Perceptions of Dry Needling for Performance & Recovery in NCAA Division I Athletes

Authors: Shemeika McCray & Joni M. Boyd, PhD. CSCS*D

Corresponding Author:
Joni M. Boyd, PhD, CSCS*D
216L West Center
Rock Hill, SC 29732
boydj@winthrop.edu
803-323-4936

Shemeika McCray is an undergraduate student in the Exercise Science Program at Winthrop University.  Dr. Joni Boyd is an Associate Professor of Exercise Science and Coaching at Winthrop University in Rock Hill, SC.

Perceptions of Dry Needling for Performance & Recovery in NCAA Division I Athletes

ABSTRACT

The aim of this study was to examine the perceptions of dry needling within NCAA Division I athletes for muscle performance and/or recovery.Seventy-seven NCAA Division I Athletes completed an 15-item online survey sent via e-mail, which included demographics, exposure to dry needling, and perceptions of effectiveness. Those that had no experience of dry needling were asked to rate their perceptions and reasoning for non-exposure. The results indicated that 66% (n=51) of participants did not have experience with dry needling, while 34% (n=26) did have experience with dry needling. Athletes that experienced dry needling reported that dry needling was effective and comfortable for efficient and speedy recovery. They also reported that they would recommend others to use this recovery treatment.  Those athletes with non-exposure to dry needling reported that they would rather use other treatments, concerned with pain or bruising from dry needling or was not sure it would work for recovery.  These results help to fill current gaps in research on dry needling.  Future research could compare treatment protocols for pain management and/or recovery effectiveness.

Keywords: dry needling, athletes, recovery, performance, myofascial trigger points

INTRODUCTION

Muscle tightness and trigger points (TrPs) cause discomfort and limited range of motion in local and affected areas of the body.  TrPs are hyperirritable areas that have sensitive tightness in a muscle that restrict range of motion and affect muscle activation (5). TrPs occur when the muscle has been contracted repeatedly causing deep aching pain in the muscle, a tender knot in the muscle, difficulty sleeping due to pain or pain that persists or worsens (14). Too many TrP can lead to myofascial pain syndrome (MPS), which is a chronic muscular pain disorder (9). However, some risk factors of MPS are muscle pain injury, stress and anxiety (14). When people experience TrPs, it can affect their quality of life, cause pain, and disability to that certain part of the body (3). TrPs are broken down into two categories -active or latent. Active TrPs are more painful when the person is moving, stretching or when pressure is applied within the TrPs area. Latent TrPs are only painful when there is direct compression to that area (7).

For years, specialists have used stretching, compression, and cortisone-injection protocols to reduce muscle tightness of TrPs, in an attempt to relieve pain and discomfort for athletes, which provided short-term pain relief. In 1942, Travell and colleagues published the first method on myofascial trigger points (TrPs) (9). In 1979, Lewit proposed that the effects of the injections was not caused by the presence of medication, but the mechanical stimulation of a TrP with the needle, which helped to reduce pain (9). Dry needling is a procedure used by many specialists, such as physical therapists and athletic trainers, and uses an acupuncture needle inserted into the skin and muscle (7). Dry needling inactivates TrPs, releasing muscle shortening, removing muscle irritation, and decreasing spontaneous muscle activity (6). When the needle is inserted into those TrPs, it causes the motor end plate to break within those tight knots. When the specialist rotates the needle aiming at tightness in the muscles, this allows the connective tissues to stretch causing the release of pain chemicals. The muscles become relaxed after the repositioning of the collagen fibers followed by normal blood flow. Oxidative metabolism begins, which allows myosin to release from actin and the contracted sarcomere to be relaxed (11). As an effect of this process, the muscles are able to function with reduced pain and increased range of motion.

Physicians can use different forms of dry needling such as, deep dry needling (DDN), superficial dry needling (SDN), or sham dry needling to help with recovery. DDN targets mostly dysfunctional motor points, while superficial dry needling targets primarily sensory afferents (1). Sham dry needling uses a small-disinfected finishing nail instead of a monofilament (13). It is important for physicians to know which technique would have the most significant outcome for their patients.

Research on the Effects of Dry Needling
The literature on the effects of dry needling is sparse.  The effectiveness of dry needling showed improvements for the management of upper trapezius pain, shoulder pain, and neck pain within the upper extremity.  Additionally, dry needling was effective in reducing pain intensity and pain pressure threshold in in the upper trapezius and sub occipital regions for participants with headaches. The results were most effective after two days, as the pain did not improve immediately after dry needling application due to soreness (16).  A similar study compared the SDN with DDN in patients with headaches and upper trapezius and sub occipital pain (15). The results indicated that DDN produced positive effects on headache index as a factor of headache intensity, frequency, decreasing trigger point tenderness, which lead to better results than SDN. However, another study indicated that SDN followed by active stretching is more effective than stretching alone, which can lead to increased TrPs sensitivity (4).  Additional research examined the influence dry needling on blood flow and oxygenation in the trapezius muscle and surrounding area.  The results indicated that blood flow and oxygen saturation significantly increased compared to pre-treatment (2). Overall, studies have shown that dry needling increased range of motion, muscle activation patterns, reduction of local and referred pain as well as decreased end plate dysfunction related to TrPs (12).

Within the lower extremities, a few studies have shown the effectiveness of dry needling. The effectiveness of dry needling in the thigh muscle for hip flexion was measure among soccer players. Dry needling was compared to water pressure massage and a placebo laser with water pressure massage. The results indicated that dry needling significantly increased hip flexion range of motion, muscular endurance of knee extensors and maximum force of knee extensors over a four-week period after the treatment (8). 

While there is research to support the effectiveness of dry needling for pain management and recovery, the method itself could be a barrier for athletes to use.  It is realistic to believe that athletes would be hesitant to attempt dry needling due to the use of needles, and potential for pain-related treatment protocol.  The aim of this study was to examine the perceptions of dry needling within NCAA Division I athletes. The study allowed athletes who have experienced dry needling as well as those who have not, to state their own perceptions on dry needling.

METHODS

This study follows a quantitative non-experimental research design. A survey was used to collect data from all athletes attending a university in the Southwestern United States. The survey consisted of 15-items, which examined the perceptions of dry needling for a recovery treatment for athletes. The perceptions of dry needling were compared between those that were exposed to those that were not exposed.

 Subjects
Data was collected from NCAA Division I Athletes, who all attended a university in the Southeastern United States during the summer of 2018 via Internet based survey. The survey includes demographic questions as well as perceptions of dry needling for recovery of myofascial pain.

The following states inclusions for participants for the study, which are:

1. Individuals who are 18 years or older.
2. Individuals who are a student-athlete at the university.
3. Individuals who agree to take the survey.

The following states exclusion for participants for study, which are:

1. Individuals who are 17 and younger.
2. Individuals who are not a student-athlete at the university.
3. Individuals who did not agree to take the survey.

Screening for inclusionary criteria was completed in the two questions of the survey. Once athletes agreed to participate, they were asked to report their age. If the athletes were 17 years old or younger, he or she was excluded from the study. Following a written statement providing the details of the study, individuals had the option to continue or not.  If the individual continued with the survey, they consented to be in the study. 

Instruments
Demographic information was collected with five items. They were asked to record their age, gender, race, classification of college and the sport they play.

Perceptions of dry needling was assessed using 5-items on perceptions of dry needling. Participants were asked about their experience with muscular pain treatment as well as their exposure to dry needling. If participants did not have exposure to dry needling to help with recovery, they were directed to the non-exposure items within the survey. Non-exposure items included questions related to their familiarity of dry needling. Then participants were asked to rate five items pertaining to dry needling as a possible pain management or recovery tool. Some of the statements were, “I am concerned of too much soreness, increased pain or bruising,”  “I’m not sure if it will actually work for muscular pain or recovery” etc. Items were rated on a 5-point Likert scale, ranging from strongly agree (1) to strongly disagree (5).

Participants, who reported having exposure to dry needling were asked to select all muscular areas that have received dry needling and how many times they have received dry needling. Then they were also asked to rate six items pertaining to their exposure to dry needling using a 5-point Likert scale, ranging from strongly agree (1) to strongly disagree (5). Some of the statements were “My dry needling therapy experience(s) have been comfortable,” “Dry needling therapy is/was effective for recovery training or competition” etc.

Procedures
After the approval of the IRB, a link to the survey was emailed to all NCAA Division I Athletes at one Division I University in Southeast United States. The survey was sent out in May and data were collected over two weeks. Over those two weeks, they were reminded three times about participating within the study.

RESULTS

The participants for this exploratory study were student-athletes attending a university in Southeastern United States. 86 people began the survey; however, data was only used from 77 participants. Two people were excluded because they were 17 years old and younger. Another two were excluded because they were no longer student-athletes. The remaining five participants had too much missing information to be included in the study. Participants were females (n =50) and males and ages ranged from 18-24 (M=19). Data were collected from participants who played basketball (6), baseball (2), lacrosse (6), softball (14), soccer (7), tennis (7), track and field/ cross country (20) and volleyball (5). Table 1 describes sample characteristics.

Table 1: Sample Characteristics

Characteristics	Frequency (n)
Gender
Female Male	50 19
Age
18-19 20-24	20 50
Sports
Basketball Volleyball Soccer Tennis Lacrosse Baseball Softball Track & Field/Cross-Country	6 5 7 7 6 2 14 20
Classification
Freshman Sophomore Junior Senior Graduate	10 14 21 15 9
Race/Ethnicity
Asian/Pacific Islander African American Hispanic/Latino White (Not Hispanic group)	2 11 3 53

Perceptions of Exposure to Dry Needling
From the 77 completed surveys, 34 % of participants had experienced dry needling as a recovery treatment and reported areas where they experienced dry needling in the past. 13 participants reported the shoulder/ arm region, 5 reported the torso (front or back) region and 13 reported lower body region (legs). They were also asked to report how many times they experienced dry needling as a recovery treatment. Seven participants reported once, nine reported two to three times and seven reported four or more.

A summary is provided for the perceptions of athletes who had previous experience with dry needling. About 61% agreed with the statement “My dry needling experience(s) have been comfortable,” while only 17% disagreed. Also, 52% agreed that “Dry needling was effective for muscle pain management,” and only 4% disagreed. We also asked if it was effective for recovery from training and competition, 52% reported agree and 4% disagreed. Just over 50% agreed to using dry needling again for recovery, and nearly 50% would recommend others to use it for recovery from training and competition as well as muscular pain (Table 2).

Table 2: Responses of athletes exposed to dry needling (N = 26)

Exposure Survey Questions	A (%)	D (%)
DN is comfortable.	14 (53%)	4 (15%)
DN was effective for muscle pain management.	12 (46%)	1 (3%)
I would use DN again for recovery.	11 (42%)	0
I would recommend others to use DN.	11 (42%)	1 (3%)

DN=dry needling; A=agree; D=disagree

Perceptions of Non-Exposure to Dry Needling
From the 77 completed surveys, 66% did not have previous experience with dry needling. Of that 66% that did not have experience with dry needling, 6 athletes (12%) never heard of dry needling and 45 athletes (88%) did.

For the ones who were not exposed to dry needling, they were asked to report their perceptions to help understand why they were not exposed to dry needling. For the statement, “I am concerned of too much soreness, increased pain or bruising,” 39% disagreed and 13% agreed. About 31% of them disagreed and 22% agreed to the statement “I am not sure if it will actually work for muscular pain or recovery.” We also asked them if they would rather use other treatments to manage pain or aid their training and competition recovery, 26% reported that they agree and 17% reported that they disagree. When stated “I’ve been advised not to use dry needling by a medical professional,” 48% of them disagreed, while 2% agreed. The last statement was “My cultural beliefs are counter to dry needling process,” 41% disagreed and only 2% agreed (Table 3).

Table 3: Responses of athletes not exposed to dry needling (N = 51)

Non-Exposure Survey Questions	A (%)	D (%)
Concerned with pain, bruising or soreness.	6 (12%)	18 (35%)
Not sure it will work for recovery.	10 (20%)	14 (27%)
Rather use other recovery treatments.	12 (23%)	8 (16%)
Advised not to use DN by medical professionals.	1 (2%)	22 (43%)
My cultural beliefs are counter to the DN process.	1 (2%)	19 (37%)

DN=dry needling; A=agree; D=disagree

DISCUSSION

The aim of this study was to examine the perceptions of dry needling within NCAA Division I athletes for muscle pain management and/or recovery. The results indicated that dry needling was effective for athletes who were exposed to dry needling. Those athletes had a decrease in muscle tightness, which enhanced their athletic performance (2, 4, 8, 16). However, those who were not exposed to dry needling would rather use other recovery treatments, such as e-stim, ice massage therapy, ultrasound etc. Gathering this information was very important to help fill the gap in previous research, but also to help athletes find another recovery treatment.

Compared to previous findings, our results support those that found dry needling to be effective for TrPs or muscle pain management. Additionally, our results support other studies that found dry needling increased range of motion, decreased muscle tightness and increased athletic performance within athletes. Our results are novel to the literature in that no other study has examined the reasons why athletes have not tried dry needling.  Our hypothesis was that athletes would fear bruising or soreness of the treatment; however, athletes who were not exposed to dry needling were not concerned with bruising or soreness. They have not used it because they believe that other treatments are better for their muscle pain management.

Strengths and Limitations
Overall, the main strength of our research is the addition to the dearth of literature that exists on dry needling, especially the perceptions and beliefs of those exposed versus not exposed. Other strengths included inclusionary screening and use of athletes that play a variety of sports.  Even though the study included 77 participants, the sample size was a limitation. While this research could help fill in the gap in dry needling research, this study was based only on perceptions, and was self-report. There was no follow-up study done to prove that dry needling did enhance athletic performance.

Future Research
Future studies should compare dry needling with other recovery treatments. This would allow coaches, physical therapists, athletic trainers as well as athletes see which treatment is better for muscle pain management. Controlled trials of pre and post measurements along with treatment would help identify potential effectiveness and mechanisms of performance enhancement.

CONCLUSIONS

For exposed athletes, dry needling is an effective tool for pain management and recovery.  Those exposed are in favor of future use, and recommendations to others.  Since dry needling is a relatively new procedure, it is expected that many athletes have not experienced it, either because it is not available or they do not perceive it to be effective. Some of them have heard of it, however, they may lack the knowledge on the effectiveness of dry needling. Without knowledge on the effectiveness of dry needling, athletes may opt for other recovery treatments, such as e-stim, ice massage therapy, ultrasound etc.

APPLICATION TO SPORTS

Understanding the perceptions of athletes reasoning for using dry needling and not using dry needling may help with other athletes’ recovery time and athletic performance in the future. This research may help coaches determine which treatment would be best for their athletes if other treatments were helping with muscle pain management. While other treatments may be better for some, dry needling may work better for others. While the research only compared the perceptions of dry needling for those who were exposed and those who were not exposed, future research should further the results.

ACKNOWLEDGEMENTS

We would like to thank the Ronald E. McNair Post-Baccalaureate Achievement Program for allowing us the opportunity to conduct this research. We would also like to thank the amazing director of the program, Dr. Cheryl Fortner-Wood and Mrs. Stephanie Bartlett, writing coach. Most importantly, thank you to Dr. Joni Boyd, my mentor and co-author, who helped me along the way.

There are no financial or non-financial conflicts of interest in this research.

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