Chronic pain conditions often lead individuals to seek non-pharmacological treatments that address the underlying causes of musculoskeletal discomfort. Dry needling, a technique frequently utilized for muscle pain and dysfunction, has gained attention as a potential therapeutic option. The question of whether this approach can offer meaningful relief for patients suffering from bursitis is a subject of ongoing inquiry within the healthcare community.
Understanding Bursitis
Bursitis is a painful condition characterized by the inflammation of a bursa, which are small, fluid-filled sacs located throughout the body. These sacs function as cushions, placed to reduce friction between bones and surrounding tissues like tendons and muscles during joint movement. When a bursa becomes irritated, typically from overuse or repetitive motion, the resulting inflammation causes the sac to swell and become painful.
The symptoms of bursitis usually include a dull, aching pain that intensifies with movement or when pressure is applied to the affected joint. Individuals may also experience localized tenderness, swelling, and a feeling of warmth over the inflamed area. This irritation can also restrict the joint’s range of motion. While bursitis can occur in many locations, it is most commonly diagnosed in major joints, such as the shoulder (subacromial), the hip (trochanteric), the elbow (olecranon), and the knee.
Defining the Dry Needling Technique
Dry needling is a therapeutic procedure that involves inserting thin, stainless steel filiform needles into the skin to stimulate underlying muscular and connective tissues. Practitioners of this technique aim to target myofascial trigger points, which are hyperirritable spots within a taut band of skeletal muscle. The term “dry” refers to the fact that no solution is injected into the body through the needle.
The primary goal of the needle insertion is to elicit a local twitch response, which is a brief, involuntary contraction and immediate relaxation of the muscle fibers. This mechanical disruption is thought to help normalize muscle fiber length and release accumulated tension. Dry needling is distinct from traditional acupuncture, as it is rooted in Western anatomical and neurophysiological principles, focusing on pain science and the musculoskeletal system.
Clinical Evidence and Proposed Mechanism for Bursitis Relief
Directly needling an inflamed bursa is generally avoided. Instead, dry needling for bursitis focuses on treating the surrounding muscles that may be contributing to joint dysfunction and irritation. Research suggests that what is often diagnosed as chronic bursitis, particularly trochanteric bursitis in the hip, frequently involves underlying myofascial pain syndrome and trigger points in associated muscles like the gluteus medius. By deactivating these muscular trigger points, dry needling addresses the mechanical stress that may be perpetuating the bursa’s irritation.
The proposed mechanisms for pain relief are multifaceted. Trigger points are often characterized by a low pH level and high concentrations of inflammatory chemicals, such as substance P and calcitonin gene-related peptide (CGRP). Inserting a needle into the hyperirritable spot and eliciting a local twitch response has been shown to reduce the concentration of these inflammatory substances. This action helps normalize the local biochemical environment while also increasing blood flow and oxygenation to the area.
Furthermore, the mechanical stimulation of the needle activates larger sensory nerve fibers, which sends signals to the spinal cord. This process is theorized to leverage the pain-gate theory, effectively blocking the transmission of pain signals originating from the bursa or surrounding tissues. Some studies examining dry needling for lateral hip pain—a condition frequently misdiagnosed as bursitis—have shown outcomes comparable to corticosteroid injections, but with fewer long-term side effects. While randomized controlled trials specifically focused on pure bursitis remain limited, the evidence supports dry needling as a promising approach for managing the muscular components that often accompany and prolong the condition.
Safety Considerations and Contraindications
Dry needling is generally safe when performed by a trained practitioner, but patients should be aware of potential side effects and contraindications. The most common adverse events are mild and localized, including temporary muscle soreness, minor bleeding, and bruising at the insertion site. Post-treatment soreness often resolves within 24 to 48 hours.
Certain patient conditions and anatomical regions require special precautions or prohibit the treatment entirely. Absolute contraindications include active systemic infections, acute medical emergencies, and inability to provide consent. The procedure is also avoided in patients with a significant fear of needles (needle phobia) or over areas with lymphedema. Individuals with bleeding disorders, compromised immune systems, or those who are pregnant should discuss the risks with their healthcare provider before undergoing dry needling.