management of musculoskeletal pain. The Journal of the American Board of Family Medicine, 23(5), pp.640-646.
• Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S. and Perreault, T., 2014. Dry needling: a literature review with implications for clinical practice guidelines. Physical therapy reviews, 19(4), pp.252-265.
• Montenegro, M.L., Braz, C.A., Rosa-e-Silva, J.C., Candido-dos-Reis, F.J., Nogueira, A.A. and Poli-Neto, O.B., 2015. Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain. BMC anesthesiology, 15(1), p.175.
• Halle, J.S. and Halle, R.J., 2016. Pertinent dry needling considerations for minimizing adverse effects–part two. International journal of sports physical therapy, 11(5), p.810.
• Zhong, D., Tang, W., Geng, D. and He, C., 2019. Efficacy and safety of acupuncture therapy for urinary incontinence in women: A systematic review and meta-analysis. Medicine, 98(40).
• Zhang, Z., Wang, W., Song, Y., Zhai, T., Zhu, Y., Jiang, L., Li, Q., Jin, L., Li, K. and Feng, W., 2021. Immediate Effect of Dry Needling at Myofascial Trigger Point on Hand Spasticity in Chronic Post-stroke Patients: A Multicenter Randomized Controlled Trial. Frontiers in neurology, 12.
• Sheikhhoseini, R. and Arab, A.M., 2018. Dry needling in myofascial tracks in non-relaxing pelvic floor dysfunction: A case study. Journal of Bodywork and Movement Therapies, 22(2), pp.337-340.
• George, A., VanEtten, L. and Briggs, M., 2018. Dry Needling for Female Chronic Pelvic Pain: A Case Series. Journal of Women’s Health Physical Therapy, 42(1), pp.8-16.
• Lin, A., Abbas, H., Sultan, M. and Tzeng, T., 2022. A critical review of interventional treatments for myofascial pelvic pain.
• Bubnov, R. and Kalika, L., Dry needling of trigger points under ultrasound guidance effective to treat chronic pelvic pain and pelvic prolapse.
• Frederice, C.P., Brito, L.G.O., Pereira, G.M.V., Lunardi, A.L.B. and Juliato, C.R.T., 2021. Interventional treatment for myofascial pelvic floor pain in women: systematic review with meta-analysis. International Urogynecology Journal, 32(5), pp.1087-1096.
• Rajkannan, P. and Vijayaraghavan, R., 2019. Dry needling in chronic abdominal wall pain of uncertain origin. Journal of Bodywork and Movement Therapies, 23(1), pp.94-98.
• Alappattu, M., Hilton, S. and Bishop, M., 2019. An international survey of commonly used interventions for management of pelvic pain. Journal of women’s health physical therapy, 43(2), p.82.
• Bartley, J., Han, E., Gupta, P., Gaines, N., Killinger, K.A., Boura, J.A., Farrah, M., Gilleran, J., Sirls, L.T. and Peters, K.M., 2019. Transvaginal trigger point injections improve pain scores in women with pelvic floor hypertonicity and pelvic pain conditions. Female pelvic medicine & reconstructive surgery, 25(5), pp.392-396.
• Hastings, J. and Machek, M., 2020. Pelvic Floor Dysfunction in Women. Current Physical Medicine and Rehabilitation Reports, 8(2), pp.64-75.
• Bazzaz-Yamchi, M., Naghdi, S., Nakhostin-Ansari, A., Hadizadeh, M., Ansari, N.N., Moghimi, E. and Hasson, S., 2021. Acute and Short-Term Effects of Dry Needling in Patients with Chronic Nonspecific Low Back Pain and Hamstring Tightness: A Pilot Study. The Scientific World Journal, 2021.

Neural Plasticity

• Dommerholt, J., Mayoral del Moral, O. and Gröbli, C., 2006. Trigger point dry needling. Journal of Manual & Manipulative Therapy, 14(4), pp.70E-87E.
• Calvo, S., Navarro, J., Herrero, P., Del Moral, R., De Diego, C. and Marijuán, P.C., 2015. Electroencephalographic changes after application of dry needling [DNHS© technique] in two patients with chronic stroke. Myopain, 23(3-4), pp.112-117.
• Hsieh, Y.L., Yang, C.C., Liu, S.Y., Chou, L.W. and Hong, C.Z., 2014. Remote dose-dependent effects of dry needling at distant myofascial trigger spots of rabbit skeletal muscles on reduction of substance P levels of proximal muscle and spinal cords. BioMed Research International, 2014.
• Sollie, M., Pind, R., Madsen, C.B. and Sørensen, J.A., 2021. Acupuncture (superficial dry-needling) as a treatment for chronic postherpetic neuralgia–a randomized clinical trial. British Journal of Pain, p.20494637211023075.
• Ren, L., Zhang, W.A., Fang, N.Y. and Wang, J.X., 2008. The influence of electro-acupuncture on neural plasticity in acute cerebral infarction. Neurological research, 30(9), pp.985-989.
• Xiao, L.Y., Wang, X.R., Yang, Y., Yang, J.W., Cao, Y., Ma, S.M., Li, T.R. and Liu, C.Z., 2018. Applications of acupuncture therapy in modulating plasticity of central nervous system. Neuromodulation: Technology at the Neural Interface, 21(8), pp.762-776
• Lo, Y.L., Cui, S.L. and Fook-Chong, S., 2005. The effect of acupuncture on motor cortex excitability and plasticity. Neuroscience letters, 384(1-2), pp.145-149.
• Liu, C.Z., Kong, J. and Wang, K., 2017. Acupuncture therapies and neuroplasticity. Neural plasticity, 2017, p.6178505.
• Li, X. and Wang, Q., 2013. Acupuncture therapy for stroke patients. International review of neurobiology, 111, pp.159-179.
• Kong, J., Gollub, R., Huang, T., Polich, G., Napadow, V., Hui, K., Vangel, M., Rosen, B. and Kaptchuk, T.J., 2007. Acupuncture de qi, from qualitative history to quantitative measurement. The Journal of Alternative and Complementary Medicine, 13(10), pp.1059-1070.
• Lee, J.D., Chon, J.S., Jeong, H.K., Kim, H.J., Yun, M., Kim, D.Y., Kim, D.I., Park, C.I. and Yoo, H.S., 2003. The cerebrovascular response to traditional acupuncture after stroke. Neuroradiology, 45(11), pp.780-784.
• Yang, Y., Eisner, I., Chen, S., Wang, S., Zhang, F. and Wang, L., 2017. Neuroplasticity changes on human motor cortex induced by acupuncture therapy: a preliminary study. Neural plasticity, 2017.
• Jiang, H., Zhang, X., Wang, Y., Zhang, H., Li, J., Yang, X., Zhao, B., Zhang, C., Yu, M., Xu, M. and Yu, Q., 2017. Mechanisms underlying the antidepressant response of acupuncture via PKA/CREB signaling pathway. Neural Plasticity, 2017.
• Tang, H., Guo, Y., Zhao, Y., Wang, S., Wang, J., Li, W., Qin, S., Gong, Y., Fan, W., Chen, Z. and Guo, Y., 2020. Effects and Mechanisms of Acupuncture Combined with Mesenchymal Stem Cell Transplantation on Neural Recovery after Spinal Cord Injury: Progress and Prospects. Neural Plasticity, 2020.
• Lai, H.C., Chang, Q.Y. and Hsieh, C.L., 2019. Signal transduction pathways of acupuncture for treating some nervous system diseases. Evidence-Based Complementary and Alternative Medicine, 2019.
• Pirnia, B., Bazargan, N.M., Hamdieh, M., Pirnia, K., Malekanmehr, P., Maleki, F. and Zahiroddin, A., 2019. The Effectiveness of Auricular Acupuncture on the Levels of Cortisol in a Depressed Patient. Iranian journal of public health, 48(9), pp.1748-1750.
• Yang, J.W., Ye, Y., Wang, X.R., Li, F., Xiao, L.Y., Shi, G.X. and Liu, C.Z., 2017. Acupuncture attenuates renal sympathetic activity and blood pressure via beta-adrenergic receptors in spontaneously hypertensive rats. Neural plasticity, 2017.
• Ye, Y., Zhu, W., Wang, X.R., Yang, J.W., Xiao, L.Y., Liu, Y., Zhang, X. and Liu, C.Z., 2017. Mechanisms of acupuncture on vascular dementia—a review of animal studies. Neurochemistry international, 107, pp.204-210.
• Li, Y., Wang, Y., Liao, C., Huang, W. and Wu, P., 2017. Longitudinal brain functional connectivity changes of the cortical motor-related network in subcortical stroke patients with acupuncture treatment. Neural plasticity, 2017.
• Wang, T., Wu, L., Liao, D., Zhou, X., Chen, Y. and Takeda, A., 2002. Effect of acupuncture on the expression of NT3 in the process of spinal plasticity. Hua xi yi ke da xue xue bao= Journal of West China University of Medical Sciences= Huaxi yike daxue xuebao, 33(1), pp.46-49.
  Vagus Nerve Stimulation
• Sprouse-Blum, A.S., Smith, G., Sugai, D. and Parsa, F.D., 2010. Understanding endorphins and their importance in pain management. Hawaii medical journal, 69(3), p.70.
• Usichenko, T.I., Dinse, M., Hermsen, M., Witstruck, T., Pavlovic, D. and Lehmann, C., 2005. Auricular acupuncture for pain relief after total hip arthroplasty–a randomized controlled study. Pain, 114(3), pp.320-327.
• Usichenko, T.I., Kuchling, S., Witstruck, T., Pavlovic, D., Zach, M., Hofer, A., Merk, H., Lehmann, C. and Wendt, M., 2007. Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial. Cmaj, 176(2), pp.179-183.
• Jaić, K.K., Turković, T.M., Pešić, M., Djaković, I., Košec, V. and Košec, A., 2019. Auricular acupuncture as effective pain relief after episiotomy: a randomized controlled pilot study. Archives of gynecology and obstetrics, 300(5), pp.1295-1301
• Taylor, S.L., Giannitrapani, K.F., Ackland, P.E., Thomas, E.R., Federman, D.G., Holliday, J.R., Olson, J., Kligler, B. and Zeliadt, S.B., 2021. The Implementation and Effectiveness of Battlefield Auricular Acupuncture for Pain. Pain Medicine.
• Shah, A.N., Moore, C.B. and Brigger, M.T., 2020. Auricular acupuncture for adult tonsillectomy. The Laryngoscope, 130(8), pp.1907-1912.
• Garner, B.K., Hopkinson, S.G., Ketz, A.K., Landis, C.A. and Trego, L.L., 2018. Auricular acupuncture for chronic pain and insomnia: a randomized clinical trial. Medical acupuncture, 30(5), pp.262-272.
• Kang, H.R., Lee, Y.S., Kim, H.R., Kim, E.J., Kim, K.H., Kim, K.S., Jung, C.Y. and Lee, J.K., 2017. A clinical study of electroacupuncture and auricular acupuncture for abdominal pain relief in patients with pancreatitis: A pilot study. Korean Journal of Acupuncture, 34(1), pp.47-55.
• Moura, C.D.C., Chaves, E.D.C.L., Cardoso, A.C.L.R., Nogueira, D.A., Azevedo, C. and Chianca, T.C.M., 2019. Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis. Revista da Escola de Enfermagem da USP, 53.
• Tsai, S.L., Fox, L.M., Murakami, M. and Tsung, J.W., 2016. Auricular acupuncture in emergency department treatment of acute pain. Annals of emergency medicine, 68(5), pp.583-585.
• Yeh, C.H., Chiang, Y.C., Hoffman, S.L., Liang, Z., Klem, M.L., Tam, W.W., Chien, L.C. and Suen, L.K.P., 2014. Efficacy of auricular therapy for pain management: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2014.
• Sator-Katzenschlager, S.M., Szeles, J.C., Scharbert, G., Michalek-Sauberer, A., Kober, A., Heinze, G. and Kozek-Langenecker, S.A., 2003. Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study. Anesthesia & Analgesia, 97(5), pp.1469-1473.
• Usichenko, T.I., Lehmann, C. and Ernst, E., 2008. Auricular acupuncture for postoperative pain control: a systematic review of randomised clinical trials. Anaesthesia, 63(12), pp.1343-1348.
• Johnson, R.L. and Wilson, C.G., 2018. A review of vagus nerve stimulation as a therapeutic intervention. Journal of inflammation research, 11, p.203.

Neurologic Conditions, Including TBI & CVA

• Ghayour Najafabadi, M., Shariat, A., Dommerholt, J., Hakakzadeh, A., Nakhostin-Ansari, A., Selk-Ghaffari, M., Ingle, L. and Cleland, J.A., 2021. Aquatic Therapy for improving Lower Limbs Function in Post-stroke Survivors: A Systematic Review with Meta-Analysis. Topics in Stroke Rehabilitation, pp.1-17.
• Pourahmadi, M., Dommerholt, J., Fernández-de-Las-Peñas, C., Koes, B.W., Mohseni-Bandpei, M.A., Mansournia, M.A., Delavari, S., Keshtkar, A. and 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), p.pzab068.
• Fernández-de-Las-Peñas, C., Pérez-Bellmunt, A., Llurda-Almuzara, L., Plaza-Manzano, G., De-la-Llave-Rincón, A.I. and Navarro-Santana, M.J., 2021. Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis. Pain Medicine, 22(1), pp.131-141.
• Sánchez-Mila, Z., Salom-Moreno, J. and Fernández-de-Las-Peñas, C., 2018. Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial. Acupuncture in Medicine, 36(6), pp.358-366.
• Mendigutia-Gómez, A., Martín-Hernández, C., Salom-Moreno, J. and Fernández-de-Las-Peñas, C., 2016. Effect of dry needling on spasticity, shoulder range of motion, and pressure pain sensitivity in patients with stroke: A crossover study. Journal of manipulative and physiological therapeutics, 39(5), pp.348-358.
• Mendigutía-Gómez, A., Quintana-García, M.T., Martín-Sevilla, M., de Lorenzo-Barrientos, D., Rodríguez-Jiménez, J., Fernández-de-Las-Peñas, C. and Arias-Buría, J.L., 2020. Post-needling soreness and trigger point dry needling for hemiplegic shoulder pain following stroke. Acupuncture in Medicine, 38(3), pp.150-157.
• Valencia-Chulián, R., Heredia-Rizo, A.M., Moral-Munoz, J.A., Lucena-Anton, D. and Luque-Moreno, C., 2020. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review. Complementary Therapies in Medicine, 52, p.102515.
• Calvo, S., Navarro, J., Herrero, P., Del Moral, R., De Diego, C. and Marijuán, P.C., 2015. Electroencephalographic changes after application of dry needling [DNHS© technique] in two patients with chronic stroke. Myopain, 23(3-4), pp.112-117.
• Cuenca Zaldívar, J.N., Calvo, S., Bravo-Esteban, E., Oliva Ruiz, P., Santi-Cano, M.J. and Herrero, P., 2020. Effectiveness of dry needling for upper extremity spasticity, quality of life and function in subacute phase stroke patients. Acupuncture in Medicine, p.0964528420947426.
• Hernández-Ortíz, A.R., Ponce-Luceño, R., Sáez-Sánchez, C., García-Sánchez, O., Fernández-de-Las-Peñas, C. and de-la-Llave-Rincón, A.I., 2020. Changes in muscle tone, function, and pain in the chronic hemiparetic shoulder after dry needling within or outside trigger points in stroke patients: A crossover randomized clinical trial. Pain Medicine, 21(11), pp.2939-2947.
• Tavakol, Z., Shariat, A., Ansari, N.N., Ghannadi, S., Honarpishe, R., Dommerholt, J., Noormohammadpour, P. and Ingle, L., 2021. A Double-blind Randomized Controlled Trial for the Effects of Dry Needling on Upper Limb Dysfunction in Patients with Stroke. Acupuncture & Electro-Therapeutics Research, 45(2-3), pp.115-124.
• Ghaffari, M.S., Shariat, A., Honarpishe, R., Hakakzadeh, A., Cleland, J.A., Haghighi, S. and Barghi, T.S., 2019. Concurrent effects of dry needling and electrical stimulation in the management of upper extremity hemiparesis. Journal of acupuncture and meridian studies, 12(3), pp.90-94.
• Ghannadi, S., Shariat, A., Ansari, N.N., Tavakol, Z., Honarpishe, R., Dommerholt, J., Noormohammadpour, P. and Ingle, L., 2020. The effect of dry needling on lower limb dysfunction in poststroke survivors. Journal of Stroke and Cerebrovascular Diseases, 29(6), p.104814.
• Bynum, R., Garcia, O., Herbst, E., Kossa, M., Liou, K., Cowan, A. and Hilton, C., 2021. Effects of dry needling on spasticity and range of motion: a systematic review. American Journal of Occupational Therapy, 75(1), pp.7501205030p1-7501205030p13.
• DiLorenzo, L., Traballesi, M., Morelli, D., Pompa, A., Brunelli, S., Buzzi, M.G. and Formisano, R., 2004. Hemiparetic shoulder pain syndrome treated with deep dry needling during early rehabilitation: a prospective, open-label, randomized investigation. Journal of Musculoskeletal Pain, 12(2), pp.25-34.
• Carusotto, A.F., Hakim, R.M., Oliveira, R.G., Piranio, A., Coughlan, C.P. and MacDonald, T.J., 2021. Effects of dry needling on muscle spasticity in adults with neurological disorders: a systematic review. Physical Therapy Reviews, pp.1-6.
• Sánchez-Mila, Z., Salom-Moreno, J. and Fernández-de-Las-Peñas, C., 2018. Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial. Acupuncture in Medicine, 36(6), pp.358-366.
• Salom-Moreno, J., Sánchez-Mila, Z., Ortega-Santiago, R., Palacios-Ceña, M., Truyol-Domínguez, S. and Fernández-de-las-Peñas, C., 2014. Changes in spasticity, widespread pressure pain sensitivity, and baropodometry after the application of dry needling in patients who have had a stroke: A randomized controlled trial. Journal of manipulative and physiological therapeutics, 37(8), pp.569-579.
• Valencia-Chulián, R., Heredia-Rizo, A.M., Moral-Munoz, J.A., Lucena-Anton, D. and Luque-Moreno, C., 2020. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review. Complementary Therapies in Medicine, 52, p.102515.
• Núñez-Cortés, R., Cruz-Montecinos, C., Latorre-García, R., Pérez-Alenda, S. and Torres-Castro, R., 2020. Effectiveness of Dry Needling in the Management of Spasticity in Patients Post Stroke. Journal of Stroke and Cerebrovascular Diseases, 29(11), p.105236.
• Bynum, R., Garcia, O., Herbst, E., Kossa, M., Liou, K., Cowan, A. and Hilton, C., 2021. Effects of dry needling on spasticity and range of motion: a systematic review. American Journal of Occupational Therapy, 75(1), pp.7501205030p1-7501205030p13.

Electrical Needling

• Dunning, J., Butts, R., Henry, N., Mourad, F., Brannon, A., Rodriguez, H., Young, I., Arias-Buría, J.L. and Fernández-de-Las-Peñas, C., 2018. Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial. PloS one, 13(10), p.e0205405.
• Dunning, J., Butts, R., Zacharko, N., Fandry, K., Young, I., Wheeler, K., Day, J. and Fernández-de-Las-Peñas, C., 2021. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. The Spine Journal, 21(2), pp.284-295.
• Ghaffari, M.S., Shariat, A., Honarpishe, R., Hakakzadeh, A., Cleland, J.A., Haghighi, S. and Barghi, T.S., 2019. Concurrent effects of dry needling and electrical stimulation in the management of upper extremity hemiparesis. Journal of acupuncture and meridian studies, 12(3), pp.90-94.
• Brennan, K., Elifritz, K.M., Comire, M.M. and Jupiter, D.C., 2021. Rate and maintenance of improvement of myofascial pain with dry needling alone vs. dry needling with intramuscular electrical stimulation: a randomized controlled trial. Journal of Manual & Manipulative Therapy, 29(4), pp.216-226.
• Fernández-Carnero, J., 2021. Effectiveness of Dry Needling with Percutaneous Electrical Nerve Stimulation of High Frequency Versus Low Frequency in Patients with Myofascial Neck Pain. Pain physician, 24, pp.135-143.
• WALSH, S., GOULT, C. and GILLETT, B., 2021. Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. journal of orthopaedic & sports physical therapy, 51(2), p.73.
• Dunning, J., 2019. Effectiveness of Electrical Dry Needling for Lower Extremity Pain Disorders.
• Hadizadeh, M., Tajali, S.B., Moghadam, B.A., Jalaei, S. and Bazzaz, M., 2022. Effects of Intramuscular Electrical Stimulation through Dry Needling on Pain and Dysfunction Following Trigger Points in Upper Trapezius Muscle: A Double-blind Randomized Controlled Trial. Journal of Modern Rehabilitation.
• Ahmed, A.F., Elgayed, S.S. and Ibrahim, I.M., 2012. Polarity effect of microcurrent electrical stimulation on tendon healing: biomechanical and histopathological studies. Journal of Advanced Research, 3(2), pp.109-117.
• Yazdan-Shahmorad, A., Kipke, D.R. and Lehmkuhle, M.J., 2011. Polarity of cortical electrical stimulation differentially affects neuronal activity of deep and superficial layers of rat motor cortex. Brain stimulation, 4(4), pp.228-241.
• Gentzkow, G.D., 1993. Electrical stimulation to heal dermal wounds. The Journal of dermatologic surgery and oncology, 19(8), pp.753-758.
• Hayashi, K. and Ninjouji, T., 2004, September. Two-point discrimination threshold as a function of frequency and polarity at fingertip by electrical stimulation. In The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (Vol. 2, pp. 4256-4259). IEEE.
• Demir, H., Balay, H. and Kirnap, M., 2004. A comparative study of the effects of electrical stimulation and laser treatment on experimental wound healing in rats. Journal of rehabilitation Research & development, 41(2).
• Balakatounis, K.C. and Angoules, A.G., 2008. Low-intensity electrical stimulation in wound healing: review of the efficacy of externally applied currents resembling the current of injury. Eplasty, 8.
• Ashrafi, M., Alonso‐Rasgado, T., Baguneid, M. and Bayat, A., 2016. The efficacy of electrical stimulation in experimentally induced cutaneous wounds in animals. Veterinary dermatology, 27(4), pp.235-e57.
• Krause, B. and Cohen Kadosh, R., 2014. Not all brains are created equal: the relevance of individual differences in responsiveness to transcranial electrical stimulation. Frontiers in systems neuroscience, 8, p.25.
• Asadi, M.R., Torkaman, G. and Hedayati, M., 2011. Effect of sensory and motor electrical stimulation in vascular endothelial growth factor expression of muscle and skin in full-thickness wound. J Rehabil Res Dev, 48(3), pp.195-201.
• Deriu, F., Tolu, E. and Rothwell, C., 2003. A short latency vestibulomasseteric reflex evoked by electrical stimulation over the mastoid in healthy humans. The Journal of physiology, 553(1), pp.267-279.
• Wang, J., Wang, H., Thakor, N.V. and Lee, C., 2019. Self-powered direct muscle stimulation using a triboelectric nanogenerator (TENG) integrated with a flexible multiple-channel intramuscular electrode. ACS nano, 13(3), pp.3589-3599.
• Nussbaum, E.L., Houghton, P., Anthony, J., Rennie, S., Shay, B.L. and Hoens, A.M., 2017. Neuromuscular electrical stimulation for treatment of muscle impairment: critical review and recommendations for clinical practice. Physiotherapy Canada, 69(5), pp.1-76.
• Asadi, M.R. and Torkaman, G., 2014. Bacterial inhibition by electrical stimulation. Advances in wound care, 3(2), pp.91-97.
• Snyder, A.R., Perotti, A.L., Lam, K.C. and Bay, R.C., 2010. The influence of high-voltage electrical stimulation on edema formation after acute injury: a systematic review. Journal of sport rehabilitation, 19(4), pp.436-451.
• Feger, M.A., Goetschius, J., Love, H., Saliba, S.A. and Hertel, J., 2015. Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review. Physical Therapy in Sport, 16(4), pp.361-369.
• Hamid, S. and Hayek, R., 2008. Role of electrical stimulation for rehabilitation and regeneration after spinal cord injury: an overview. European Spine Journal, 17(9), pp.1256-1269.
• Reilly, J.P., 2012. Applied bioelectricity: from electrical stimulation to electropathology. Springer Science & Business Media.
• Gordon, T., Amirjani, N., Edwards, D.C. and Chan, K.M., 2010. Brief post-surgical electrical stimulation accelerates axon regeneration and muscle reinnervation without affecting the functional measures in carpal tunnel syndrome patients. Experimental neurology, 223(1), pp.192-202.
• Hwang, I.H. and Thompson, J.M., 2001. The effect of time and type of electrical stimulation on the calpain system and meat tenderness in beef longissimus dorsi muscle. Meat science, 58(2), pp.135-144.