TRIGGER POINT DRY NEEDLING

What is trigger point dry needling? Trigger point dry needling or (TDN) is a treatment technique which uses small filament or acupuncture type needles to release tight muscles. The goal is to permanently reduce muscle pain and dysfunction. Physical therapists are now using this technique around the world to effectively treat acute and chronic orthopedic and musculoskeletal conditions. Dry needling uses a small needle for deactivation and desensitization of a myofascial trigger point. This technique should stimulate a healing response at the tissue and reduce the biomechanical stress of the muscle treated. TDN can help patients reduce muscle spasms and combined with other therapies, can eliminate mysofascial pain.

What is myofascial pain syndrome? Myofascial pain syndrome is a disease of the muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and a sensory abnormality (tenderness and referred pain). Myofascial pain syndrome is classified as a musculoskeletal pain syndrome that can be acute or chronic, regional or generalized. It can be a primary disorder causing local or regional pain syndromes or a secondary disorder that occurs as a consequence of some other condition. This is a treatable condition which can respond well to manual and injection techniques but requires attention to postural, ergonomic, and structural factors.

What is a trigger point?  The term “trigger point” was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:

• Pain related to a discrete, irritable point in skeletal muscle or fascia not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
• The painful point can be felt as a tumor or band in the muscle and a twitch response can be elicited on stimulation of the trigger point.
• Palpation of the trigger point reproduces the patient’s complaint of pain and the pain radiates in a distribution typical of the specific muscle having the trigger point.
• The pain cannot be explained by findings on neurological exam.

 Overall, TDN is a treatment that addresses dysfunction of the neuromuscular system. Trigger points develop in the muscle secondary to various stresses (i.e. postural, repetitive motion, psychological, emotional etc.) and are more likely to develop in tissue that has neurological dysfunction. Most dysfunctions are caused by compression, disc dysfunction, facet joint dysfunction, vascular compression, metabolic stress, biomechanical stress, and postural abnormalities. When muscles develop trigger points, they neurologically remain tight causing local compression of vascular, neurological and joint/biomechanical structures hampering the normal function of that tissue. All tissues away from the involved nerve will likely be involved. If you adequately release the muscle, the tissues are then allowed to resume normal function with improved neurological conduction and vascularity.

Lastly, TDN is a treatment that uses acupuncture needles but that is where the similarity to acupuncture ends. Acupuncture tends to be a more superficial treatment that focuses on restoring energy or “Qi” to the body. It is thought there are blockages that can be restored by properly placing needles along energy channels called meridians. TDN directly treats the neuromuscular system affecting muscle tightness, joint mobility and symptoms of pain and irritation. Testing active trigger points with an EMG needle has shown there is increased spontaneous electrical activity causing the nerve muscle connection to trigger the muscle to be tight. This tightness can cause a decrease in joint movement and many times will restrict the joint enough to limit normal functional activities of the whole body. Relatively new research has reported that there are numerous inflammatory and pain producing chemicals at an active trigger point causing pain and dysfunction of the muscle, consequently affecting the local nerves and joints.

TDN has been shown, when causing a twitch response in the acute trigger point and muscle fiber, to decrease or completely reduce that spontaneous electrical activity and eliminate the irritating chemicals in that active trigger point. This release can immediately improve range of motion, decrease pain and improve function. Patients often feel a significant cramping sensation from the twitch response but then feel an immediate improvement of their symptoms.

Finally, utilizing TDN in physical therapy allows the patient a hastened return to strengthening and exercise, which in turn, results in an accelerated return to function and improved maintenance of that dysfunction.

Dave Blanchard MPT
www.vailhealth.com