When is it appropriate to use electrical stimulation with dry needling?

Example of lumbar ETOIS

There are clear contraindications when it is not appropriate to use electrical stimulation combined with dry needling (DN), but the clinical decision for when it is appropriate may not be so evident. In our courses, it is common for students to question when the use of electrical stimulation with DN is indicated for their patients. To partially answer this question consider the following article:

A study by Chu J. et al. investigated the use of electrical twitch-obtaining intramuscular stimulation (ETOIS) for diffuse low back pain. The study included a crossover design where subjects would receive deeper needling without electrical stimulation, followed by superficial needling (serving as control treatment), followed by ETOIS. Needling was done bilaterally from T10 to S1 along the paraspinals. Each subject received the same amount of needle sticks (30). Treatments were completed once every 2 weeks and outcomes were collected weekly. The sample size was small (N=12) and the study lacked randomization. All 12 subjects received the same treatment sequence and crossover procedures. The study results demonstrated significant changes in pain for the subjects after ETOIS compared to the other treatments in the immediate term and 2 weeks after treatment.

The use of (ETOIS) is as an adjunct to trigger point dry needling to enhance the treatment effect for pain relief. The researchers in this study used the electrical stimulation for 2 seconds at each needlepoint, but the optimum dosage of electrical stimulation is unknown. It has been suggested that a dry needle induced local twitch response (LTR) propagates greater pain relief than a needle penetration without the local twitch. Although eliciting the LTR has been shown to reduce pain, it may also be the source of post-treatment soreness. If the twitch elicited from electrical intramuscular stimulation causes the same electrophysiological response as what occurs with a LTR, it may be a way of obtaining this desired treatment effect without the post-treatment soreness. In this study, the authors did not mention if the local twitch response occurred in any of the groups. A comparison study between deep needling that targets an LTR, and ETOIS would be beneficial to clinical practice. It would also be beneficial to compare the intensity and frequency of post-treatment soreness.

David Griswold PT, DPT, COMT, CIDN, CMP

Frank Gargano PT, DPT, OCS, MCTA, CIDN, CWT