Allied Health Professions Act, 1982 (Act No. 63 of 1982)

Dry needling (DN) is within the scope of practice of South African Chiropractors. It is part of the undergraduate education of South African Chiropractors at the Durban University of Technology and the University of Johannesburg, consisting of both theoretical and practical training. In the case of Osteopaths, DN is within the scope of practice, provided it has formed part of the education and training in the foreign qualification. It is a commonly-used intervention by Chiropractors and Osteopaths, locally and internationally as well as by other manual therapists such as physiotherapists.

DN is a ‘skilled intervention that uses a filiform needle to penetrate the skin and stimulate underlying myofascial trigger points (MFTP), muscular and connective tissues for the management of neuromusculoskeletal pain and movement impairments’ APTA Public Policy Practice and Professional Affairs Unit [1]. It is different from acupuncture [2]. DN targets nerves, muscles or connective tissues [3] and is often used to treat MFTP’s. Dependant on the tissue that is been targeted during DN, the physiological impact of the treatment will vary. For example, targeting MFTPs results in a different physiological effect from targeting connective or scar tissue, fascia or muscle tension [1]. MFTP’s are hyperirritable spots found in skeletal muscle associated with a taut band that is hypersensitive [4]. They may result in referred pain, tenderness, and autonomic phenomena such as local sweating, vasodilation/constriction or pilomotor activity [4, 5]. MFTPs may be active or latent and must be differentiated from tender points occurring in muscles [2].

DN is considered to be one of the fastest and most effective ways to treat MFTP’s [6]. It is considered an invasive therapy [6] with a large body of scientific literature supporting its use and effectiveness [2]. The needle is inserted into the MFTP resulting in a twitch response. Although the exact mechanism is still under debate it is theorised that this results in altered motor end-plate activity and thereby brings about an analgesic effect [7]. The mechanism appears to be centrally mediated as opposed to purely peripheral in nature [8]. Various techniques of DN can be used. The practitioner may employ dynamic needling, whereby the needle is slowly moved in and out of the MFTP. Alternatively, static needling can be used whereby the needle is left in situ, or it can be rotated several times to engage the soft tissue [9].