The two types of things I really like to read are scientific/medical literature and fantasy books. The more awesome magic and world building, the better. In the fantasy books, that is. A few of my favorite authors are Steven Erikson, Brandon Sanderson, and Robert Jordan. The things I see on a consistent basis when treating patients with the combination of dry needling (DN) and manipulation, however, consistently make me more and more certain that some serious sorcery is taking place, right here on earth.

Check out my blog on sclerotomal quantum entanglement for more on real world magic.

Now, before you write me off as crazy (I’m not by the way, my mom had me tested), allow me to describe to you some of the limited knowledge we currently possess on the wonderous and magical ways DN and manipulation reduce post-operative narcotic intake, reduce healing times, and improve overall patient outcomes.

There is so much we do not understand about the human mind and body. If we could somehow quantify all the medical knowledge available out there in the ether or wherever it is, I bet we know less than 5% of the total. This is exciting! There are so many mind-bogglingly awesome things to discover. The regulatory and homeostatic neurophysiologic changes thoughtful needling and manipulation induce are nothing short of extraordinary. Currently, my main interest is the homeostatic effect of needling on the autonomic nervous system (ANS) and the processes by which that homeostatic effect occurs. Specifically, the effects on the hypothalamic-pituitary-adrenal (HPA) axis and enteric nervous system, part of the gut-brain axis, which are both part of the ANS.

Dry needling to reduce post-operative opioid intake

Recent studies have shown that needling can reduce opioid intake post-operatively by up to 50%, with many patients completely discontinuing use. This has been seen in both morphine and fentanyl use. Now listen, I know research studies on this are limited, however, that does not mean they do not hold water. Research to include high level studies are extremely costly and sadly the funds tend to go to pharmaceutical companies whom financially benefit on the end product. There is more tied into the pharmaceutical world than I will dive into, however, there does appear to be a trend in regards to fewer studies on treatments that are hollistic and highly effective. Especially if there is little to no profit to be made from those treatments. Needless to say, any non-pharmaceutical intervention that drastically reduces opioid use is going to be memory-holed, deemed as quackery, and forgotten, ASAP.

Examples of Positive Dry Needling Outcomes: Neuropathy.

Let me give you a real-world example I am currently experiencing with a new patient of mine. This is so freakin cool. This dude randomly read one of my blogs online and was in such bad shape and in so much pain that he and his wife decided to fly out to Nebraska to see if my proclamations of magical healing abilities were for real. Suckers!! Ha, ha, ha… This guy had a lumbar fusion about a year and a half ago to fix left leg neuropathy. He is one of the few lucky ones that had excellent results. Following surgery, he was hiking, walking the dog, traveling, just enjoying life, pain-free. He is in great shape. About a year ago, he got shingles in the left gluteal region. After the visible shingles went away, he began to experience increasingly severe nerve and muscle pain from his left glutes to his left foot. 6 months ago, his pain got so severe that he could only get around in a wheelchair. Walking for 30 seconds caused him debilitating pain. He was prescribed a ton of different medicines, including powerful narcotics, none of which provided any significant relief.

When I first saw him 2 weeks ago, his life was in shambles. In the space of a year, he had gone from a normal, healthy, active person to a cripple. He was hopeless. And it’s no wonder. He had tried everything.

The traditional treatment suggested by doctors provided no significant results:

• Gabapentin
• Oxycontin
• Morphine
• Massage

…nothing made a dent. The combination of mental and physical distress emanating from him was palpable. It was like a chaotic energy field engulfing his entire being.

The treatment I suggested: I have treated him with:

• electrical dry needling and manipulation 3x in the past 2 weeks.

The results from dry needling + manipulation: His pain is 90% gone, and I took him for a mile-long walk with my dogs the other day with zero issues, aside from slight muscle soreness.

So, you see, like I mentioned earlier, magical sorcery. How else could this drastic, positive change occur? A year of excruciating pain and disability, basically fully resolved, without medication, in 3 days.

This is not an uncommon result, in any sense of the imagination, if proper and thoughtful needling combined with manipulation are employed.

Why Dry Needing + Spinal Manipulation Reduce Post-Operative Narcotic Intake + Improve Patient Outcomes

The underlying mechanism by which this magic occurs is ANS homeostasis, typically, depressing the sympathetic ANS (SANS) and elevating the parasympathetic portion of the ANS (PANS). Inducing ANS homeostasis is absolutely vital to solving 100% of all medical ailments. Remember: Most patients we see in physical-therapy-land have SANS hyperactivity, and just about all post-operative patients have SANS hyperactivity. So, depressing sympathetic activity is good. Doing this leads the ANS to homeostasis.

Aside from the mechanical regulatory effects of restoring normal anatomical muscle and joint orientation which, by itself, nudges the ANS toward homeostasis, directly targeting the PANS with needles and manipulation induces improved epigenetic regulation. This is a cutting-edge area of medical research that is providing extremely promising results in real-time. The epigenome controls how our DNA is expressed and how our cells are regulated. It includes newly discovered substances naturally occurring in our bodies such as exosomes and silent information regulators, specifically sirtuin-6. Sirtuin-6 helps reprogram old, damaged DNA to repair and restore senescent cells to a youthful stage, fighting all types of disease. Our body does not produce and express sirtuin-6 in proper quantities if our nervous systems are off kilter. Thoughtful needling and manipulation bring the nervous systems toward homeostasis, allowing the body to do what it wants to do most: Be healthy.

An example of epigenomic dysfunction is Parkinson’s disease, where the alpha synuclein protein becomes misfolded and ends up in the brain, causing problems. Basically, the instructions that DNA provides to produce certain substances gets messed up. One form of Parkinson’s starts in the gut, travels up the vagus nerve (the primary ANS nerve), and enters the brain. As far as we know, this is, on a causative level, an epigenome malfunction, leading to DNA transcription errors. This happens secondary to an error in reading DNA, like having a scratch in a CD. It’s like translating a short story into another language, but you forget a certain word and just guess. This is, more or less, what happens when our epigenome malfunctions. DNA instructions get read incorrectly and weird stuff gets produced. ANS homeostasis helps prevent these issues from occurring.

ANS homeostasis has profound known, and as yet undiscovered, physiologic benefits, including facilitation of post-operative recovery. Thoughtful needling entices the ANS toward homeostasis via numerous methods, including but not limited to inducing neural plasticity, which regulates hormone production epigenetic expression. Epigenetics are the instructions DNA needs to make the right stuff and make it correctly, taking our body toward equilibrium. This is so cool. Our actual genes are only responsible for about 20% of what actually happens. This is called the Missing Heritability Problem by many. What controls the other 80% or so? Scientists now believe the epigenome, along with other less-known systems such as the endocannabinoid system, play a large role in the actual expression of our genes and overall health. Lots of neat research on things like exosomes is shedding light on how this all works and is leading to amazing medical advances. Again, needling and manipulation don’t sound as cool as injecting exosomes, and it doesn’t seem like they could possibly make that big a difference, but they do.

The best trick to reducing post-operative narcotic intake and improve surgical outcomes is to nudge our bodily systems to do what they typically do, but better, regulating chemicals like endogenous opioids and pro-inflammatory peptides (TNF-a, IL-6) to improve and facilitate the innate human ability to heal. This methodology of scientific intervention is leading to real-world, super-power-like-miracles. Our bodies have an incredible ability to heal if given a little help and the ideal circumstances. Check out Dr. David Sinclair’s work at Harvard Medical School to read about some insane new medical treatments, including curing blindness and complete spinal cord severing in mice (human trials are also ongoing and have shown stunningly positive results thus far). A lot of what he is accomplishing is based on using the body’s own awesome abilities to heal. Thoughtful needling and manipulation also stimulate this healing ability.

Auditory stimulation at certain frequencies induces various neurologic responses. For example, 40 Hz auditory stimulation induces increased attention and focus via epinephrine and dopamine release. This is typically not the goal of my treatments, as the majority of my patients already have sympathetic hyperactivity. Low frequency stimulation (1-5 Hz) induces relaxation, SANS depression, and PANS elevation via serotonin and beta endorphin release from the HPA and gut-brain axes, along with suppression of pro-inflammatory substances such as tumor necrosis factor alpha (TNF-a) and interlukin-6 (IL-6), guiding the ANS toward homeostasis. I posit, this neurophysiologic response is more strongly elicited by inducing the pulsatile rhythm through monofilament needles in the concha of the ears (auricular branch of the vagus nerve). Aside from stimulating the vagus nerve, the actual pulsin sound you hear reduces pain, reduces post-operative narcotic intake, and improves recovery time and quality. Vagus nerve stimulation has been shown in a huge amount of research to be a powerful tool to reduce pain. Why is it not more common, especially doing it non-invasively by needling the ear? It’s cheap and effective, that’s why.

Our bodies have built in fail-safe systems by which we can stimulate and/or inhibit various pathways. The trick is learning to understand the signs and translate a variety of markers into an overall picture, to properly treat whatever is going on. The reason we react to things like fentanyl is because we already have receptors that react to opioids because our body has a built-in painkiller system. Needling combined with manipulation, targeting the PANS, amplifies the release of our endogenous opioids (beta-endorphin, in particular), reducing the necessity for exogenous opioids (fentanyl) along with the coinciding risk of addiction and other negative side effects of narcotics, like death.

As far as I know, most of the painkillers in typical use act by blocking, masking, facilitating, or inhibiting various pain pathways throughout our bodies. They are band-aids. They don’t actually address the underlying cause for the pain; they simply act on certain pathways which, by the way, we know appallingly little about. Again, pharmaceutical companies absolutely hate any treatment that effectively addresses the root cause of pain or any other issue, for that matter. Like needling and manipulation. Remember, people, we have a sick-care system, not a health care system.

Needling in combination with manipulation addresses the underlying cause and more superficial causes of pain. This includes addressing muscle shortening, abnormal tissue tension, abnormal hormonal concentrations, and nervous systems dysfunction. Tight musculature and abnormal joint position can cause the most excruciating pain known to man. Not directly, but indirectly, via nervous system malfunction, chemically amplified pain, etc. This is a poorly understood fact in much of the medical field. I do not enjoy hearing other medical professionals simply write off patient complaints of discomfort as being “all in your head,” like they are inventing it. Inventing pain is totally possible, but it does not make the pain any less real to the person feeling it. This results in medical professionals either not taking the time to figure out the underlying cause of the pain or not seeing the benefit. Of course, the pain is in your head. Ever met anyone in pain with a dead brain? Anyone? Pain can absolutely be invented in the brain, and it is absolutely real. Now, post-surgery, we obviously know that having our body cut apart and put back together hurts. However, the cutting part is not what actually hurts. It is the nervous system response to the cutting that creates the sensation of pain.

For all the surgeons out there, I know you guys have been totally screwed over by the government cracking down on ALL opioid scripts, regardless of whether you shattered your pelvis, stubbed your toe, or are simply addicted. I love getting patients with serious surgeries who have been prescribed like 2 days worth of painkillers because that is all the MD’s are allowed to give. It’s not like being in excruciating pain following surgery hinders outcomes, right? Pain, sympathetic elevation, vasoconstriction, tight muscles, tissue hypoxia, chemically induced pain, hyperalgesia, allodynia, and the negative feedback loop continues…

Properly performed needling and manipulation safely address all causes of post-operative pain, from tight muscles, joints and tissues, to nervous system dysregulation, central sensitization, hyperalgesia, allodynia, psychologically induced pain, etc. This is why all surgeons should have competent people to needle and manipulate all their post-surgical patients day 1 post-op (obviously you are not going to manipulate a fused spinal segment or a newly repaired elbow, but manipulating what is safe and possible, to anatomic neutral, has awesome mechanical and physiologic benefits). Needling should be performed as acutely as possible following surgery to stop the negative feedback loop mentioned above from starting or from going out of control, at least. I have never met a patient whose pain and post-operative recovery can’t be significantly improved with manipulation and needling, if performed properly. This is via both known and unknown pathways; however, the bottom line is, it works. I’ll go so far as to say that if performed properly, there is no better treatment that exists on planet earth, currently, to safely reduce post-operative pain and narcotic intake while at the same time improving healing time, quality of life, and overall patient outcomes than electrical dry needling combined with manipulation.

References

Rhythmic Auditory Atimulation to Regulate the Nervous Systems

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Neural Plasticity

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B-endorphin

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Enteric Nervous System, Gut-Brain Axis

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• Vagus Nerve Stimulation
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• 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

• 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.

Orthopedic Conditions

• Clark, N.G., Hill, C.J., Koppenhaver, S.L., Massie, T. and Cleland, J.A., 2021. The effects of dry needling to the thoracolumbar junction multifidi on measures of regional and remote flexibility and pain sensitivity: A randomized controlled trial. Musculoskeletal Science and Practice, 53, p.102366.
• Navarro-Santana, M.J., Gómez-Chiguano, G.F., Cleland, J.A., Arias-Buría, J.L., Fernández-de-Las-Peñas, C. and 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), p.pzaa216.
• Ma, Y.T., Li, L.H., Han, Q., Wang, X.L., Jia, P.Y., Huang, Q.M. and Zheng, Y.J., 2020. Effects of trigger point dry needling on neuromuscular performance and pain of individuals affected by patellofemoral pain: a randomized controlled trial. Journal of Pain Research, 13, p.1677.
• 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.
• Haser, C.H.R.I.S.T.I.A.N., Stöggl, T.H.O.M.A.S., Kriner, M.O.N.I.K.A., Mikoleit, J., Wolfahrt, B., Scherr, J., Halle, M. and Pfab, F., 2017. Effect of dry needling on thigh muscle strength and hip flexion in elite soccer players. Med Sci Sports Exerc, 49(2), pp.378-383.
• Ceballos-Laita, L., Jiménez-del-Barrio, S., Marín-Zurdo, J., Moreno-Calvo, A., Marín-Boné, J., Albarova-Corral, M.I. and Estébanez-de-Miguel, E., 2019. Effects of dry needling in HIP muscles in patients with HIP osteoarthritis: a randomized controlled trial. Musculoskeletal Science and Practice, 43, pp.76-82.
• Geist, K., Bradley, C., Hofman, A., Koester, R., Roche, F., Shields, A., Frierson, E., Rossi, A. and Johanson, M., 2017. Clinical effects of dry needling among asymptomatic individuals with hamstring tightness: a randomized controlled trial. Journal of sport rehabilitation, 26(6), pp.507-517.
• Osborne, N.J. and Gatt, I.T., 2010. Management of shoulder injuries using dry needling in elite volleyball players. Acupuncture in medicine, 28(1), pp.42-45.
• Albin, S.R., Koppenhaver, S.L., MacDonald, C.W., Capoccia, S., Ngo, D., Phippen, S., Pineda, R., Wendlandt, A. and Hoffman, L.R., 2020. The effect of dry needling on gastrocnemius muscle stiffness and strength in participants with latent trigger points. Journal of Electromyography and Kinesiology, 55, p.102479.
• Navarro-Santana, M.J., Sanchez-Infante, J., Gómez-Chiguano, G.F., Cleland, J.A., López-de-Uralde-Villanueva, I., Fernández-de-Las-Peñas, C. and Plaza-Manzano, G., 2020. Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clinical Rehabilitation, 34(11), pp.1327-1340.
• Segura-Ortí, E., Prades-Vergara, S., Manzaneda-Piña, L., Valero-Martínez, R. and Polo-Traverso, J.A., 2016. Trigger point dry needling versus strain–counterstrain technique for upper trapezius myofascial trigger points: a randomised controlled trial. Acupuncture in Medicine, 34(3), pp.171-177.
• Charles, D., Hudgins, T., MacNaughton, J., Newman, E., Tan, J. and Wigger, M., 2019. A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. Journal of bodywork and movement therapies, 23(3), pp.539-546.
• Mullins, J.F., Nitz, A.J. and Hoch, M.C., 2021. Dry needling equilibration theory: A mechanistic explanation for enhancing sensorimotor function in individuals with chronic ankle instability. Physiotherapy theory and practice, 37(6), pp.672-681.
• Cagnie, B., Castelein, B., Pollie, F., Steelant, L., Verhoeyen, H. and Cools, A., 2015. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review. American journal of physical medicine & rehabilitation, 94(7), pp.573-583.
• Sánchez-Infante, J., Bravo-Sánchez, A., Jiménez, F. and Abián-Vicén, J., 2021. Effects of Dry Needling on Muscle Stiffness in Latent Myofascial Trigger Points: A Randomized Controlled Trial. The Journal of Pain.
• Alaei, P., Ansari, N.N., Naghdi, S., Fakhari, Z., Komesh, S. and Dommerholt, J., 2020. Dry Needling for Hamstring Flexibility: A Single-Blind Randomized Controlled Trial. Journal of Sport Rehabilitation, 30(3), pp.452-457.
• Dommerholt, J., 2011. Dry needling—peripheral and central considerations. Journal of Manual & Manipulative Therapy, 19(4), pp.223-227.
• Tough, E.A., White, A.R., Cummings, T.M., Richards, S.H. and Campbell, J.L., 2009. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. European Journal of Pain, 13(1), pp.3-10.
• Ansari, N.N., Alaei, P., Naghdi, S., Fakhari, Z., Komesh, S. and Dommerholt, J., 2020. Immediate effects of dry needling as a novel strategy for hamstring flexibility: a single-blinded clinical pilot study. Journal of sport rehabilitation, 29(2), pp.156-161.
• Mason, J.S., Crowell, M., Dolbeer, J., Morris, J., Terry, A., Koppenhaver, S. and Goss, D.L., 2016. The effectiveness of dry needling and stretching vs. stretching alone on hamstring flexibility in patients with knee pain: a randomized controlled trial. International journal of sports physical therapy, 11(5), p.672s