This question comes up a lot in pelvic floor physical therapy sessions: "What are all my options for treatment?" One very under-utilized, and sometimes forgotten about, treatment option is dry needling.
Pelvic floor therapy is a type of therapy focusing on the health and function of your whole self as it pertains to the pelvis and pelvic floor. To read more about what pelvic floor PT actually is, we go further in depth in this article.
Dry needling, previously known as trigger point dry needling, is a technique where a thin, filiform needle is inserted into muscle and soft tissue. The goal of dry needling is to improve local blood flow, muscle activation, pain, and create a nervous system change for the better.
"You want to put a needle...where??!"
The pelvic floor is made up of muscles and other soft tissue that respond well to dry needling. Needles do not penetrate any organ or canal (we stay away from the bladder, vagina, penis, and rectum). Dry needling may also be beneficial in other locations as well, such as the abdomen or hips. The location in which a needle is inserted should relate back to your main goals of treatment.
What are some conditions where dry needling for the pelvic floor would be beneficial?
While you could make a case for any condition benefiting from improvement in blood flow and nervous system regulation provided by this technique, here are some common conditions where people see benefit in using dry needling.
Significant muscle tension causing pain
Inability to orgasm or difficulty achieving an orgasm
Persistant genital arousal disorder (PGAD)
Leaking any type of fluid you don't want (incontinence)
Under-activation of the pelvic floor muscles
Chronic pain conditions (endometriosis, tailbone pain, painful intercourse)
Nerve pain (persistent itching, persistent burning, sensitivity to touch)
Frequent urination throughout the night
How does dry needling provide pain relief?
The needles used in dry needling are inserted into muscle tissue, often dysfunctional tissue such as a trigger point.
It is important to understand what a trigger point is to understand the relief gained from dry needling. The current, most-accepted hypothesis of what a trigger point is states that there is a development of a taut band of fascia around the muscle due to excess stimulation at a cellular level (Simons et al, Gerwin et al). Essentially, more signal to contract and not relax equals a contracted muscle fiber that cannot let go. To picture this, think of a piece of meat wrapped in cling wrap. The tighter the cling wrap, the more it suffocates that piece of meat.
This constant tension creates hypoxia (lack of oxygen) and ischemia (lack of blood flow) to that muscle fiber. Lack of blood flow and oxygen create sensitivity of the nerves in the surrounding area (we all need blood flow and oxygen to be happy), and long term nerve sensitivity in the area can lead to chronic pain and persistent sensitivity.
Insertion of a needle into the taut band of tissue, the trigger point, can then improve local blood flow and promote healing. Blood flow is associated with pain relief, as it often carries with it the necessary building blocks to heal and soothe irritated areas through a natural opioid response.
What about dry needling with electrical stimulation?
In dry needling with electrical stimulation (ES), the needles are inserted into the muscle, and then a small electrical current is applied to the needles. The electrical current stimulates the muscle tissue and can help reduce pain, improve circulation, and increase muscle function.
The use of electrical stimulation with dry needling is thought to enhance the effects of the needling by increasing the intensity and duration of the muscle contractions that are stimulated by the needles. The technique is generally safe when performed by a trained professional, and may be used in combination with other physical therapy techniques to help treat various musculoskeletal conditions.
Dry needling with ES can also help the nervous system in several ways. When thin needles are inserted into specific trigger points, they can stimulate nerve fibers and activate a local healing response. This can help reduce pain and inflammation, improve circulation, and promote tissue healing. In addition, electrical stimulation can enhance the effects of dry needling by directly stimulating the nerves and muscles in the targeted area. The electrical current can increase blood flow, release endorphins (natural pain-relieving chemicals in the body), and promote the release of substances that reduce inflammation and promote tissue healing. Electrical stimulation can also help to decrease muscle spasms and improve muscle function, which can improve overall nerve function.
In essence, the happier and healthier the nervous system, the better muscles function and heal.
Getting started and what to expect
If you think dry needling for your pelvic floor condition would be right for you, or at least you'd like to discuss it with a provider, you need to:
Find a Pelvic Floor Therapist in your area. Reach out to them or their company for a complimentary consultation.
Inquire about their comfort treating your condition and whether or not they are certified in dry needling.
Currently, dry needling is a modality that requires post-graduate certification so not every physical therapist or clinician can perform this service.
Your first appointment for dry needling may vary depending upon if you've already had an initial evaluation with the provider you choose or not. They should discuss your goals with you, as the goals you have will determine location for needle placement and use of electrical stimulation or not. The length of time the needle remains in the tissue is also completely dependent upon providers. Some leave them in for less than 5 minutes, and some an upwards of 20-30 minutes.
You may experience soreness after treatment for the first 24 hours. Small bruising can be common depending upon the area treated, and if a small capillary was hit during needling.
Electrical stimulation should feel like a heartbeat or tapping within the muscle, and you may even see the muscle itself contract. There shouldn't be any zinging or sharp pain with ES, and if there is the needle placement may need to be changed. The tip of the needle is what conducts the electricity, so if the needle is fully in muscle, but the tip is in fascia or fat then you'll feel a zing that isn't conducive to reaching your goals.
TLDR:
Benefits of Pelvic Floor Physical Therapy and Dry Needling for pelvic health:
A. Relief of pelvic pain and discomfort
B. Improved bladder and bowel control
C. Enhanced sexual function
D. Improved posture and physical performance
E. Reduced risk of surgery
Dry needling is a safe and effective way to reduce pain and reach the goals you have in physical therapy, which include a better quality of life and movement.
About the Author:
Caroline Gamwell, DPT is a Doctor of Physical Therapy specializing in Pelvic Health and Orthopedics. Dr. Gamwell earned her doctorate at Northwestern University in Chicago, IL with a focus on chronic pain rehabilitation. Dr. Gamwell owns Worth It PT, LLC, a boutique physical therapy practice based in Denver, CO focusing on all things Women’s Health. She holds post-graduate certifications in Pelvic Floor Physical Therapy, as well as in treating pregnant and postpartum athletes. Her strongest passions lie with helping others conquer their chronic pain and achieve their intimacy goals.