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The Benefits of Dry Needling for Athletes

PrevMyopain Seminars training course in progressThe Use of Dry Needling by Athletic Trainers29 June 2023NextMen’s Health Physical Therapy22 July 2023
July 20, 2023

The Physical and Mental Impacts on Athletes

The physical and mental demands of physical training and competing in sporting activities can be stressful and taxing to athletes of all levels. Sport participation has become a year-round activity, with young athletes involved in the same sport without having an off-season to allow the body to recover from the stresses and strains imposed. The role of the rehabilitation specialist in sports medicine has become more valued as greater demands on training and competition are placed on athletes at all levels. As a result of the increased pressure of competition and the expectations of excelling, athletes are often regulated to participate and train in a single sport. Sports-specialized training places athletes at a higher risk of injury because of over-use, repetitive activity, and year-round training (Myer et al., 2015).

A media content analysis revealed that over 72% of elite tennis players suffered from injury-related problems compared to about 27% of amateur players (Musa et al., 2022). Muscle injuries range from 10% to 55% of all sporting injuries and may have the highest incidence in sports (Ruf et al., 2022).

Repetitive stresses are abundant as athletes continually train to improve strength, endurance, and agility. Athletic competition can also tax athletes as the stresses generated and imposed can cause soft tissue injuries. Lastly, athletes’ mental stresses (both internal and external) can affect their ability to perform and recover.

Trigger Points in Athletes

Trigger points are commonly found in many different kinds of athletes, including elite swimmers (Hidalgo-Lozano et al., 2010; Hidalgo-Lozano et al., 2013), baseball players (Chiu et al., 2020), track and field athletes (Thompson et al., 2021), professional basketball players (Yeste-Fabregat et al., 2021) and wheelchair basketball players (Ortega-Santiago et al., 2019), runners (Jungmalm et al., 2020), ice hockey players (Brewster et al., 2021), overhead athletes (Kamali et al., 2019), soccer players (Paantjens, 2013), professional volleyball players (Osborne & Gatt, 2010), and handball players (Ceballos-Laita et al., 2021), among others.

Rehabilitation Technique for Athletes: Dry Needling

Athletes at all levels rely upon medical staff personnel to provide care and treatment for their injuries and aid recovery. Dry needling therapy is a relatively new rehabilitation technique for athletes. As the demands for athletes have increased, so have the demands for rehabilitation techniques for sports medicine and athletic training. Dry needling (DN) by athletic trainers and sports physical therapists is performed to augment recovery, prevent injury, and enhance performance.

Examples of Dry Needling Treatment for Sport Injuries

Trigger Points (TrPs) can develop in athletes due to muscle overload, overuse, repetitive activity, and excessive eccentric muscle activity (Gerwin, 2008). Dry needling affects the biomechanical (Langevin et al., 2006), chemical (Shah et al., 2008), and vascular (Larsson et al., 1999) properties of soft tissue. Also, DN is more effective in improving pressure pain thresholds than manual TrP therapy (Llamas-Ramos et al., 2014). Patients with unilateral ankle instability that received DN into the lateral fibularis muscle along with proprioception and strengthening exercises have improved outcomes in both pain and outcome functional measurements compared to those receiving exercise training alone (Salom-Moreno et al., 2015). Tendinopathy can be debilitating in athletes, as a lack of blood flow and ensuing a hypoxic tissue environment can lead to pain and disability. Dry needling has been advocated in managing tendinopathy as it has been shown to increase blood flow via local vasodilation (Kubo et al., 2010; James et al., 2007) and collagen proliferation (Langevin et al., 2007).

Osborne and Gatt (2010) revealed improved shoulder range of motion, function, and decreased pain in elite volleyball players receiving DN to the scapulohumeral musculature during the season. Dry needling in subjects with supraspinatus tendon lesions (tendinosis or partial tear) has been shown to have improved outcome measures and shoulder range of motion (Rha et al., 2013).  Posterior shoulder tightness is a common finding in overhead athletes, for which stretching, massage, and joint mobilizations are often utilized in treatment. Passigli and coworkers (2016) demonstrated using DN to the infraspinatus, teres minor, and posterior deltoid muscles to improve shoulder horizontal adduction and internal rotation range of motion and decrease pain reproduction. Dry needling followed by active stretching is more effective than stretching alone, which could lead to increased TrP sensitivity (Decoster et al., 2005).

Dry needling has increased maximal endurance and force in knee extensor muscles in elite soccer players (Haser et al., 2017). Another study showed that DN improved hamstrings flexibility (Alaei et al., 2021). Bandy et al. (2017) demonstrated a significant increase in vertical jump following one session of dry needling in a group of healthy subjects as compared to sham dry needling. TrPs have been shown to accelerate muscle fatigue and tax neighboring motor units to the TrP (Ge et al., 2012). Eliminating the TrP can reduce augmented muscle fatigue and help reduce potential overload within the muscle (Ge et al., 2012). Ershad et al. (2019) showed that DN can be used as a novel recovery strategy for quadriceps muscle fatigue. Athletes can also suffer psychological stresses from competition and non-competition sources (Noblet and Gifford, 2007). Psychological stressors can decrease the rate of strength recovery from strength workouts (Stults-Kolehmainen and Bartholomew, 2012). Dry needling can influence the anterior cingulate cortex and limbic system (Hui et al., 2000; Wu et al., 2002), which could affect frequent emotional stresses in athletics.

Dry Needling Is an Effective Option for Athletes

Athletes seek professional care in providing daily maintenance and rehabilitation following injury. Dry needling is a treatment technique that can be utilized in the care of athletes that provides many benefits. In addition to augmenting local tissue recovery, DN has been shown to release opioid peptides, reduce the nociceptive input from the TrP, and therefore decrease the overall pain and sensitivity that accompanies TrPs (Lavelle et al., 2007; Ge et al., 2009; Affaitati et al., 2011). While the use of opioids in athletics is well documented (Ekhtiari et al., 2020), practitioners need to offer alternative options that provide effective care aimed at both restoring function and decreasing the pain that often accompanies sports.

Dry needling is a treatment technique that can aid athletes in pursuing training and competing in their sporting activity. As physical therapists and athletic trainers seek to expand their treatment skills through continuing education, DN can be an effective treatment modality to aid an athlete in returning to play.

Todd Hooks, PT, ATC, OCS, SCS, FAAOMPT

Jan Dommerholt, PT, DPT

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