What is Trigger Point Dry Needling?
Trigger Point Dry Needling is a technique that can help to manage your pain symptoms. It is a technique used to treat trigger points using solid metal filament needles. There is a growing amount of research which supports this technique in treating a number of musculoskeletal conditions. Dry needling is also used to treat orthopedic pain syndromes of muscles, nerves, connective tissues and joints with or without the use of electrical stimulation. The following are some commonly asked questions about trigger point dry needling that should help give you a greater understanding of how it may help you and what you can expect.
1. What are trigger points?
Trigger points are tight irritable areas within your muscles, what many of us call “muscle knots.” They may start from a specific injury or repetitive stresses. Trigger points do not get enough blood flow (ischemia) or oxygen (hypoxia) because of the tight contraction in the muscle and can lead to poor muscle activation and limited range of motion. They can cause pain where they are located, or may send pain to another area of the body. For example, trigger points in your piriformis muscle may send pain into the back of your thigh, and trigger points in your neck muscles may cause headache pain.
2. What is trigger point dry needling? How is different from a trigger point injection?
Trigger point dry needling is the use of a solid filament needle inserted into a trigger point. It is called “dry” needling because the needle itself is the treatment; there is no medication or other liquid substance being injected. This is in contrast to a trigger point injection, which involves injecting medication into the trigger points with a hypodermic needle. Some research indicates that there is no significant difference between dry needling and trigger point injections, so this is an excellent medication-free alternative treatment.
3. How does trigger point dry needling work?
Inserting the needle creates mechanical, chemical, and neurophysiological changes in the muscle, nerves, connective tissues and the joint. These changes lead to improved blood flow and oxygen in your muscle, improved range of motion, decreased irritability and sensitivity of your muscle, and improved activation of your muscle. By improving blood flow and desensitizing the trigger point, we are placing your muscle in the optimal position to heal in order to return the muscle to normal, pain-free function.
Dry Needling has also been shown to produce a mild reactive inflammatory process in the area treated in order to jump start the healing process. This is why some of our patients may experience a mild increase in pain for the first 24-36 hours. In addition, there is an endogenous opioid release with dry needling that can provide a temporary relief of pain and lead to a permanent desensitization effect after successive treatments. Lastly, it has been shown that dry needling can help to clear the junction between the nerve and muscle of neurotransmitters that sustain a muscle contraction and/or a trigger point.
The addition of electrical stimulation to the needles has been demonstrated to enhance the effect of the dry needling. Read more HERE.
4. How is it different than acupuncture?
While both techniques use the same type of filament needles, they have different goals. Acupuncture is a Traditional Chinese Medicine technique with a goal of balancing energy flow (qi) through the body’s meridians. Trigger point dry needling is a Western medicine technique which specifically treats trigger points and orthopedic pain syndromes in the muscles, nerves, connective tissues and joints. Read more HERE.
5. Do you need to be certified to perform this technique?
Yes. Currently, we have several therapists who are certified in dry needling. In order to perform trigger point dry needling in the state of Massachusetts, training is required.
Benefits of Trigger Point Dry Needling?
6. What conditions can benefit from this technique?
Trigger points have been identified in many different diagnoses including: radiculopathies(nerve pain), disc pathology, tendonitis, temporomandibular joint dysfunction (TMJ), headaches, carpal tunnel syndrome, whiplash, and joint dysfunction. This is not an exhaustive list, and we would be happy to discuss whether or not trigger point dry needling may be a beneficial treatment technique for you.
7. What happens during my treatment?
After a thorough evaluation, we will determine if trigger point dry needling is appropriate for you. The first step is to palpate your muscle to find where your trigger points are. After thoroughly cleaning your skin, the small filament needle will be inserted. I perform a gentle pistoning movement of the needle while it is inserted in order to stimulate the trigger point. Depending on the goal of your treatment, the needle may remain in place for 30 seconds to 3 minutes. You may feel a jump in your muscle, called a local twitch response. While the needles are inserted, there should be no pain from the needle, but you may feel a temporary reproduction of “your symptoms.” For instance, if we are working on your neck, you may feel a reproduction of your headache symptoms. We may also decide to add electrical stimulation to your treatment to further intensify the benefits of the treatment. After the needles are removed, your treatment will also consist of an individually designed exercise program intended to address the reason why these trigger points formed and help prevent their return. Each step of the process will be explained to you as we move through the treatment, and any questions and concerns will be answered.
Dry Needling can also be performed with the focus of treatment on an orthopedic pain syndrome of your muscles, joints, nerves and/or connective tissues such as ligaments or tendons. During the treatment, we will needle a combination of trigger points, acupoints and ah-shi points. Read more HERE. We may also attach a subtle electrical stimulation to the needles to enhance the effects of the dry needling. You may experience some mild soreness for 24 hours after your session but this will gradually subside with a significant decrease in your pain thereafter.
8. How deep are the needles inserted?
Depending on the goals of your treatment and the area we are treating, we may stay on the surface of the muscle, or we may need to go deeper. For instance, some of our hip muscles, such as the piriformis, are deeper and require a larger needle. The needles range in size from 1-4 inches long, and all needles used are very thin.
9. What can I expect from treatment? Are there any side effects?
Though unlikely, there are some risks associated with this procedure. These risks include bleeding, infection, nerve or vascular injury, feeling faint, or penetration of an organ. Precautions are taken to avoid all of these risks, including using sterile needles which are only used on you and are disposed of after each treatment. You may have some discomfort in the region of treatment for up to 48 hours; this is a normal reaction.
10. How many treatment sessions will I need?
Depending on the nature and severity of your symptoms, you may need a total of 2-6 sessions to achieve maximum benefit.
11. What does the research say about trigger points?
Research has continually shown that muscles with trigger points demonstrate the following:
- Altered muscle activation patterns on EMG (Lucas, 2010; Wadsworth, 1997)
- Reduced muscle strength (Celik, 2011)
- Accelerated muscle fatigue (Ge, 2012)
- Reduced antagonist muscle inhibition (Ibarra, 2011)
- Increased number of trigger points on the painful side (Alburquerque-Sendin, 2013; Bron, 2011; Fernandez-de-las-Penas, 2012; Ge, 2006; Ge, 2008)
It is highly valuable to focus on the treatment of trigger points to restore muscle activation patterns. Being able to press the “reset button” on a muscle is important for re-establishing normal muscle activation patterns prior to exercise.
More information on the research that PTs have done on dry needling:
Here is some more information form the American Physical Therapy Association on dry needling
Please let us know if you have any other questions.
“I have been a patient receiving physical therapy for a number of years. The lower back pain I have is the result of a herniated disc in July 2008. Originally, I went to physical therapy at Sports Medicine North, in Peabody. Since then I’ve been a patient at OrthoWell Physical Therapy for the last four years.
During the past two weeks I have experienced Dry Needle Therapy at OrthoWell Physical Therapy. Kathryn Murphy is my therapist. She has done any excellent job explaining how this therapy works and what I should expect after each session. I have two more sessions left and then she’ll evaluate my progress. I feel a lot less pain in my lower back. In comparison to the way I felt two weeks ago I would say I have improved at least 70%. The therapy is not painful or even uncomfortable yet the effect is a much improved condition for my lower back. I feel more comfortable as I do the things I enjoy. I don’t need to rest during the day. I enjoy activities all day long. Sometimes I am babysitting out two year old and our four year old grandchildren. I can stay out of the house most of the day doing shopping, errands, or visiting friends without discomfort. Dry Needle Therapy has really worked to decrease the level of pain substantially.
I definitely would recommend Dry Needle Therapy to anyone who experiences back pain and sciatica nerve pain.” – Theresa N.
“My experience with dry needling was very positive. I was experiencing constant pain in my lower back L4/L5 and L5/S1, that worsened with stair climbing and bending with rotation. There were residual muscle spasms from a back injury in July 2014, that were not responding completely to stretching ex’s or other devices used to treat spasm. The dry needling made a difference after the first treatment, and after 4 treatments I feel that I am ready to be discharged.” – Cheryl J.