Foreword by Frank Gargano, PT, DPT, Director of Dr Ma Integrative Dry Needling Institute


The release of this textbook comes at an opportune time because of the controversy surrounding the practice of dry needling (dn). A public battle has been waged between acupuncturists and practitioners of modern dry needling. This animosity stems from the acupuncture community’s assertion that dry needling is nothing more then acupuncture renamed, therefore attempting to limit the practice of dn exclusively to acupuncturists. This textbook provides clarity and a scientific rationale in delineating the differences between modern dry needling and traditional acupuncture. 

There is also a more private debate within the dry needling community that challenges the dogma of myofascial trigger point approach. dr. Ma describes the evolution of dry needling from the concept of points, such as trigger points and acupuncture points, to the idea of an innervation field supplied by peripheral nerves. Precisely palpating and needling ideological points is acceptable, but may be clinically unnecessary. He illustrates how needling into the innervation fields, not the points, supplied by peripheral nerves, can achieve the same clinical results. 

chapter 2 and 3 discusses the different models of dry needling and how they differ in theory and application. Attempting to determine if one model is superior to another is not possible, as comparative research does not currently exist. Potentially all models are equally effective if practiced by well trained practitioners. He instead suggests that integrating all models into a global treatment paradigm may result in greater clinical efficacy. 

In chapters 4 and 5, the physiological mechanisms of needling are emphasized to enhance the clinicians’ understanding of the procedure regardless of the chosen theory or model. The effects of inflammation and edema are expertly broken down into relevant information that is not written from a scientific perspective but one that is clinically enlightening. This deeper understanding of the needling mechanism allows the reader to appreciate the systemic influence that dry needling has on the nervous, cardiac, immune and endocrine systems 

chapters 6 and 7 address the complex subject of the central and peripheral neurological mechanisms of pain. Moreover, these chapters describe the influence of dry needling on all levels of the nervous system for pain management. Pain can appear anywhere in the human body; knowledge of peripheral nerve innervation patterns is imperative. The relevant neuroanatomy is presented to assist in understanding how this “hardwiring” serves as a conduit for the systemic nature of pain and the effects of dry needling. In these chapters the reader acquires a greater appreciation for the influence of the nervous system in signaling, maintaining and ultimately resolving pain. 

In chapter 8 an updated and detailed description of the 24 homeostatic points and the important role they play in understanding how pain is propagated by the peripheral nervous system is explained. In chapter 9 the neurosegmentation of the body is outlined and the relationship of segmental innervation to the homeostatic treatment concept is described. Both of these neurological constructs are used with peripheral nerve mapping of musculoskeletal pain and dysfunction 

chapter 10 provides the clinician with a tool to predict the efficacy of dry needling treatment using a Quantitative analysis. It is explained that the level of sensitivity of the peripheral nervous system is directly related to the degree of central sensitization, or in other words, the healing potential of the 

patient. The greater the level of central sensitization the individual possesses, the poorer the prognosis for pain modulation that may be provided by dry needling treatment. 

chapters 12, 13 and 14 describe commonly encountered lumbopelvic, upper and lower limb conditions, their genesis and the rationale for using dry needling as part of the treatment regimen. 

chapter 15 provides the functional neuroanatomy and muscle innervations for all the major peripheral nerve roots. This chapter assists the clinician in the mapping of peripheral nerve symptoms to direct proper dry needling intervention. chapter 16 further expands the neurological model with the addition of electrical dry needling (edn). Benefits, precautions and clinical application are outlined to maximize the safety and efficacy of edn. 

chapter 17 informs the reader on the current safety issues, potential adverse reactions and their management, when applying dn. The final chapter outlines the current protocols for managing the potential risks from blood borne pathogens associated with the practice of dry needling. relevant OsHA’s standards are discussed to assist the clinician in developing policies and procedures for implementation of dry needling into their clinical practice. 

One of the major features of the systemic approach of this dry needling model is to stimulate the peripheral nerves to organically rebalance the human biomechanics to achieve musculoskeletal homeostasis. Both human physiologic and biomechanical homeostasis are naturally combined together through systemic approach. 

I met dr. Ma in 2007 while attending my very first dry needling course; it did not take long before I witnessed his passion and deep understanding for the art and science of dry needling. ever since those early years, Integrative dry needling (Idn) has certainly helped shape the way in which I practice, as it has for the thousands of the Idn students we have trained. dr. Ma and I became friends, colleagues and now as the President of dr. Ma’s Integrative dry needling Institute, I find myself in a unique position to lead the Idn concept to the next level. I coined the term the 3rd generation of dry needling, which represents our current body of knowledge. This textbook represents the culmination of diverse knowledge and experience; it contributes a fresh perspective with progressive thinking that bridges the gap between the science of dry needling and its clinical application. I believe it will serve as the compass to the 4th generation of Integrative dry needling. 

– Frank Gargano, PT, DPT, OSC, CLDN, MCTA, 

President, Dr. Ma’s Integrative Dry Needling Institute, LLC,Solon, Ohio