by 
Sports medicine has come a long way since the 1960s, when Runner’s World was first published. Back then, runners with a muscular or joint injury were prescribed rest, ice, compression, elevation (RICE)—and that’s about it. X-rays detected fractures, which usually landed a runner in a hard cast with weeks of immobilization.
Stay up to date on the latest injury prevention methods with RW+
Today there are many more diagnostic and treatment options available. From bone scans to MRIs, from biomechanical video analysis to gait retraining, from muscle stimulation to kinesio tape, sports-medicine practitioners have more tools than ever at their disposal to heal runners and keep them healthy.
More From Runner's World
But that’s just the beginning. Researchers are always striving to develop advanced therapies that are more effective and that give athletes with persistent injuries a nonsurgical option. “The field is really at a fascinating juncture,” says Joseph C. McGinley, M.D., Ph.D., a sports-medicine physician and radiologist and clinical instructor in the department of radiology at the University of Washington School of Medicine in Seattle. “We are starting to treat conditions that once required surgery and significant downtime with minimally invasive therapies.”
While the development of cutting-edge treatments is exciting, the research on some of them is young and the results thus far are mixed, says John Ball, D.C., C.C.S.P., an Arizona-based chiropractic sports physician. “This doesn’t mean some of these treatments can’t be effective, but they should be used as a last resort, for injuries that haven’t responded to traditional therapies.”
Of course, it’s every runner’s dream to stay pain-free so there’s never need for any advanced interventions. But in case you aren’t so lucky, there’s value in knowing what might be available to you down the road—to help you stay on the road. In this article, we will focus on dry needling, but you’ll find links on other cutting-edge therapies that may better serve your injuries.
What is dry needling?
The most mainstream of the therapies described in our Cutting-Edge Pain Therapies feature, dry needling is used by physical therapists who want to reach problematic areas of tissue that lie deep in a muscle. They insert thin (acupuncture-like) needles into tense bands of muscle. When the needles penetrate them, they help relax these bands and release the neurochemicals that are causing pain, says Scott Epsley, P.T., R.M.S.K., former director of physiotherapy and clinical diagnostics for the NBA’s Philadelphia 76ers.
“It causes muscles to relax, bloodflow to increase, and the body’s natural healing process to activate,” he says. “Once the trigger point is released, the muscle quickly begins to contract and function normally.”
What does dry needling treat?
Epsley says he frequently treats runners with lower back pain, knee pain, hip pain, shin splints, and plantar fasciitis using dry needling.
How effective is dry needling?
There is a growing body of published evidence showing the benefits of dry needling for soft-tissue injuries.
Who’s had dry needling?
Three-time Ironman world champion Mirinda Carfrae uses the therapy when she is deep in training. While Carfrae says deep-tissue massage work alleviates most of her problems, sometimes she’ll have a “super tight muscle” that just won’t loosen up. For these cases, she turns to dry needling, which “can go deeper and only takes a session or two to help the muscle relax.”
Does dry needling hurt?
The needles are very fine, so there is minimal discomfort upon entry. Once the needles penetrate the trigger point, you can expect a dull pain, similar to someone pressing on a bruise, depending on the location. The needles remain in the trigger point for five to 15 minutes, or are inserted and withdrawn from the area several times.
There may be some soreness for a day or two following the treatment, but “nothing so bad,” according to Epsley—with one exception: the calves. Epsley is judicious about needling this area, especially if a runner has an event coming up or needs to resume training immediately. “The calves tend to be more sore than other areas for a couple of days after needling,” he says.
Who offers dry needling?
Physical therapists are using dry needling in nearly every state now. That said, few use ultrasound to guide the needle, something Epsley does do and which he says “leads to more precise placement and thus better outcomes.” (A special certification is required for therapists to use ultrasound; Epsley believes more therapists will seek this certification, so you may want to ask about this technique.)
What does dry needling cost?
Some insurance companies do not cover dry needling. It may be employed as part of an overall consultation but cannot be billed separately, so sometimes there is a small fee for including it. Offered as a stand-alone treatment (without a prescription for PT), you can expect to pay anywhere from $65 to $120.
Treatment plan?
Epsley says runners require anywhere from two to seven sessions over the course of a few weeks. If the issue doesn’t improve after multiple treatments, he says, “something other than a soft-tissue issue, like a stress fracture, may be causing the problem.”
Not into dry needling? Consider these massage guns.
More comfortable to hold
So small, you’ll want to take it everywhere.
Quiet with a long battery life
A solid build and plenty of attachments, for less
Long handle and multiple grip options
This article is part of the “End of Pain?” feature that looks at five cutting-edge pain therapies. It originally appeared in the March 2017 issue of Runner’s World.
