Dry Needling, Pneumothorax & Infection: Risk vs Reward

Summary:
If properly trained in needling, there is almost zero risk of pneumothorax and infection. I have been needling for almost 10 years, have put hundreds of thousands of needles into people, and have never had a negative experience. What I have observed, however, are consistent, mind-bogglingly awesome results for a wide variety of impairments.

Dry needling, if properly trained, is super safe and effective. It is, without question, the most powerful tool physical therapists (PT’s) have at their disposal to improve all impairments. There is no medical condition that does not benefit from improved autonomic nervous system (ANS) homeostasis (that I know of), and thoughtful needling regulates the ANS towards homeostasis. However, many medical doctors (MD’s) and other medical professionals who refer patients to PT's, are unfamiliar with dry needling and are understandably, although unduly, concerned with the risk of pneumothorax and infection. In relation to needling, infection is typically the primary concern of physicians following surgery.

Related: Click here to read my blog on "Dry Needling Scar Tissue to Regulate the Autonomic Nervous System & Improve Health"

Needling & Infection Following Surgery

Needling reduces the risk of infection following surgery. Yes, I meant to say that. Needling reduces the risk of infection following surgery. When you take a step back and think about the needle itself, and the neurophysiologic responses induced by needling, this is not surprising.

The typical needle I use is 0.2 mm in diameter. It is a solid, sterile piece of surgical steel. It does not take a piece of skin into the underlying tissue like a hollow needle does. Studies have been performed to see the amount of infectious causing material one of these needles can bring into the body, and it is orders of magnitude less than the smallest amount needed to potentially cause an infection. The reason for this is one of the reasons why you don't get constant infections from paper cuts and other stuff like that. It basically never happens. The improved immune function stimulated by thoughtful needling far outweighs any minuscule increased risk of infection simply utilizing a needle entails.

The overall effect of needling is a reduction of sympathetic autonomic (SANS) activity and elevation of parasympathetic autonomic (PANS) activity. This happens almost regardless of how you needle. If you specifically target the PANS, along with whatever else you are treating, this homeostatic ANS response is significantly strengthened. Remember, trauma, which is what surgery is, causes SANS hyperactivity.

Evolutionarily speaking, SANS hyperactivity (including our fight-or-flight response) evolved to help protect our bodies from further immediate damage. A bunch of epinephrine, cortisol, cytokines, and other neuropeptides / hormones are released from the hypothalamic-pituitary-adrenal (HPA) axis. The enteric nervous system malfunctions, peripheral vasoconstriction and hypoxia ensues, and our muscles get tight to prevent further tissue damage. This inhibits ideal healing and it hurts! Especially considering we are typically in a safe and controlled environment following surgery and are not in immediate threat of further injury. If this immediate SANS hyperactive response is not controlled, negative autonomic feedback loops begin to form, leading to all sorts of issues. Increased risk of infection being one of them.

The gut-brain axis (enteric nervous system & brain) and the HPA axis play huge roles in regulating and improving immune function. Following surgery, both of these axes become dysfunctional. Employing thoughtful needling, specifically targeting the PANS, reduces SANS hyperactivity and nudges the ANS toward homeostasis. ANS homeostasis allows maximal function of the HPA and gut-brain axes, improving immune system response and reducing the risk of infection following surgery.

The local neurophysiologic effects of implementing needling treatments relatively close to surgical repairs, immediately following surgery, reduces the risk of infection. Following surgery, there is good blood flowing to the surgical site, but not flowing through the surgical site. Super tight muscles can restrict veinous blood flow. Veins don’t have thick walls like arteries do, so they can get squished. This squishing, from muscle contraction, is a primary way blood gets returned to the heart, along with the one-way valves inside veins. This is sometimes referred to as “milking veins.”

If muscles produce trigger points and become hypertonic, as they do following surgery, the squishiness of veins is their downfall. Weaklings! Muscles compress them and blood flow slows down. Then, rather than muscles contracting and relaxing, you just have grumpy, contracted, hypoxic, rigid muscles. This leads to decreased venous blood flow. This is one of the reasons edema and swelling occur, along with peripheral vasoconstriction secondary to SANS hyperactivity.

Hypoxia and poor blood flow through a surgical site increase the risk of infection. Stagnant, old blood that gets stuck in tissues near surgical sites does not have healthy white blood cells or other nutrients to fight off infection. Needling stimulates significant increases in vascular and microvascular circulation via vasodilation, secondary to SANS depression, PANS elevation, calcitonin-gene-related-peptide release (a potent microvascular dilator), sarcomere relaxation, and other known and unknown processes.

Trigger points are hypercontracted groups of sarcomeres (muscle cells) that can occlude just about all blood flowing through them. This leads to a buildup of pain amplifying and potentially infectious agents. Like infection ninjas... Trigger points also shorten muscles. Short muscles hurt, causing more SANS hyperactivity and vasoconstriction, hindering HPA and gut-brain axis function, harming our immune systems, and increasing the likelihood of infection. Needling is the best way that exists on the planet to rapidly and effectively remove trigger points and normalize muscle length, thus regulating the ANS toward homeostasis, or vis versa, reducing the risk of infection following surgery.

Dry Needling & Pneumothorax

If properly trained, the risk of needle-induced pneumothorax is basically zero. Again, I have placed hundreds of thousands of needles into people without ever having any type of negative experience, infection and pneumothorax included. The primary reason for needle-induced pneumothorax is error in judgment. Trying to do something you should not, without the assistance of imaging guidance. This makes not causing a pneumothorax super easy. Don’t try to do things you shouldn’t. I know that sounds kinda dumb, but it really is true. The trick is, however, understanding what you shouldn’t do in the first place.

There are a few rules of thumb to go by when needling over the pleural field, and if these are followed, you will never have a problem. Osteopaths have done some really cool studies looking at things like the average vertebral size in the pleural field and how far it is on average from the surface of the skin to the surface of the pleura. Along with a few technical instructions, simply understanding the typical and atypical anatomy of the plural field and utilizing solid judgment on an individual patient basis, allows you to needle over the pleural field with as close to a zero percent chance of pneumothorax as possible.

If you would like to learn these techniques, let me know and we will get you signed up for a course. Thanks.

Intricate Art Spine & Body Solutions and its affiliates are not responsible for any injury or damage that may result from the use of techniques taught or information being provided. This content is provided for informational purposes only and by participating you are doing so at your own risk.

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