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Trigger Point Dry Needling

What is a trigger point?

A trigger point is a taught band of skeletal muscle located within a larger muscle group. They are locally painful to the touch and palpation can elicit referred pain to other areas of the body. They occur when the muscle undergoes a stress it is unaccustomed to. This can be something obvious like a fall or miss-step, or commonly, a low load stress on the muscle over a long duration of time (forward head posture while sitting behind a computer for work).

 

What is trigger point dry needling?

Trigger point dry needling (TDN) is an invasive procedure that involves placing a solid thin filiform needle into the skin and muscle at the level of the trigger point. TDN results in reduced pain, an anti-inflammatory immune reaction, and improved range of motion and muscular performance. 

How does it work?

The exact mechanism to TDN is unknown; however, increasing research suggests that inserting a needle into a trigger point causes favorable biochemical changes after a twitch response that essentially "control, alt, deletes" the muscle, improving it's performance,  and breaking the pain cycle. 

Is it the same as Acupuncture?

Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists.  Some acupuncturists perform TDN as well, so it can be confusing. The main differences include the following: TDN involves the needling going into muscle tissue, not only the skin, and clams local versus systemic effects. 

Is it painful?

The needle is very thin, so many don't even feel the needle entering the skin. As the needle comes in contact with a trigger point, a twitch response is elicited, which feels like a deep, crampy, ache. It is normal to have this ache radiate into other parts of the body, and consistent pain patterns have been identified for specific muscles. Learn more here. 

How long does it take?

Treating one trigger point takes around 4-5 seconds; however, the duration of treatment is determined based on the size of the area being treated, the number of trigger points, and patient tolerance.

What should I do after?

Typically after needling, soft tissue massage and exercise are indicated to increase blood flow and retrain the treated muscle.

How many treatments does it take?

If there was an incident, like a fall, that caused the trigger point, 1-3 treatments is usually all it takes. If something is causing the trigger point to reoccur, or there are multiple within the area, a few more treatments may be required. Individuals whom are very active, perform manual labor, have sustained a significant injury, or are in chronic pain may do routine needling for maintenance/pain management. 

What are the risks? 

The most serious risk associated with TDN is accidental puncture of a lung (pneumothorax) in muscles on the thorax. This is a rare complication, and in skilled hands should not be a concern. If this were to occur, it may likely only require a chest x-ray and no further treatment as it can resolve on its own. The symptoms are pain and shortness of breath. A more severe lung puncture can require hospitalization and re-inflation of the lung. If you feel any related symptoms, immediately contact your therapist and seek medical attention from your physician, or if necessary, go to the emergency room. 

Are there any side effects?

It is common to feel very relaxed, tired, or energized, after the treatment. Other reactions that are not worrisome include: local  bruising, soreness, and ache/discomfort over the treated area. As the needles are very small and do not have a cutting edge, the likelihood of any significant tissue trauma from TDN is unlikely. Possible, but rare, side effects include feeling faint/dizzy, nauseous, and sweating. These are normal reactions that may be present due to changes in blood pressure (high or low), mainly associated with the patient’s first experience with needling.

Can everyone be needled?

No. There are a few conditions and instances where needling is contraindicated. Please notify your provider if you have a fear of needles, are pregnant, have any implants, are on anticoagulant (blood thinners), or have any conditions that can be transferred by blood. Your practitioner will review your medical history and ensure needling is safe and appropriate for you.  

Please consult with your practitioner if you have any questions regarding the treatment above.

References:

1.) Kalichman L, Vulfsons S. Dry needling in the management musculoskeletal pain. J Am Board Fam Med. 2010;23(5):640–646

2.) Kietrys, D. M., Palombaro, K. M., Azzaretto, E., Hubler, R., Schaller, B., Schlussel, J. M., & 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.

3.) Liu, L., Huang, Q. M., Liu, Q. G., Thitham, N., Li, L. H., Ma, Y. T., & Zhao, J. M. (2018). Evidence for dry needling in the management of myofascial trigger points associated with low back pain: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 99(1), 144-152.