Dry Needling, Graston Technique!

By Abbey Celarek, DPT


Dry needling and Graston Technique approaches are not new but are becoming the trendy avenue to achieve results faster than ever before. Here is what you need to know and why you might want to consider using one of these as your go-to next time that muscle or headache starts acting up again.

Dry Needling:

Dry needling is not acupuncture, which is traditional Chinese medicine. Dry needling is based on neuroanatomy and modern scientific study of the neuromuscular and musculoskeletal systems. A small filament is inserted into the skin and then penetrates to the deeper layers of the tissue. Dry needling works by causing irritation to shortened tissue, controlling the local inflammation, and then inhibiting the pain, which ultimately reduces the overall pain and restores balance in a person’s body.

Dry needling has been around since the 1930’s and involves a physical assessment and then the use of small monofilaments used to treat painful neuromuscular conditions in any region of the body. The conditions and treatments are based on models from J Kellgren, J Travell,D.G. Simon, Dr. C.C. Gun, and further developed into IDN (Integrative Dry Needling) along with the peripheral nerve model and 3rd generation of dry needling by HC Dung and Y.T. Ma. IDN is focused on pain management and sports rehabilitation based on anatomy and physiology of the peripheral nervous system.

Conditions that can be assisted by needling include but are not limited to the neck, back, shoulder pain, arm pain, headaches, jaw pain, buttock, and leg pain. We strive to make needling virtually painless but a local twitch is not uncommon momentarily. Patients may describe this initial prick as a little electric shock, cramp, or an ache sensation. Soreness after needling may last 1-2 days, use heat and light massage. Movement is beneficial. Light bruising with certain areas is more prevalent. Larger bruises may occur but are less common.

Dry needling responses vary from person to person based on the self-healing abilities of the individual. Soft tissue pain management is relatively predictable depending on the self-healing potential and severity of symptoms of each patient. With these two considerations in mind therapist focus on common localized pain in soft tissue sites. If needling non-soft tissue areas efficacy is less quantitative.

Locally, dry needling creates lesions in soft tissue thereby becoming a therapeutic modality for soft tissue dysfunctions. Damaged tissue creates inflammation, sensitized nerve tissue, scar tissue, tissue adhesion, blood deficiency, and decreased lymphatic circulation. Dry needling creates a lesion in the tissue that lasts for a few days. The lesion intern initiates the physiological mechanisms of remodeling injured and inflamed soft tissues in and around the needling site making exact needling precision negligible. Tissue remodeling includes: physical stress reduction, normalizing inflammation, and replacement of injured tissues with healthy tissue of the same type.

Due to the insertion of a needle into the body, we as skilled clinicians are creating both local and systemic effects helping the body to achieve homeostasis (aka balance, reducing both physical and systemic stress: involving the immune, cardiovascular, and endocrine system). Essentially, upon inserting a needle into the musculature, the body tries to regain both physiological and systemic homeostasis. Needling is not a cure-all but is able to assist as a modality for biological self-healing.

Graston Technique:

You may have heard of a therapist using a variety of tools or modalities to help patients/athletes get back to their activity and wonder “well aren’t they all the same?”… NO. They are not the same. The Graston Technique is patented and set apart in the IASTM (instrument assisted soft tissue mobilization) because these instruments are particularly useful in not only soundly locating anatomical structures but also helping find remote myofascial strain patterns. The instruments magnify what the hands feel with each stroke. They allow the hands to feel the intensity of the thickening, ridges, adhesions, fibrotic nodules, and scar tissue. Graston instruments assist the practitioner to facilitate movement within the soft tissue structure which activates the alignment of fibroblasts and myofibroblasts in the direction of stress. This is important because movement maintains a balance between collagen synthesis. This movement is important to restore gliding between layers of tissue. Essentially each instrument is structured to assist with breaking up adhesions in the body in multiple directions.

The Graston Technique was created by David Graston after being unable to recover his knee from water skiing. David Graston worked closely with Dr. James Cyriax who helped to create the primary concept behind the technique.

Graston instruments are effective for treating a variety of conditions both chronic and acute. Depending on the stage of healing and what is best for the athlete/patient the therapist may decide to try the Graston technique to assist with self-healing. Some examples of clinical indications include: plantar fasciitis, ITB syndrome, myofascial pain, tendinopathies such as lateral epicondylosis, AC ligament sprains, ligament pain syndromes, scar tissue/adhesions, entrapment syndromes, edema reduction, secondary soft tissue lesions associated with other diagnoses.

Increased tissue perfusion takes place after the 1st session and during the 1st week but clients may not feel immediate effects. It is more common to notice effect between 4-12 treatments. Sessions can be brief and some people may tolerate an increased intensity and penetration, but nevertheless, all Graston mobilizations create mechanical disruption in fibrotic tissue to increase the range of motion.

Side effects of stretching tissue may induce petechiae or bruising (not always) along with some pain or discomfort which will dissipate. If excessive bruising occurs please notify your therapist. They will be able to assist with the bruising. If you have increased soreness after a treatment you may use ice for a short bout of time (no longer than 10 minutes). After all sessions it is important to hydrate.

Take Home:

You always have options, the Olympians don’t shy away from alternative therapy approaches to get themselves back quicker than their competition. Everyone is different and there are many different therapy approaches and one is bound to work for you. It’s always good to have options. As a physical therapist, I am trying to continually learn more about the benefits of alternative therapy approaches in conjunction with traditional views.

It’s incredibly rewarding to help someone find a modality that helps relieve their pain and get them back to their sports or just simply breathing better. Seeing someone stop having sinus pain because of a simple 5-10min technique is the best thing in the world to me as a therapist. Living in this day of polypharmacy and chronic pain I think it is reassuring that there are still options to find pain relief.