Abstract of the Week: Adverse Events Following Trigger Point Dry Needling

Abstract: Adverse events following trigger point dry needling: A prospective survey of chartered physiotherapists.

J Man Manip Ther. 2014 Aug;22(3):134-40. doi: 10.1179/2042618613Y.0000000044. Brady S1McEvoy J2Dommerholt J3Doody C1.

Adverse events with dry needling, namely visceral puncture or pneumothorax, are analogous to worries of vertebrobasilar insufficiency or dissection with upper cervical manipulation.  These authors performed a prospective study of clinicians using two forms to record mild and significant adverse events.

Image from Henry Gray (1918) “Anatomy of the Human Body”
Image from Henry Gray (1918) “Anatomy of the Human Body”

A significant adverse event was essentially any condition following dry needling treatment that would require further medical intervention or hospitalization.  Some of the more common mild adverse events that were recorded included bleeding, bruising, and pain during/after treatment.  There was no report of a significant adverse event in this prospective study with a calculated risk of such an even occurring as ≤ 0.04%  The results of this study should not scare clinicians from using dry needling for fear of an adverse event.  Additionally because the authors conclude that dry needling is a safe treatment intervention, clinicians should not have a false sense that there are no risks.  Considering the psychomotor component to dry needling, the technique is not nearly as difficult to master compared with spinal manipulation, potentially giving clinicians a false sense of safety.  The most imperative component once an appropriate candidate has been identified, is accurate surface anatomy palpation with recognition of the relevant neurovascular or visceral structures in the area of the target muscle you wish to treat.

Why You Should Care:

Marketing a new modality like dry needling to physicians is often met with either skepticism or worries about potential complications such as visceral puncture, pneumothorax, injury to nerves, bleeding, etc.  This article clearly shows, when adequately trained, dry needling has a very low risk (< 0.04%) of resulting in a significant adverse event, i.e. pneumothorax, that would result in the need for further medical attention.  This article provides clinicians with a much stronger case for allowing dry needling as a part of the care of patients.

Would love to hear your take! Leave comments and questions below and join us for Dry Needling Upper Quadrant in Dallas, TX September 19-20 or advance your skills in one of these manual therapy courses coming up in your region.

Gary KearnsPT, COMT, FAAOMPT

NAIOMT Guest Faculty & Clinical Fellowship Instructor

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