Australasian Science: Australia's authority on science since 1938

The Needles Are as Thin as the Evidence

By Marko Petrovic

Practitioners of dry-needling swear by it, yet there is no evidence it will relieve your muscular aches and pains.

With alternative medicine now coming to a university near you, and the Free Trade Agreement with China pledging to welcome and promote traditional Chinese medicine in Australia, you can expect to see many more promises online and elsewhere about the alleged benefits of alternative health practices.

Dry-needling is among them. Practitioners of dry-needling swear by it, yet it is not the miracle treatment for your muscular aches and pains.

In science you cannot prove anything, only support it with evidence, yet allied health professionals who practice dry-needling often sell it as a proven and effective remedy for assorted muscle-related issues. Far from standing on the elusive pedestal of being proven, dry-needling is barely supported by good quality evidence.

Before going any further, an important distinction has to be made between dry-needling and acupuncture as the two come from the same stable and are often conflated by practitioners.

Dry-needling involves the insertion of acupuncture needles into painful nodules of taut muscle known as trigger point sites with the aim of relieving pain. It seems to be popular among those who profess to treat sports injuries.

Acupuncture is the esoteric belief that sticking needles into prescribed places on the body unblocks invisible energy channels and somehow heals the patient. Dry-needling proponents follow this line.

The adverse events associated with both treatments are quite similar. Bleeding, bruising or swelling in the local area where the needle penetrated is common. More serious effects such as pain or numbness lasting up to 2 weeks are also possible. Life-threatening adverse events such as pneumothorax, where a lung collapses, are rare but do happen.

The Australian Physiotherapy Association states that the evidence for dry-needling has increased substantially over the past decade. They go on to say that evidence supports dry-needling as a remedy for lower back pain, migraine headaches, pelvic girdle pain, knee osteoarthritis, elbow pain and shoulder issues.

However, the literature often describes the evidence for dry-needling as unsatisfactory and of low quality. While a systematic review published in 2013 (tinyurl.com/odmnh9t) emphatically recommended the use of dry-needling compared with placebo or sham, the review completely contradicted its own results, which actually demonstrated that dry-needling was either worse or no better than sham treatments.

A Cochrane review (tinyurl.com/nj8d7cn) found that while the evidence was insufficient to make any recommendations about dry-needling being used as a sole therapy, it may be a minimally useful adjunct to normal care. Other reviews have pointed to the lack of quality of scientific studies as well as their scant number.

As is usual with alternative treatments, some practitioners will stand up at this point and defend dry-needling by saying that it works for their patients, and that they have seen amazing results. To those individuals I would say that we use evidence-based practice and not practice-based evidence for a reason. Anecdotes about treatments are coloured by the thoughts and feelings of the practitioner and the patient, which is why we single, double and even triple blind experiments. We do as much as we ethically can to remove bias.

Being invested financially or emotionally in a treatment, such as dry-needling, can certainly introduce bias and therefore cloud judgement. Consequently, with ethics in mind, the financial cost and the potential for an adverse event from dry-needling cannot be justified. So far no substantial benefit to the patient has been shown by rigorous scientific research, and it costs them their hard-earned cash.

But if personal revelations are to be given any credibility, from unfortunate personal experience I can say that someone sticking a needle into a sore point of muscle hurts a lot, but what hurt more was the $75 charge at the end of the session.

Marko Petrovic is an exercise physiologist who is currently studying Mechanical Engineering at Curtin University.