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Trigger Point Dry Needling

 

 image1What is dry needling?

Dry needling involves the use of a fine filament needle to de-activate a Trigger Point within a taut muscle band. Dry needling is a treatment for muscular tightness and spasm which commonly follows injuries and often accompanies the degenerative processes.  This muscular tightness and spasm can cause compression and irritation of the nerves exiting the spine. When the nerves are irritated, they cause a protective spasm of all the muscles to which they are connected.  This may cause peripheral diagnoses, such as carpel tunnel, tendonitis, osteoarthritis, decreased mobility and chronic pain.  Small, thin needles are inserted in the muscles at the trigger points causing the pain referral.   The muscles would then contract and release, improving flexibility of the muscle and decreasing symptoms. 

What are trigger points?

The classical and most commonly used description of trigger points is that defined by Travell and Simons. The presence of exquisite tenderness at a nodule in a palpable taut band of muscle. Trigger points are able to produce referred pain, either spontaneously or on digital compression. Trigger points are likely the underlying cause of myofascial pain syndromes. 

What are the goals of dry needling:

Dry Needling uses filament needles to inoculate minor lesions into the soft tissues (skin, muscles, fascia, tendon and ligament, etc) to activate the healing process, resulting in pain relief and restoration of healthy physiology.

    • The Primary goal of Dry Needling is to desensitize supersensitive structures and restore motion and function.
    • Releasing muscle shortening
    • Removing the source of the irritation by needling shortened paraspinal muscles
    • Decrease spontaneous electrical activity (SEA) at the site of the Trigger Point
    • Promote healing (needle produces local inflammation)

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How does dry needling work:

Dry Needling improves function and reduces pain achieved through mechanical, neurophysiologic, and chemical mechanisms:

  • Mechanical effects:
  • Dry Needling causes relaxation by mechanically disrupting a dysfunctional motor end plate
  • Needling results in a Local Twitch Response (LTR)
  • The LTR results in an alteration to muscle fiber length as well as having an inhibitory effect on antagonistic muscles
  • Neurophysiologic effects:
  • Baldry (2001) suggests that dry needling techniques stimulate A-nerve fibers (group III) for as long as 72 hours post needling
  • Prolonged stimulation of the sensory afferent A- fibers may activate the enkephalinergic inhibitory dorsal horn interneuron’s, which implies that dry needling causes opioid mediated pain suppression
  • Another possible mechanism of dry needling is the activation of descending inhibitory systems which would block noxious stimulus into the dorsal horn
  • Chemical effects:
  • The LTR may also utilize the excessive ACh in the tissue which previously was triggering increased firing of localized fibers
  • Studies by Shah and colleagues (2001) demonstrated increased levels of various chemicals at sensitized motor end plates such as: Bradykinin, Substance P and CGRP (regulator of Calcium and Phosphate balance). These chemicals were reduced immediately post a LTR
  • CGRP enhances the release of ACh from nerve terminals, which results in increased ACh receptors at the neuromuscular junction
  • Needle penetration will cause micro-trauma and micro bleeding (localized inflammation) and hence the introduction of PDGF into the area to help promote healing

In summary:

Tiny injuries created by the needle insertion cause a local healing response in the dysfunctional, painful tissue, which restores normal function through the natural healing process.

Dry Needling stimulates neural pathways which blocks pain by disrupting pain messages being sent to the central nervous system. The pain control process occurs by:

Opioid suppression at the spinal cord level.
Stimulates the gate mechanism of pain control.
Activating neurotransmitters in the central nervous system, which contribute to a systemic pain inhibiting effect, and this neurotransmitter response extends the therapeutic benefit to other areas of the body.
Dry Needling causes a local chemically mediated response through the release of Bradykinin, Substance P, and other body proteins and neurotransmitters, which block the transmission of pain messages.

What is the difference between the needles used for dry needling and syringe injections?

Dry Needling is a general term that describes the use of a needle to stimulate the soft tissues of the body for a positive health outcome outside of the theoretical paradigm of Acupuncture. Previously, syringe needles were used without any injectate in order to treat the “trigger point”. The move to use solid fine filament needles for dry needling was made in order to make the procedure more comfortable for the patient and to reduce the possibility of the needle to cause damage to the tissue. A syringe needle has a beveled edge necessary to “cut” through the tissues, while the solid fine filament needle is a very sharp cone shape which separates the tissue rather than cutting through it. This needle is often only 20% the diameter of the typical 18 or 20 gauge needle.

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Who can be helped with dry needling?

  • Chronic pain patients that have tried many other treatments without or limited benefit.
  • Athletic population that have good overall health but have a specific reoccurring injury.
  • Elderly Population – They often have few resources for pain management due to the condition of the body and inability for significant & safe home exercise programs.
  • Anyone with pain and dysfunction!
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    Should you schedule an appointment?

    Please contact our clinic to schedule a consultation to determine if trigger point dry needling will benefit you!

    We are both certified in trigger point dry needling and acupuncture. We don’t believe one is better than the other, but believe the appropriate treatment is always the best option – and we have found that many patients benefit from a combination of dry needling, acupuncture and all of the treatment measures utilized in our clinic.