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Source publication
Objective
To review current scientific knowledge as to the efficacy of dry needling of scars on pain and other related symptoms and explore the possible physiological mechanisms of action.
Methods
A narrative review of scientific literature published in English.
Results
Two randomized controlled trials found that dry needling of scars (using the...
Citations
... Needle diameter significantly varies, with reported needle sizes of 0.16 mm (Foell, 2012), 0.18 mm (Wang et al., 2021), 0.20 (Fang, 2014), 0.25 mm (Park et al., 2012;Liang et al., 2023), 0.28 mm (Sun & Ma, 2006;Cai et al., 2014), 0.30 mm (Song and He, 2013;Liang et al., 2019;Rozenfeld et al., 2020;Zhai & Lu, 2021;Song, 2023;Zhang et al., 2021), 0.35 mm (Xin et al., 2003;Shi et al., 2013) and 0.40 mm (Gillingham, 1994;Lu et al., 2011;Zhou, 2011). A number of authors emphasise the importance of manipulating the needles after insertion in order to promote the manifestation of deqi (needling sensation obtained in the local area). ...
... In consideration of the significant variation in how the SD technique is performed, Rozenfeld et al. (2020) recommend a protocol for scar needling drawing from a literature review and their personal clinical experience. Their protocol consists in inserting needles (0.25 mm × 30 mm) around the entire scar or, in the case that a section of the scar is 'active' or painful, surrounding the problematic area. ...
A literature review was performed to determine the evidence-based effectiveness of the ancient traditional Chinese medicine (TCM) ‘Surrounding the Dragon’ (SD) acupuncture technique for different types of health conditions. A total of 40 articles published between 1992 and 2023 were retained. The quality of each article was assessed based on a pilot methodology, the overall risk of bias index (ORBi). Only 7 articles out of the 40 obtained an ORBi score that indicated high quality evidence, while 5 articles were medium quality and 28 low quality. High and medium quality articles provide evidence of the SD’s effectiveness for treating dermatological manifestations such as chloasma, acute herpes zoster, post-herpetic neuralgia, pressure sores, skin ageing, skin wounds and non-segmental vitiligo. The SD technique can also be effective for the treatment of other dermatological manifestations, as well as for mastitis and a number of musculoskeletal and neurovascular conditions, particularly if combined with other therapeutic modalities. This systematic review also allowed comparison of scientific
findings with the TCM theorised effects of SD. For instance,
the increased blood perfusion induced by the SD technique
in skin wound clinical studies matches the TCM theory of
increased qi and blood flow. The TCM theorised effects of
SD at the superficial layer where the wei-defensive qi runs also
matches the observed SD effects on skin involving increased
dermal proliferation of fibroblasts and production of collagen.
Similarly, the induction of de qi through needle manipulation
finds its biomedical parallel in the production of extracellular
purines and their anti-nociceptive effects in inflammatory and
neuropathic pain. The empirical evidence of the effectiveness
of multiple needling technique also appears to be supported
by the Neural Acupuncture Unit (NAU) theory that could
explain its enhanced stimulation of different types of afferent
nerve fibres. These examples of convergence between TCM
and biomedical science emphasise the need for increased
efforts to integrate TCM and biomedical knowledge for
better approaches in healthcare. This is particularly relevant
when considering that (i) a number of clinical studies
revealed superior therapeutic effects of the SD technique
over biomedical therapeutic approaches, and (ii) positive
therapeutical outcomes can be enhanced by combining SD
acupuncture with allopathic drugs.
(https://www.journalofchinesemedicine.com/the-surrounding-the-dragon-wei-ci-acupuncture-technique-a-systematic-review.html)
... Dry needling may be an effective method to treat scars, but it has low to moderate quality evidence. The probable mechanism of action is based on suppression of systemic and local inflammation, stimulation of epithelialization, and reduction of scar formation [35,43]. ...
Scar formation is a natural part of the healing process after CS. This process, lasting up to two years, depends on the number of factors including type of incision, wound size, the person's age, body weight, health condition, and many others. Abnormal scarring should not be treated only as a cosmetic defect or superficial tissue defects. Functional and anatomical considerations must also be considered. Large varieties of non-invasive treatment modalities have been used to enhance wound healing and scar treatment. The article proposes a comprehensive approach to scar prevention and remodeling. The role of manual techniques, dry needling, cupping therapy, compression therapy, Kinesio taping, and physical agents is highlighted.
... Prolonged and abnormal wound healing may cause the development of hypertrophic scars which can be itchy and painful, resulting in serious functional disabilities and/or cosmetic defects. It has been suggested that local application of needles around the scars effectively facilitates the scar healing process and alleviates pain and other scar-related symptoms [8]. Therefore, there is a need to continue research to verify the efficacy of local management with needling for scar tissues. ...
... In other research studies, needling was carried out in the immediate vicinity of the scar, around the scar or along the scar. These needling locations are recommended by acupuncturists [31] and dry needling practitioners [8]. Rozenfeld believes needles should be placed around the entire scar or, in the case of scar section being "active" or painful, around the problematic area [8]. ...
... These needling locations are recommended by acupuncturists [31] and dry needling practitioners [8]. Rozenfeld believes needles should be placed around the entire scar or, in the case of scar section being "active" or painful, around the problematic area [8]. Abbate recommends acupuncturists should palpate around the border of the scar and find two most painful places [31]. ...
Background
There is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment.
Objective
The aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms ‘acupuncture,’ ‘needling,’ or ‘dry needling’ to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture.
Search strategy
The search strategy included different combinations of the following keywords: ‘scar’, ‘keloid’, ‘dry needling’, ‘needling’, ‘acupuncture’, ‘treatment’, ‘physical therapy’. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023.
Inclusion criteria
The studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included.
Data extraction and analysis
The main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results.
Results
As a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2–4 out of 8 points on the JBI checklist, five studies scored 5–7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous.
Conclusions
The studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation.
Systematic review registration
INPLASY no. 202310058.
... These treatments can be categorized into manual therapy and specialized physiotherapeutic methods, as well as physical modalities such as mechanotherapy, electrical therapy, electromag-netic fields, light therapy, and their various combinations [12][13][14][15]. There is preliminary evidence suggesting that dry needling may also contribute to wound healing and impact scar appearance [10,16,17]. ...
... Needle twisting should be depended on the patient's sensitivity. The treatmentduration is about 20 min once or twice a week until resolution, or a symptom plateau is achieved.20 ...
Background
The skin is a protective barrier of the body against external factors, and its damage leads to a loss of integrity. Normal wound healing results in a correct, flat, bright, and flexible scar. Initial skin damage and patient specific factors in wound healing contribute that many of these scars may progress into widespread or pathologic hypertrophic and keloid scars. The changes in cosmetic appearance, continuing pain, and loss of movement due to contracture or adhesion and persistent pruritis can significantly affect an individual's quality of life and psychological recovery post injury. Many different treatment methods can reduce the trauma and surgical scars. Manual scar treatment includes various techniques of therapy. The most effectiveness is a combined therapy, which has a multidirectional impact. Clinical observations show an effectiveness of manual scar therapy.
Material and methods
The aim of this work was to evaluate effectiveness of the scar manual therapy combined with complementary methods on the postoperative scars. Treatment protocol included two therapies during 30 min per week for 8 weeks. Therapy included manual scar manipulation, massage, cupping, dry needling, and taping.
Results
Treatment had a significant positive effect to influence pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters (scar elasticity, thickness, regularity, color) was also noticed.
Conclusion
To investigate the most effective manual therapy strategy, further studies are needed, evaluating comparisons of different individual and combined scar therapy modalities.
... Terapię blizn można wspomóc codzienną higieną, stosowaniem kosmetyków i leków dedykowanych ich pielęgnacji [12]. W przypadku rozległych, szpecących blizn pomocna jest profesjonalna terapia z użyciem techniki suchego igłowania, która wywołuje ograniczony stan zapalny prowadzący do przebudowy strukturalnej tkanek, a tym samym zwiększa ich elastyczność i poprawia estetykę [13]. ...
... Current treatment strategies for hypertrophic scars are surgical manipulations, topical and intralesional corticosteroid injections, laser therapy, silicone gel sheeting, drug therapy, and radiotherapy (14)(15)(16). There are only a few clinical studies of the effect of acupuncture and dry needling (DN) on scar tissue (17,18). DN is an invasive technique used by an increasing number of physical therapists to treat patients with pain and dysfunction (19). ...
Abstract
Background: In this case report of a 31-year-old female, we describe the effects of dry needling on scar tissue following total hip arthroplasty.
Case report: A 31-year-old woman underwent an elective bilateral total hip replacement due to a motor vehicle accident. Based on physical examination, the patient had burning pain at the incision site at the time of menstruation and limited hip range of motion worse on the right side. The treatment program consisted of six sessions of dry needling over a three-week period alongside infrared radiation for 20 minutes during each session. The needles were spaced along the entire length of the scar tissue and rotation was performed back and forth across the scar region to release the adhesion between the scar line and the underlying tissue, focusing more on the painful-to-touch spots and adhesive points. Following the completion of the dry needling treatments hip range of motion and the patient’s functional outcome improved. Dry needling may be an effective and rapid treatment for scar tissue adhesion after surgical procedures. High-quality randomized-controlled studies are needed to verify the efficacy of this method.
Keywords: Dry Needling, Hypertrophic scar, Total hip arthroplasty, Scar treatment, Scar adhesion
... Additional studies were conducted to identify the effects of DN. DN has been shown to: improve spasticity and range of motion (ROM) 43 , improve flexibility of muscles [44][45][46] , myofascial trigger point pain [47][48][49][50] , scar tissue 51 , and neuromuscular control 52,53 . Since DN can be applied across different pathological conditions, there has been an increasing number of healthcare professionals becoming trained and certified in DN. ...
... definitions and criteria from established protocols35,51 . The lack of consistency on what "consensus" should be defined as makes it imperative for researchers to provide clear reporting of the standards for consensus. ...
Background: Physical Therapists in the United States can perform Dry Needling (DN) in most states with the legal requirement for the therapist to obtain written and/or verbal informed consent (IC). When consenting patients to DN treatment, it is necessary to inform patients of potential risks of harms.In cases where risks are disclosed as part of IC, patients have potentially shown poor recall which calls into question how best this type of information should be presented. Purpose: To develop a risk of harm statement that can be used on an IC form for DN in both the clinic and research settings to improve patient autonomy and decision making. Research Design and Methods: The Delphi study involved three rounds of questionnaires to gain expert consensus for inclusion of AEs for IC. Inclusion criteria for DN experts included: (1) >= 5 years practice performing DN and one of the following secondary criteria: (a) Certification in DN, (b) Completion of a manual therapy fellowship that included DN training, or (c) >= 1 publication involving the use of DN. Participants rated their level of agreement using a 4-point Likert scale. Consensus was defined as >= 80% agreement or >=70% and < 80% agreement with Median >= 3, Interquartile Range <= 1, and Standard Deviation <= 1. A Nominal Group Technique (NGT) methodology was used to achieve consensus among participants to identify what needs to be included in a risk of harm statement to allow patients understand the true risks. Participants included: policy experts, legal experts, DN experts, and patients who received DN. The NGT session consisted of 5 rounds of idea generation and final consensus voting which lasted for 2 hours. Consensus for inclusion of ideas was defined as >= 80% agreement following 2 rounds of voting. Analysis: In both studies, median, Interquartile range (IQR), standard deviation, and percent agreement (combined “strongly agree” and “agree” responses) were calculated. A Wilcoxon rank-sum test was used to evaluate the consistency and stability of responses between questionnaire responses. Statistical significance was defined as P < 0.05. Kendall’s coefficient of concordance (w) was calculated in each round to determine agreement between participants. Readability analysis included: Flesch-Kincaid grade level, Flesch Reading Ease Score, and sentences. Results: Thirty-Nine DN experts were included in the Delphi Study and five participants were recruited in the NGT study (N=1 legal expert, N=1 policy expert, N=2 DN experts, and N=1 patient). Fourteen AEs identified for inclusion on a risk of harm statement: bleeding, diaphoresis, fatigue, pain during/after, pneumothorax, soreness, bruising, dizziness/lightheadedness, drowsiness, superficial hematoma under skin, skin redness, neurological symptoms, syncope, and temporary increase in symptoms. Each AE was categorized by the experts where 93.6% agreed with the definitions for both severity and likelihood. In the NGT, participants identified 27 elements for IC, 22 of which reached final consensus. The elements pertaining to a risk of harm statement included being able to order the risks that can occur and to stratify the severity and likelihood of each risk. Conclusion: A final risk of harm statement was generated for inclusion on IC for DN. The final risk of harm statement was 20 sentences long, was written at a 7th grade reading level, contained an ordered list of risks by severity and likelihood of occurrence, and had a Flesch Reading Ease Score of 65.0.
... The approach to a scar usually needs a holistic trend, attention to individualized characteristics, and a combination therapy. [1][2][3][4][5][6][7][8] Scars in dermatology are usually caused by trauma, burn, surgery, or as a sequel of inflammatory mucocutaneous disorders, wounds, or ulcers, especially as a consequence of severe nodulocystic acne vulgaris. [1,2,[5][6][7][8] Each of these etiologies could result in any type of scar or even concurrent forms of scar. ...
... [1][2][3][4][5][6][7][8] Scars in dermatology are usually caused by trauma, burn, surgery, or as a sequel of inflammatory mucocutaneous disorders, wounds, or ulcers, especially as a consequence of severe nodulocystic acne vulgaris. [1,2,[5][6][7][8] Each of these etiologies could result in any type of scar or even concurrent forms of scar. Various therapeutic methods have been used for the treatment of scars, and there are many systematic reviews and/or meta-analyses which discuss the results of these studies. ...
... Needling There are a lot of studies about the positive effects of needling on the healing process of atrophic scars (e.g., acne scars) and reduction of complications of scars, so it could be considered as a well-tolerated and minimal method with a high level of patient satisfaction. [1,2,[5][6][7][8] There are few studies about the positive effects of needling on the hypertrophic and keloidal scars. [3,4] The related review articles suggest examining needling as a promising adjuvant therapy for non-atrophic, hypertrophic, or keloidal scars, which needs more studies and long-term follow-up periods in comparative trials conducted on resurfacing modalities. ...
Scars are among the most prevalent referral cases of dermatology clinics, including atrophic, hypertrophic, or keloidal scars. Approach to scar usually needs a holistic trend, attention to individualized characteristics, and combination therapy. Scars usually need multiple sessions of therapy and the use of combination therapeutic approaches to reach the most acceptable outcomes by safe modalities. Studies on scars are always one of the most important fields of research in medicine, especially in dermatology. For writing this review study, we searched all the databases to find the most relevant and the newest studies related to our topic, because based on expert opinion, this topic may be really practical and interesting for dermatologists and all physicians of various specialties or subspecialties who manage and treat various kinds of scars, including hypertrophic scars and keloids. Based on our results, we concluded that different procedures, which basically use needling, lasers, especially pulsed dye laser (PDL) and carbon dioxide (CO2) laser, and MesoBotox (micro-injection of botulinum toxin), are really promising therapeutic options for hypertrophic and keloidal scars and a combination of these therapies results in more efficacy and lesser side effects in the field of scar management.
... Treatments can help stimulate branches of the femoral nerve to disrupt the quadriceps inhibition reflex that can develop after knee replacement [58]. Preliminary evidence suggests that DN can also help address incision-related pain and aid wound healing under certain circumstances [59]. ...
Physical therapy is a necessary part of the recovery process after most orthopedic procedures. Effective treatment, patient satisfaction, and financial reimbursement hinge on the successful implementation of both surgical and nonsurgical interventions. Evidence-based practice and open communication between therapists and orthopedic surgeons continue to form the foundation of patient care. The aim of this paper is to familiarize orthopedic surgeons with the relevant data behind some of the recent advances in rehabilitation adjuncts to better address the needs of our patients. Although each intervention has been found to be relatively safe, high-quality evidence is still sparse. Opportunities exist for improved outcomes with further well-designed studies to investigate the role of these therapy modalities among orthopedic patients.
