David G. Simons, MD, co-author of the Simons, Travell, and SimonsTrigger Point Manual, has stated that, “Since no medical specialty claims skeletal muscle as their organ, it is often overlooked.”
Indeed, several studies have confirmed that myofascial pain is one of the most commonly ignored causes of persistent pain. Many of our patients report that previous healthcare providers rarely have included the detailed and specific muscle examination that is common at Clarity Physical Therapy. The hallmark feature of myofascial pain syndrome is a so-called “trigger point,” which can be responsible for prolonged pain and dysfunction. A common characteristic of trigger points is referred pain, which may confuse those clinicians who are not familiar with common referred pain patterns. Dr. Janet Travell, MD, perhaps best known as President Kennedy’s White House physician, has mapped out the referred pain patterns of most skeletal muscles.
Although trigger points and myofascial pain are poorly recognized worldwide, there is a growing number of scientific studies that confirm that trigger points are indeed a very common source of pain and dysfunction. Trigger point dry needling is one of the most effective treatment options to inactivate myofascial trigger points.
What Is Dry Needling (DN)?
Dry needling is an invasive procedure in which a solid filament needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle. The needle can treat very deep parts of the muscle, allowing the ability to achieve significant pain relief.
How Does DN work?
Myofacial pain is caused by trigger points (TrP), which are hyperirritable spots in taut band of a skeletal muscle, that usually refer feature referred pain. In TrP and in the surrounding area there is decreased blood flow, decreasing oxygen in and around the TrP. When the muscle is deprived of blood rich oxygen it results in a low pH or acidic. Results have been measured through microdialysis studies. These studies, demonstrate the sensitization around the TrP, resulting in a lower threshold for activation of nociceptors (pain response), meaning that with active TrP present the amount of stimulation to result in pain has lessened, ie the lower threshold. An acidic chemical milieu of CGRP, bradykinin, STP, 5-HT, PG and excessive ACh all have a profound effect on the initiaion and perpetuation of muscle pain. The needle breaks up and releases the TrP, allowing the muscle to return to normal pH levels, decreasing pain locally and often referred pain.
Will DN Help Me?
DN works best when the muscles are one of the sources of your pain. With the DN technique the therapist is able to treat certain muscles in the body and can treat the muscle at depths impossible with other types of bodywork. DN is not appropriate for people with recent injuries that are swollen and acutely painful.
Does The Needle Hurt?
Because filament needles are very fine and solid, they don’t hurt as they pass through the skin like a hollow injection needle does. The local twitch response elicits a very brief (less than a second) painful response. Some patients describe this as a little electrical shock; others feel it more like a cramping sensation. Again, the therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.
How Many Needles Will I Need?
We will start very slowly during the first session to give you a feel for the technique. The first session will focus on a few muscles that are key to your problem. These key areas can give you excellent relief with less soreness. Subsequent treatments will target more specific areas to fine-tune the effect. Sessions are usually spaced 2-5 days apart and you should expect to feel a marked difference after only 1-2 sessions.
During the Treatment
You will be in a comfortable position; usually lying on your stomach, your side, or on your back. When the needle is inserted you may feel a little prick through the skin. However, when the muscle is relaxed, you will not feel the needle at all.
If the muscle is tight, there will be some soreness. When the needle touches the trigger point it will elicit a local twitch response. This twitch is very brief and unexpected. It can be momentarily uncomfortable. During your visit, multiple trigger points in several areas will be treated.
How Will I Feel After TDN?
You will know positive change has occurred right after the session, because you will be sore in the way that you would feel after too much activity. The muscle will feel fatigued and the soreness can last from a few hours to 1-2 days but should not interfere with your everyday activities. We encourage you to be active during this time to keep the soreness to a minimum. After a day or so, you’ll experience a new feeling of less pain and tightness that will last. The chronic injury you thought was there to stay would actually start to improve. Please call us today to give DN a try. Dry needling could be the ideal treatment choice for your condition.
Identifying Trigger Points
It has been theorized that dry needling destroys the motor end plate, triggering normal muscle regenerative processes. Dry needling has been shown to reduce peripheral sensitization as well as central sensitization, by modulating descending inhibitory pathways and enhancing activity in the areas of the brain involved in pain reduction and a sense of well-being.
Click here for a comprehensive guide to trigger point referral patterns.
What are the advantages of Dry Needling?
The advantage of Dry Needling over other techniques is that we can treat parts of the muscle and deeper layers of muscles, which our hands and fingers cannot reach. Also, this method is far superior in achieving a local twitch response over other manual techniques. In addition, there are no drugs used so we can treat many trigger points during each treatment.
Relief and deactivation of the trigger points can bring considerable relief of symptoms, then we can train the muscles to work in their newly-gained pain free range of motion. Thus, results are achieved with dry needling which cannot be obtained with any other treatment.
Dry Needling, combined with manual physical therapy treatment most of the musculoskeletal pain syndromes including the following conditions:
- Neck and Lower back pain
- Hip Pain
- Knee Pain
- Sciatic Pain
- Frozen Shoulder
- Tennis and Golfer Elbow
- Chronic pain conditions
- Muscle Spasms
- Headaches and whiplash
- Dry Needling treatment is never a treatment by itself. It is always done in conjunction with other forms of physical therapy treatment. These may include exercises, postural training, education, and other hands-on techniques such as soft tissue work and manipulation.
- Dry Needling is only “one” component of a multidimensional treatment approach, geared at creating a successful outcome for you.
Related research articles can be found here.
Finally, Dry Needling must not be confused with any type of acupuncture. The therapist has completed comprehensive course study and has obtained the certification required by the state of IL to practice the advanced skill of Intramuscular Manual Therapy Dry needling.