Dry Needling

Trigger Point Dry Needling (TDN) is an effective treatment for myofascial (muscle) pain. Dysfunctional muscles can have localized pain and can cause referred pain at a location away from the actual muscle. Trigger point dry needling uses small, thin needles, like acupuncture needles, that are inserted into the trigger points of dysfunctional muscles. When the needle mechanically stimulates the trigger point it causes a reaction that helps to disengage the active trigger point and release the muscle. By disengaging and desensitizing the trigger point, the dysfunctional muscle will have improved flexibility and diminished symptoms.

A trigger point is a discrete, focal, hyperirritable spot located in a taut band of skeletal muscle that often refers pain. Trigger points develop in muscles, mainly in the center of a muscle belly and present with palpable nodules and taut bands found within the tight muscle. Trigger points can be found in any skeletal muscle of the body.  Trigger points can be caused by acute trauma or repetitive muscular stress causing micro trauma to the muscle.  When a trigger point is palpated properly it often has a twitch response or jump sign associated with it. A twitch response is when the trigger point can be touched in a way to cause a mini contraction. A Jump Sign is when the trigger point is pressed firmly causing the patient to jump or move due to pain caused by the pressure. Trigger points are often associated with chronic musculoskeletal disorders. Common causes of trigger points include:

• Ageing
• Traumatic Injury
• Poor Posture
• Lack of Exercise
• Repetitive Muscular Stress
• Muscle overuse and microtrauma
• Chronic Stress Conditions (Anxiety, Depression, Psychological Stress Trauma)
• Vitamin Deficiencies
• Sleep disturbances
• Joint Laxity or Hypermobility Syndromes

Symptoms of trigger points are persistent pain that results in increased tone of the involved muscle.  Increased tone in a muscle can cause localized or referred pain, decreased range of motion, and dysfunctional joint function. Trigger points are directly related with Myofascial Pain Syndromes. Myofascial pain syndromes refer to regional pain of soft tissue that is associated with muscle tenderness that arises from Trigger Points and can be found in multiple sites in muscle and the fascia that surrounds muscle tissue.

Dry Needling is a therapeutic treatment to improve and resolve myofascial pain syndromes, muscular tightness, and spasm which commonly follows injuries, accompanies the degenerative processes, and chronic musculoskeletal conditions. Muscular tightness and spasm can cause reduced mobility, excessive compression and irritation of muscles, joints, and nerves in the body.  These conditions can cause increased pain and stimulate our myofascial pain receptors. When our body receives stimulation from our pain receptors it reacts by causing protective spasms to muscles that surround the dysfunctional area. Areas of dysfunction can also lead to conditions and pain syndromes away from the initial source of dysfunction. Conditions may include peripheral diagnoses such as carpel tunnel, tendonitis, osteoarthritis, decreased mobility and chronic pain.

“Is Dry Needling that same as Acupuncture” is a common question from our patients.  The primary similarity is that trigger point dry needling and acupuncture use the same type of needles.  Other than the needle, the two techniques have very different methods of treatment.  

Acupuncture is a highly recognized alternative treatment technique that addresses energy flow in the human body.  Meridians are energy highways that Acupuncturists will evaluate a patient’s energy flow by assessing their pulses. The goal of acupuncture is to rebalance a patient’s energy flow.  Poor energy flow can be associated with poor health, dysfunction, medical conditions, and disease. 

Dry Needling is a well-recognized specialized therapeutic skill to address myofascial pain syndromes.  A Physical Therapist who is a Certified Dry Needling Specialist will assess the patient for trigger points by locating palpable nodules within taut bands in the surrounding tissue of the injury.  A trigger point can be confirmed by the therapist producing a twitch response or jump sign.  Once the trigger point is located the thin needle is inserted into the trigger point.  Needling techniques can include a pistoning motion (up and down), twirling motion, or the needle can be left in the muscle for several minutes and connected to electric stimulation.  The goal of dry needling is to eliminate the active trigger point, resolve dysfunctional muscular tightness, improve the cellular circulation, and resolve the patient’s movement dysfunction and pain.

Improvement after dry needling is determined not only by whether your pain has improved, but by how much your body shows improvement in your functional movements. Generally, it takes a few sessions to have a positive effect, though many people can feel an immediate decrease in pain and an increase in mobility. When your body is aligned properly, moves better, and functions better it often responds by reducing the pain you feel. You often will show improvements in the muscle tightness, improvements in joint motion, and improvements with dysfunctional joints after one treatment. However, to eliminate a patient’s pain requires sustained improvement in all the categories discussed above. To maintain improvement often requires several treatment sessions that combination of myofascial techniques (including dry needling), manual therapy techniques, and targeted exercise that specifically addresses your body’s biomechanical dysfunctions. As your body progressively improves your pain will diminish over time and often resolves.

It is common to have soreness in the muscles that were needled for 24-48 hours.  Soreness can linger sometimes, but should dissipate each day.  

Following dry needling treatments, you should:

1. Promote circulation in the muscle that was needled. 
   1. Keep Moving: you want to frequently and repetitively move the body part that was needled.  Go for a walk after having your lower extremity needled.  Shoulder rolls and repeated movements 
   2. Avoid sedentary positions (long drives, prolonged sitting) after dry needling. 
   3. Use heat, not ice.  Heat will increase the circulation in the area that was needled.  Taking a hot bath, hot shower, or heating pad will help promote circulation.  Ice will restrict microcirculation of a muscle and should not be used immediately after needling. 
2. Stay Hydrated.
   1. Drink lots of water to help promote better cellular circulation and health.
   2. Limit diuretic drinks by limiting caffeine and alcohol in your drinks. 
3. Light stretching of the muscles that were needled.