What is trigger point dry needling?
Trigger point dry needling (TDN) is an effective treatment for muscular tension and discomfort. Physical Therapists use TDN in the treatment of myofascial pain, which commonly accompanies conditions such as arthritis, joint degeneration/damage, nerve irritation, muscular strain, ligament strain and disc injuries. It is called “dry” needling because there is no solution injected; instead, the needle itself and the effects it produces within the muscle tissue are the treatment.
TDN is a minimally invasive procedure in which a solid filament needle is inserted into the muscle directly at a myofascial trigger point. This creates a local twitch response (a reflex) which is both diagnostic and therapeutic. Research shows that the twitch response decreases muscle contraction, reduces chemical irritation, improves flexibility and decreases pain over time.
What type of problems can be treated with trigger point dry needling?
TDN can be used as a treatment option for a variety of musculoskeletal problems. Muscles (and fascia) can be primary sources of pain and can cause symptoms along with biomechanical changes in the system. When a trigger point is released, normal balance (strength, mobility, etc) are restored, alleviating the symptoms and often the cause of the pain. Some examples of conditions that see strong improvements after TDN in the research include:
neck pain
headaches, jaw pain & TMJ
back pain
shoulder pain (and all associated diagnoses)
arm/elbow pain (carpal tunnel, tennis elbow, etc
knee pain
buttock & leg pain (sciatica, hamstring tendonitis, etc)
ankle & foot pain (plantar fasciitis, achilles tendonitis, etc)
How does trigger point dry needling work? What does the current research say?
The exact mechanisms of TDN are unknown. What research has shown, is that there are consistent significant mechanical and biochemical effects of the process. Based on studies by Dr. Jay Shah and colleagues at NIH, we know that inserting a needle into trigger points (TrP) causes favorable biochemical changes, which assist in reducing pain. It is essential to elicit the "local twitch response," which is a spinal cord reflex.
Want more science? Here's a short summary of some current theories in the literature:
Neurophysiological & Chemical effects (Theories)
Baldry (2001) suggests that dry needling techniques stimulate A-nerve fibers for as long as 72 hours post needling.
Prolonged stimulation of the A-nerve fibers may activate the inhibitory dorsal horn interneurons, which implies that dry needling causes mediated pain suppression.
AKA: a possible mechanism of dry needling is the activation of descending inhibitory systems which blocks painful stimulus in the dorsal horn (the part of the spinal cord where pain transmissions are received).
Studies by Shah and colleagues (2001) demonstrated increased levels of various chemicals at trigger points. These chemicals included: bradykinin (a painful chemical when in muscle), substance P (a chemical pain simulator), acetylcholine (ACh) and CGRP (a regulator of Calcium and Phosphate balance - both of which determine muscle contractility).
These chemicals contribute to muscle tightness & in the wrong quantities, change pH levels.
After trigger point dry needling, these chemicals were reduced immediately (post a local twitch response).
Though unproven, the localized twitch response is also thought to utilize the excessive ACh (acetylcholine) in the tissue. This eliminates the increased firing of localized fibers that occurs when it is in large amounts, thus allowing the muscle to "relax."
But why did this "trigger point" occur in the first place?
When an injury occurs from repetitive use, overuse or sudden trauma, inflammation is produced at the damaged tissues.
The damaged tissues then go into a protective tense state, or contracture, to guard against potential further damage that might occur with continued use of the injured tissue. When palpating this muscle, the therapist will feel a "taut band" and then search for nodules of increased tightness. Within this nodule are several "contraction knots."
These knots are areas of inflammation & tightness - both of which inhibit micro-circulation, limiting the oxygen rich blood reaching the injury and the waste products leaving the injury. The injury site becomes hypoxic (decreased in oxygen), changes is pH (becomes more basic/less acidic).
Over time, this stimulates the body to produce fibroblasts, a cell that produces fibrosis or scar tissue. This fibrosis and scarring builds up around the muscles and tissues limiting the tissues ability to fully function (lengthen/shorten) and can also cause compression and irritation of nerves – all of which inevitably lead to biomechanical disturbances in movement and function.
So basically, this trigger point occurred because life happens. (It's frustrating right?)
Where does trigger point dry needling fit into the entire rehabilitation program?
Generally speaking, there is no "one fix" for pain. As such, TDN represents only a part of your whole physical therapy plan of care. In the case of myofascial pain, trigger point dry needling offers a quick and effective means of restoring motion and decreasing pain that will compliment other treatments we use at ACRO PT (manual therapy, corrective exercise, patient education & activity modification and other modalities).
Frequently Asked Questions
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No. While there are similarities between the methods, trigger point dry needling is based on Western medical research and principles, whereas acupuncture is based on Traditional Chinese Medicine. While both use the same sterile, disposable solid filament needles, the goals and theories behind the practices are quite different. It is important to note that licensed physical therapists in a growing number of states can use TDN under their scope of their practice (after training and certification), while they cannot practice acupuncture.
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Most patients do not feel the insertion of the needle. The local twitch response elicits a very brief (less than a second), sometimes painful sensation. Some patients describe this as a little electric shock, while others feel it more as a cramping sensation. Again, the therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.
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Yes, we only use sterile needles. All physical therapists that have been certified in trigger point dry needling are aware of, and practice safe clinical hygiene techniques. This minimizes the risk of infection and keeps patients, and providers safe.
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Most patients report being sore after the procedure. The soreness is described as muscle soreness over the area treated and into the areas of referred symptoms. Typically, the soreness lasts anywhere between several hours and a few days.
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Our recommendations vary depending on the amount of soreness that you have and on the individual response to the treatment. As each case is different, Angie will give you specific instructions based on your needs. Often though, we will recommend ice/heat to the area, increased water intake and focal (gentle) stretching to take advantage of the increased mobility in the muscle.
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Typically, it takes several visits to see a consistent positive change in function/pain. As many conditions did not "appear overnight," neither does their resolution. With trigger point dry needling, we are trying to cause biochemical and mechanical changes without any pharmacological means. Therefore, we are looking for a cumulative response over time to achieve a certain threshold after which the pain cycle is disturbed.
That said, most patients do notice an immediate change - whether it be a decrease in stiffness, less tightness or more motion. These changes are important to take note of, and often help to direct subsequent treatments and physical therapy interventions.
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In the US, TDN is viewed by many as a "newer modality." While it has been in practice for several decades, trigger point dry needling has only been published/discussed in American medical literature for the last 15 or so years. Until that time, there were few researchers studying it (and with little funding), so it did not gain much traction in the profession. But, with time and good results, more people began to look at it as a source of pain relief. Increased interest brought increased funding and more studies were done. There's more out there on the subject now, so more people are being introduced to the procedure.
If you're interested, feel free to inform your doctor about this treatment option and open a dialogue with them. We are happy to provide you (and your doctor) with copies of relevant literature to assist in spreading the word about this effective modality and helping you both decide if this is a treatment that would benefit your care.
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The musculoskeletal system is under constant pressure from gravity, stress, work, etc. A regular exercise program combined with things like good posture & nutrition are essential for keeping you healthy. Once we break the pain-cycle, it is our goal at ACRO PT to give you the tools to maintain that relief. Like all physical therapy techniques, trigger point dry needling is meant to be a means to repair and restoration. Once you reach a point where it is no longer required in your care, it will be discharged from your treatment. After all, physical therapy is designed to give you back your function and help you maintain it - not be a constant requirement for your long-term day-to-day lifestyle!
That said - if the pain comes back, or things change, we will be here to help. Never worry - you can call, email or message us anytime for help and answers!
Questions? Concerns? Thoughts in general? Message us below and we would be happy to answer them for you on a one-on-one basis!