Trigger Point Dry Needling: What You Can Expect

There are many causes of pain coming from the musculoskeletal system in the body. We practitioners who are mostly involved in the treatment and care for the joints, muscles and bones of the body are well aware of the different methods involved in assessing the different pain sources and developing a plan in order to treat the source(s) of pain. One of the most common sources of pain, specifically from the muscles, is pain from myofascial trigger points. ( MTrP abbreviated).

A MTrP is briefly defined as, “a hyper-irritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. This spot is tender when pressed upon, and can give rise to characteristic referred pain, motor dysfunction and autonomic phenomena….’ (Simons et al, 1999) A trigger point develops in a muscle when normal muscle function is compromised and/or a muscle is overworked. When trauma or overuse in a particular muscle causes its neural end plate to release excessive amounts of a neurotransmitter called acetylcholine (ACH) the muscle will contract. If the contraction is prolonged, the muscle will experience an “energy crisis”, meaning the portion of the muscle that is continuing to contract is utilizing significant amounts of oxygen and nutrients in order to sustain a contraction and the supply of energy will become deficient. The energy crisis will lead to the release of sensitizing substances that stimulate the nerves in the area producing pain. (3) This contraction will continue until something is done to reduce the ACH release and normalize the sensitivity at the end plate of the nerve breaking the chemical cycle, relieving the energy crisis, and re-establishing normal circulation into the area. We believe that trigger point dry needling is an effective method used to treat the sensitive knots and taut bands in muscles containing MTrPs and re-establishing normal, pain-free muscle function. (1)(2)2)

Like acupuncture, trigger point dry needling utilizes the same type of filiform needle in order to treat the trigger points in muscles.(see video comparing acupuncture and TPDN needles/methods needles/methods). The main differences between acupuncture and trigger point dry needling methods are twofold: 1) acupuncture needling technique is used to stimulate certain acupoints along an acupuncture meridian in order to gain a particular change in energy flow over that point or meridian. Trigger point dry needling treatment is only addressing the tender and taut bands within muscles that contain trigger points; 2) most acupuncture treatments will include multiple needles that are inserted into the acupoints and remain for at least 30 min. Trigger point dry needling techniques consist of inserting a needle into a trigger point looking for a “twitch” response from the muscle, and then the needle is removed. One trigger point at a time is treated and then on to the next.

At Arvada Sport and Spine Group, we are often asked if trigger point dry needling hurts. It has been our experience that most people are very surprised at how little pain is involved during the dry needling treatment. One usually feels the initial “pin prick” as the needle first enters the skin, but in most cases, there is only some minor discomfort but not intense. Now and again a very tender trigger point, one that has been present for a long period of time, may produce significant discomfort while needling. This increased sensitivity in this point will usually reduce well in subsequent treatments.

One can expect an occasional minor bruise at a needle insertion point from dry needling as well as from acupuncture and just about any other treatment form that utilizes a needle to puncture the skin. This bruising will reduce in just a few days to a week.

As a general rule, we will have the patient use heat on the treated area for about 15 min., and drink plenty of water after a dry needling session. This is helpful in reducing the potential for soreness as well as helping the body rid itself of the substances that were congesting the muscles, much like one would do after a deep tissue massage.

We like to utilize trigger point dry needling in many conditions such as:

• muscleinjuries,
• golfer’s elbow or tennis elbow
• plantar fasciitis
• TMJ
• Headaches
• Tight/sore shoulders and other postural conditions where muscles are overworked
• Rotator cuff and impingement
• Knee pain
• Deep thigh bruise
• Chronic neck pain
• Chronic back pain
• Spasms in the neck and back

These are just some of the conditions that we have used Trigger Point Dry Needling for over the many years we have been performing the treatment at the clinic.

Please give us a call at Arvada Sport and Spine Group if you would like to try dry needling or if you have further questions regarding the pain you are experiencing.

Gary Spears, D.C., F.I.A.M.A.

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References:

• Kietrys, D., Palombaro, K., M., Azzaretto, E., Hubler, R., Schaller, B., Schlussel, J., Mathew, & Tucker, M. (2013) Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain:A Systematic Review and Meta-analysis.Journal of Orthopaedic & Sports Physical Therapy, 43(9), 620-634
• Gattie, E., Clelenad, J.A., & Snodgrass, S.(2017)The Effectiveness of Trigger point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis.The Journal of Orthopaedic and Sports Physical therapy, 47(3), 133-149
• Awad EA.: Interstitial myofibrosis: hypothesis of the mechanism.Archives of Physical Medicine 54:440-453. 1973