This is the 1st paper I have seen on dry needling (specifically) and dizziness or vertigo, especially as it relates to trigger points (1), though I have talked about it my articles here and here. It has been associated with increased balance (2, 3) and the acupuncture literature has many references to treating dizziness (4).
The study (1) compared the effectiveness of dry needling of the neck muscles combined with exercise vs exercise alone for alleviating the dizziness caused by cervical myofascial pain syndrome. It was an RCT that looked at 61 middle aged women, with the groups split approximately in half. They found that there were improvements in both groups, and the DN + exercise group had superior results. No huge surprises here. We have seen that exercise increases the efficacy of dry needling ( 5-8) and can help reduce post needling soreness.
Why? Most likely it has something to do with temporal and spacial summation. We like to think we normalize the function of the spindles and joint receptors and the exercise continues to stimulate those pathways.
We remember that we have 3 systems that keep us upright in the gravitational plane: The visual system, the vestibular system and the proprioceptive system, which we have talked about here before. In this particular case, we will be affecting primarily the proprioceptive system through the spinocerebellar connections of the muscle spindles and Golgi tendon organs. We also remember that the upper four cervical neuromeres feed directly into the flocculonodular lobe of the cerebellum (which feeds forward to the vestibular nuclei) ; everything caudal to this needs to pass through the spinocerebellar pathways. This is one of the reasons needle in the upper cervical spine his so vital in treating patients with dizziness or vertigo.
When a patient presents with dizziness, especially if you believe to be of myofascial origin, go on and needle them! Make sure to get those upper cervicals!
1. Aydin T, Dernek B, Sentürk Ege T, Karan A, Aksoy C.The Effectiveness of Dry Needling and Exercise Therapy in Patients with Dizziness Caused By Cervical Myofascial Pain Syndrome; Prospective Randomized Clinical Study. Pain Med. 2018 Apr 28. doi: 10.1093/pm/pny072. [Epub ahead of print]
2. Rossi A, Blaustein S, Brown J, et al. SPINAL AND PERIPHERAL DRY NEEDLING VERSUS PERIPHERAL DRY NEEDLING ALONE AMONG INDIVIDUALS WITH A HISTORY OF LATERAL ANKLE SPRAIN: A RANDOMIZED CONTROLLED TRIAL. International Journal of Sports Physical Therapy. 2017;12(7):1034-1047.
3. Zhu Y, Qiu ML, Ding Y, Qiang Y, Qin BY. [Effects of electroacupuncture on the proprioception of athletes with functional ankle instability]. Zhongguo Zhen Jiu. 2012 Jun;32(6):503-6.
5. Arias-Buría JL, Martín-Saborido C, Cleland J, et al. Cost-effectiveness evaluation of the inclusion of dry needling into an exercise program for subacromial pain syndrome: evidence from a randomized clinical trial [published online February 22, 2018]. Pain Med. doi: 10.1093/pm/pny021
6. Arias-Buría, José L. et al. Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial The Journal of Pain , Volume 18 , Issue 1 , 11 - 18
Cover image credit: https://en.m.wikipedia.org/wiki/File:PSM_V71_D110_Stained_purkinje_cell_from_a_human_cerebellum.png