DRY NEEDLING
Dry Needling is a skilled treatment where a thin filament needle is inserted into a taut muscle that may contain a trigger point, muscular and connective tissue, and/ fascia restrictions for the management of pain and movement impairments. It is called “dry needling” because there is no solution injected. The needle itself and the effects it produces is the treatment. The “needle effect” was discovered by Jan Travell in the 1920s, she would place medications into these trigger points she found in the body via a needle. However the effects of the dry needle being just as effective as a needle with medication was published in 1979 by Karel Lewit.
When the needle enters the skin, many times patients will not even feel it. Once the needle penetrates into the muscle, a twitch may be felt. This is a desired effect when treating trigger points.
It is the result of releasing the trigger point, with the intent of reducing pain and restoring normal length and function of the involved muscle and fascia. Patients may feel a referral of pain or similar symptoms for which they are seeking treatment. This is affirmation of the location of the pain for which they are being treated.
Positive results will be apparent within 1-4 treatment sessions but can vary depending on the cause and duration of the symptoms. It is an effective treatment for both acute and chronic pain. It assists with restoring normal range of motion and function of muscle and fascia.
WHAT IS A TRIGGER POINT?
• A hyperirritable, sensitive tender spot that is usually found within a taut band of skeletal muscle or fascia ( Travell and Simons)
• A Latent trigger point:
– is not actively or currently causing pain,
– can cause functional restrictions
– with palpated can cause local and referred pain.
– Furthermore has been shown to have effects at the dorsal horn despite no pain reported or felt; and can quickly become an active trigger point.
• An Active trigger point:
– Causes spontaneously and referred pain locally and/or away from site of trigger point without being palpated.
Biochemicals associated trigger points
• An elevated level of inflammatory mediators
• Catecholamines
• Neuropeptides
• Pro-inflammatory cytokines
• Known to be associated with pain, Myofascial tenderness, intercellular signalling and inflammation.
Is this for real, trigger points?
Yes, you can see on Ultrasound and is easily palpated by a trained specialist in manual trigger point release.
• 2D US imaging confirms tissue abnormality and morphological changes
• Differences in echogenicity and stiffness – elastography
• Disruption of normal muscle fiber structure and change in local tissue characteristics.
• Potential contraction knots, from increased muscle fiber contraction/recruitment, local injury and/or ischemia
How do we get trigger points?
• Overload – maximal or submaximal contractions
• Underload
• Repetitive motion – low level muscle contrations
• Visceral problems
• Unaccustomed eccentric contractions – walking down a mountain.
• Respiratory stress
• Direct trauma – (for example: Motor vehicle accidents )
WHY GET DRY NEEDLED?
• Immediate reduction in pain:
– local, referred or wide spread *
• Improve ROM and motor function immediately *
• Improve sport performance
• Improve sexual performance *
Costantini et al; Fernand-Carnero et al; Hsieh et al.; Anderson et al.
Diagnoses proven efficacy with dry needling:
• Chronic pelvic pain
– Pain in lower abdomin/back/pelvis
• Urinary urge and frequency
• Low back pain
• Lower extremity pain
• Shoulder dysfunction and pain
• Temporal Mandibular Joint pain or dysfunction
• Decreased mobility
• Decreased strength
Other Common diagnoses/conditions that may benefit from dry needling:
• neck/back/shoulder pain
• tennis elbow
• carpal tunnel
• golfer’s elbow
• tension headaches and migraines
• jaw pain
• sciatica
• hamstrings strains
• calf tightness/spasms
Diagnoses/ conditions related to the PELVIS that may benefit from dry needling?
Conditions that may benefit from dry needling of the pelvic musculature are:
• Pudendal neuralgia
• Nerve entrapments
• Vulvar pain disorders
• Coccygeal pain
• Vaginismus
• Interstitial cystitis
• Prostatodynia
• Incontinence
• Bowel disorders
• Pelvic floor muscle tension disorders
Dry needling of the pelvic floor muscles may include:
the Ischiocavernosus, Bulbospongiosus, transverse Perineal, Pubococcygeus, Iliococcygeus, Coccygeus, and Obturator Internus muscles.
How does the Needle reduce Pain?
• Restores Normal Range of Motion
• Restores musculoskeletal balance
• Sensitization of central nervous system and peripheral nervous system can be reduced
• Restores Soft tissue function and activation
• Restores normal chemical environment of active trigger point
Do we have to use a needles to release trigger points?
NO
• Shock wave therapy ($40,000) are to be very affective at releasing trigger points.
• Manual techniques can also release trigger points
What to expect?
• Treating central and peripheral nervous system
• Therefore it can be emotional
• No pain no brain
• Autoimmune responses
• Sweating
• Pain – it is a needle
THEORIES OF WHY IT WORKS
Jan Dommerholt
“Why the needle does what it does, no one knows”. What is known “ certain chemicals– termed “inflammatory mediators” – are dissipated by needling.
Dr. MA
Ma’s
• “integrative systemic dry needling approach” with a goal of normal tissue and overall decreased systemic stress and homeostasis
• Contemporary Dry needling Theory developed in 2005 and 2010 from Dr. Gunn and Janet and Travell’s work
Baldy: British – superficial dry needling
5-10mm. He practised deep trigger point release until he treated a scalene were he went superficial and just above it.
Dr. Gunn out of Canada leader and researcher in Dry Needling
• Myofasical pain syndrome is always the result of peripheral neuropathy or radiculopathy “ and defines MPS as “ a condition that causes disordered function in the peripheral nerve” .
• Based on Rosenblueth’s “Law of Denervation”: states that the function and integrity of innervated structures is dependent up on the free flow of nerve impulses to provide a regulatory or trophic affect.
• Coined term “intermuscular stimulation”
• Gunn considers myofascial pain to be secondary to neuropathy.
• Big on multifidi needling to open pathways, along with trigger points associated with patients pain
• Shortening of paraspinal multifidi
• Causing peripheral neuropathy
• Compression of supersensitive nociceptors – decreasing flow
References:
• Baldry P. Acupuncture, Trigger Points, and Musculoskeletal Pain, 3rd edition. Elsevier Churchill Livingston.
• Dommerholt, J. Dry Needling – peripheral and central considerations. Journal of Manual and Manipulative Therapy 2011; 19: 223-237.
• Affaitati G, Costantini R, Fabrizio A, et al. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain 2011; 15: 61-9
• Fernanadez-Carnero J, La Touche R, Ortega-Santiago R, et al. Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. J Orofac Pain 2010; 24: 106-12.
• Hsieh YL, Kao MJ, Kuan TS, et al. Dry Needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. Am J Phys Rehabilitation 2007; 86: 397-403.
• Rainey C.E. The Use of Trigger Point Therapy dry needling and Intramuscular Stimulation For a subject with chronic LBP: A case report.
• Sikdar S, Shah J, Gebreab T, et al. Novel Applications of Ultrasound Technology to Visualize and Characterize Myofascial Trigger Points and Surrounding Soft Tissue. Arch Phys Med Rehabil 2009; 90: 1829 -1838.
• Montenegro M., Lemes E., Vasconcelos, et al. Importance of Pelvic Muscle Tenderness Evaluation in Women with Chronic Pelvic Pain. Pain Medicine 2010; 11: 224-228.
• Weiss, J.M. Pelvic Floor Myofascial Trigger Points: Manual Therapy For Interstitial Cystitis and the Urgency –Frequency Syndrome. The Journal of Urology 2001; 166: 2226-2231.
• Myburgh C, Lauridsen HH, Larsen AH, et al. Standardized manual palpation of myofascial trigger points in relation to neck/shoulder pain; the influence of clinical experience on inter-examiner reproducibility. Man Ther 2011; 16: 136-40.
• Schuller, E., w.Eisenmenger, and G. Beier, Whiplash injury in low speed car accidents. J Musculoskeletal Pain, 2000. 8 (1/2): p. 55-67
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