Dry Needling, What's the Deal? Treating Myofascial Trigger Points (muscle pain!).

Date: March 26, 2020 Author: James Categories: Latest
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Dry Needling - What’s going on and is it useful?

Let’s talk about dry needling!

You might be surprised to hear that each week we have a handful of clients here at the clinic who actually look forward to coming in for a session of treating muscular pain via repeated poking with needles to their most tender points.

Crazy though it may sound they are part of an increasing body of clients who enjoy the benefits of a clinical technique known as Intramuscular Stimulation (IMS), or more simply as dry needling.

Dry needling (DN) is a western needling technique - vis a vis it’s more commonly known eastern cousin acupuncture. 

Acupuncture treats dysfunctional flow of “chi energy” by needling specific  energy points along well defined “energy meridians”. Acupuncture is a robust practice that is used by many clinicians to treat a wide variety of clinical ailments ranging from infertility to liver dysfunction. 

Dry needling on the other hand is used specifically and only for myofascial pain, pain resulting from muscle or tendon dysfunction. It comes out of the sport medicine world and is used as a less aggressive alternative to “wet needling”,  lidocaine injections which are a common medical treatment for muscle pain.

And instead of being concerned with energy points on meridians, Dry needling focuses instead on Myofascial Trigger Points (MTrP’s).

A trigger point is an irritable point in a muscle that is characterised by a sensitive palpable point (known as a nodule). This nodule is located in a tight band of muscle fibers and is painful on compression. The tight band of contracted muscle fibers remains contracted over prolonged periods and It can be the offending culprit for referred pain, weakness and movement dysfunction. 

Trigger points come in a variety of flavours. Active trigger points are those we are most concerned with, and are painful muscle nodules that are activated through simple movement and are acutely tender to the touch. They can also refer pain along a distribution away from the trigger point  that can mask as pain from another source.

Latent trigger points are nodules in muscles only painful on palpation (ie. they hurt when you press them!), but are not activated through simple movement alone.

 

Why do MTrP’s develop 

Trigger points can develop in muscles with acute injury or by repetitive strain injuries. Traumatic injuries are those characterised by an “event” that you can easily identify as being the culprit for your pain. And bonus! If this is the cause of your issue you may also choose to regale your friends with your tales of how you hurt yourself, it’s the consolation prize of traumatic injury…

Repetitive strain injuries are those that occur, obviously,  from repeated action over time. They are often associated with changes in your typical routine. Say an increase in volume or intensity at the gym or a novel training style that you take on.

In either case, traumatic or repetitive strain, trigger points can develop and are typically easily identifiable by a clinical exam. They are painful to the  touch and as mentioned they will often refer pain in a predictable pattern that is dependant on the muscle where they are located. Stretching this muscle will also trigger the same pain.

Trigger points contribute to the overall pain situation much more than we typically appreciate and therefore by extension, treating them can contribute to reducing pain much more than we might appreciate as well! 

 

Dry needling has been shown to reduce pain in the short to medium term.

While the exact physiological mechanisms (ie. the “how does it work?”) of dry needling remains a question under research, there is a decent body of science showing that dry needling reduces muscle pain and muscle tone (tightness) in the short to medium term - that is 0-12 weeks. 

Current consensus is that dry needling activates pain relieving mechanisms in the brain and spinal cord that produce these positive effects.

One of the very interesting things about trigger points is that over the medium to long term they promote pain sensitisation. This means that through consistent and repeated stimulation of the nervous system, a trigger point  can contribute to lowering the threshold at which pain is perceived by your brain. Furthermore, when we experience pain sensitisation, things that might not typically trigger perception of pain can in turn begin to trigger pain. If you’ve ever experienced pain from a chronic injury triggered by weird input like light touch or the blowing of cold air then you know what I mean. Finally, pain sensitisation is marked by various forms of pain referral including creeping of the size of the painful area, or the onset of new pain in a remote area of the body.

By treating the muscular trigger point and thus removing the chronic overstimulation of the nervous system, dry needling can be an effective treatment for the pain sensitization, so that’s nice.


Needling? But that sounds heinous! Does it hurt?

I used to say when I first started practicing dry needling that “No! This won’t hurt at all!”. I don’t say that any more :) The truth is that it’s likely not the most comfortable experience you’re ever going to have. In fact, I'll go ahead and say It can be kind of uncomfortable. 

But the truth is also that it doesn’t hurt that bad. It’s simply not god awful. Think 4/10 pain intensity that is mostly characterised by a dull ache. It’s really more that the feeling is unusual.

What does the needling procedure look like?

Thankfully, dry needling is a pretty low key procedure that can be done in your physiotherapists office. The needle is very fine - less than a quarter millimeter thick. Even so, people tend not to get too excited about having it done, you will after all have a needle several centimeters deep in your muscle. The practitioner will likely use a pistoning technique that inserts and pulls back the needle without completely removing it. This action continues in a repeated fashion until a twitch response is elicited. 

A twitch response is a spontaneous contraction of the muscle that is part and parcel of the larger set of pain relieving, muscle tension relieving responses. The twitch response indicates that we are doing something right! The twitch is non voluntary and so  is more of a weird than a painful sensation. Still it would be deceptive of me to suggest that it feels “good” :)

Like any treatment procedure there are risks for unwanted events associated with dry needling.  These events range from the very minor to the not so minor (but also very rare). Any well trained clinician will have a thorough discussion with you about the risks and benefits of dry needling before you consent to it!

Common minor side effects include bruising, swelling and most commonly soreness that feels like a post workout soreness and which lasts up to 48 hours post needling before reducing to an overall improved pain situation.

Many people do not experience any of these side effects and can feel improvement immediately after treatment.

Take a look at the video above for a live action demonstration of Lauren needling me! Our hope is that this gives you some better sense of what to expect and takes some of the anxiety out of trying the procedure.

Dry Needling is a safe, evidence based and effective treatment for the muscular pain that comes with many injuries. It can be a great option for those willing to brave the (not so bad at all) trial of being needled.

If you are interested, I highly suggest that you discuss dry needling with your physiotherapist, you might find you like it!

 

Further reading (if you really want to impress your friends)

Ansari, N. N., Alaei, P., Naghdi, S., Fakhari, Z., Komesh, S., & Dommerholt, J. (2019). Immediate Effects of Dry Needling as a Novel Strategy for Hamstring Flexibility: A Single-Blinded Clinical Pilot Study. Journal of sport rehabilitation, 1(aop), 1-6.

Dommerholt, J., & de las Penas, C. F. (2018). Trigger Point Dry Needling E-Book: An Evidence and Clinical-Based Approach. Elsevier Health Sciences.

Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. journal of orthopaedic & sports physical therapy, 47(3), 133-149.

Gerber, L. H., Sikdar, S., Armstrong, K., Diao, G., Heimur, J., Kopecky, J., ... & Shah, J. (2013). A systematic comparison between subjects with no pain and pain associated with active myofascial trigger points. PM&R, 5(11), 931-938.

Lavelle, E. D., Lavelle, W., & Smith, H. S. (2007). Myofascial trigger points. Anesthesiology clinics, 25(4), 841-851.

Liu, L., Huang, Q. M., Liu, Q. G., Ye, G., Bo, C. Z., Chen, M. J., & Li, P. (2015). Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 96(5), 944-955.

Mense, S. (2010). How do muscle lesions such as latent and active trigger points influence central nociceptive neurons?. Journal of Musculoskeletal Pain, 18(4), 348-353.

Travell, J. G., & Simons, D. G. (1983). Myofascial pain and dysfunction: the trigger point manual (Vol. 1). Lippincott Williams & Wilkins.