Trigger point dry needling – Is it for you?
The majority of people I have met, tend to avoid needles at all cost, and perceive it as a painful experience. What if I told you that needles could potentially relieve your pain? You might have heard your local physio or friends mention the terms Trigger Point Dry Needling or Acupuncture, but what is it and how does it work?
Firstly, Eastern Acupuncture is based on Traditional Chinese medicine, whereas Trigger Point Dry Needling techniques are based on Western medical research, principles and studies. There is also Western Acupuncture, which utilizes traditional Chinese meridian points, but with a western medical approach.
Trigger point dry needling is a procedure in which an acupuncture-like needle is inserted into the skin and muscle in the location of a myofascial trigger point with the primary goal of reducing pain and restoring range of motion.
Myofascial pain syndrome
Myofascial pain syndrome is a regional muscular pain condition characterized by, myofascial trigger points (MTrPs) found in one or more muscles and/or connective tissues. Myofascial pain syndrome (MPS) is associated with hyperalgesic zones (abnormally sensitive/painful areas) in your muscles called myofascial trigger points.
It is estimated that MTrPs are the primary cause of pain in approximately 30–85% of patients with musculoskeletal disorders. When palpated, active myofascial trigger points cause local or referred symptoms, including pain. For example when palpating through an active trigger point in gluteus medius or piriformis (Posterior hip muscles) symptomatic patients often feel referred pain down the back of the leg.
Myofascial pain can be associated with but is not limited to:
- Muscle spasms
- Increased sensitivity (including pins and needles and numbness)
- Muscular stiffness
- Muscle weakness
- Decreased range of motion
- Autonomic dysfunction
The process of dry needling
Dry needling uses a very fine, solid filament needle that is inserted into a contracted painful knotted/tight muscle to create a local twitch response which is both diagnostic and therapeutic as it is the first step in breaking the pain cycle. The twitch response is a localized, reflexive response of a dysfunctional area/muscle. The twitch response aims to improve muscle function at the neuromuscular junction to reduce pain allowing the patient to commence a rehab program to prevent re-injury from occurring.
During the needling process needles are removed once the trigger point is deactivated, typically within 1-2 seconds. Dry needling reducespain in the short term and when combined with a home exercise/stretching program prescribed by your physiotherapist or exercise physiologist relaxes the actin-myosin bonds in the tight bands (resulting in some muscle lengthening) in your muscles to produce long term pain relief and improved muscular function1.
The twitch response reduces pain in the short term by improving the muscles function allowing long term strategies to be implemented by your physio to permanently reduce pain, improve muscle strength, movement control, biomechanics and muscle activation patterns.
In summary this means that if we do not induce a twitch response it minimizes the expected improvements from your dry needling session. In summary, twitches induced by dry needling are good!
What to expect following your dry needling session
Studies have found that patients have greater pain relief and range-of-motion increases instantly following dry needling releasing the active myofascial trigger points. In summary a 2017 systematic review of 15 recent studies found that dry needling is effective in producing:
- Instant pain relief/reduction
- Increased range of motion
- Improved quality of life when compared to no intervention/sham/placebo interventions.
- Occasionally dry needling can produce minor bruising and/or cause the patient to feel fatigued. This does not always happen but it is normal. Following treatment drinking water, gentle stretching and icing bruised areas can help to reduce/avoid soreness.
- Common conditions treated by Dry Needling
- Acute/chronic neck and lower back pain
- Shoulder Pain
- Cervicogenic headaches
- Hip and gluteal pain
- Tennis & Golfer’s elbow
- Arthritic conditions (e.g. knee pain)
- Muscle and/or ligament sprains (in conjunction with a rehab program)2
Does dry needling hurt during and after treatment?
Patients may or may not feel the actual needle insertion however as the dry needling process elicits a local twitch response a brief cramping/painful sensation lasting less than or up to one second is produced. Patients report feeling slightly tender or a mild dull ache between a few hours or up to 2 days following the needling process. It is important to remember that the therapeutic pain relieving response occurs following the twitch response that aims to improve neuromuscular function.
If you have any further questions regarding whether or not trigger point dry needling is for you or whether it will be beneficial for your specific condition feel free to give us a call or book a Back In Motion Free Initial Assessment to discuss your treatment options.
1 Kietrys, D., Palombaro, K., Azzaretto, E., Hubler, R., Schaller, B., Schlussel, J., & 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. doi: 10.2519/jospt.2013.4668
2 Espejo-Antúnez, L., Tejeda, J., Albornoz-Cabello, M., Rodríguez-Mansilla, J., de la Cruz-Torres, B., Ribeiro, F., & Silva, A. (2017). Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complementary Therapies In Medicine, 33, 46-57. doi: 10.1016/j.ctim.2017.06.003
Article written by Llewellyn van Loggerenberg, Physiotherapist and Trigger Point Dry Needler