**IDN ARTICLE: The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine related painful: a systematic review with meta-analysis.

JOURNAL OF MANUAL & MANIPULATIVE THERAPY. (2019)   https://doi.org/10.1080/10669817.2019.1589030

Authors: David Griswold, M. Wilhelm, M. Donaldson, K. Learman and J. Cleland

We recently had a systematic review with meta-analysis comparing superficial to deep dry needling or acupuncture for orthopedic spinal conditions published in JMMT.   Deep needling (>10 mm) was found to be more beneficial with regard to pain reduction than superficial (<10 mm), however, both were effective at reducing pain. Superficial needling is necessary to perform in certain areas of body where depth of tissue is minimal. A great example of that, facial needling. Trigeminal nerve irritation is related to conditions like cervicogenic headaches, migraines, sinus pain, temporomandibular pain, or auricular related pain. Clinical application of needling to the CN V distribution necessitates a superficial approach.  Clinically we have seen for years that even a superficial needle insertion works, but it is important to see aggregate data to support our empirical data.  Beyond tissue depth, superficial needling can be considered for patients who are new to needling, clinicians who are new to needling until their comfort level improves, patients on blood thinners, or when the patient’s pain is in the distribution of a pure sensory nerve.  Furthermore, these results support the fact that it is not imperative to insert the needle deep into a MTrP in order to positively influence pain.

When you can….go deep!   The depth of tissue and neural impact, in my opinion, is one of the greatest advantages of needling compared to other forms of manual therapy. Inserting the needle at a greater depth you create a larger tissue lesion and can affect abnormal microcirculation and reduce muscular guarding at deeper levels.  This affords the opportunity to reducing neural sensitivity to structures that are difficult to reach with traditional manual therapy.  The slightest increase in needle depth can make all the difference with some patients.  Dr. David Griswold-IDN Instructor