At HTC our Physiotherapists & Osteopaths provide Dry Needling as part of their therapy spectrum. This article provides the essential information relating to its practice, it’s theory and its application.
It is aimed at myo (muscle)-fascial (tendon-like structures that divide or connect muscle structures) trigger points which are irritable symptom spots in skeletal muscle.
The formation of trigger points is caused by the creation of a taut band within the muscle.
Taut muscle bands are produced as a normal protective, physiological measure in the presence of actual or potential muscle damage. They are thought to occur in response to unaccustomed muscle activities such as sustained postures / positions or repetitive strain activities.
Trigger point dry needling can be carried out at superficial or deep tissue level(s).
This was developed by Dr. Peter Baldry. He recommended the insertion of needles 5-10mm in length over a Trigger Point for approximately 30 secs. Palpation of the Triger Point then determines the level of response and whether needle stimulation was sufficient to alleviate the related pain. If not, the need is re-inserted.
These are thought to be caused by an excessive release of chemicals from selected nerve endings within muscle tissue.
They can be divided into Active or Latent myofascial trigger points.
Active trigger points can spontaneously trigger local or referred pain. They cause muscle weakness, restricted range of movement and autonomic phenomena (reactions such as increased sweating or skin temperature / colour changes).
Latent trigger points do not cause pain unless they are stimulated. They may alter muscle activation patterns and contribute to restricted range of movement.
Therefore, both active and latent trigger points cause allodynia (unusual oversensitivity i.e. pain on just light touch) at the trigger point site and hyperalgesia (excessive pain reaction e.g. during movement) away from the trigger point following applied pressure.
Dry needling of these myofascial trigger points via mechanical (needle) stimulation causes an analgesic (pain relieving) effect.
In detail; The mechanical stimulation by the needle causes a local twitch response called an LTR. An LTR is an involuntary reflex via the nerve and then spinal cord which initiates a reflex contraction of the muscle fibres within the involved taut band.
Triggering an LTR has been shown to reduce the concentration of nociceptive (pain responding) substances within the chemical environment near myofascial trigger points.
The needle may also cause a very small tissue disturbance which then triggers muscle cell repair or replace damaged muscle fibres. This occurs 7-10 days after dry needling. It is unclear whether continued dry needling within this period may disrupt this process.
The Treatment Process
A practitioner should always complete a full medical history and examination prior to applying Dry Needling techniques.
Examination identification of myofascial trigger points in the muscle through palpation.
Deep dry needling application should reproduce the patient's pattern of pain
The minimum criteria for diagnosis of myofascial trigger points are:
- Spot tenderness in a palpable band of skeletal muscle
- Subject recognition of pain with palpation
- Clinical presentation
The Benefits of Dry Needling
1. Promotes Blood Flow. Trigger points cause tightness in muscles which can restrict blood flow and therefore oxygen delivery. This lack of oxygen can contribute to pain in the affected area. By using dry needling to deactivate trigger points in the muscle, we can reduce the barrier to blood flow and improve oxygenation.
2. Promotes Healing. By creating tiny injuries in a dysfunctional muscle with the use of a needle, the body responds with an inflammatory response in the area. This is a natural healing process which stimulates healing through collagen and protein formation and can help to restore a muscle’s normal function.
3. Reduces Pain. This can take many forms. In many cases, the deactivation of trigger points alone can reduce pain locally; however, by improving muscle extensibility this can, in some cases, take pressure off joints to reduce joint pain, or nerves to reduce radicular pain. Additionally, chemical changes within the muscle and associated nerves can block or influence the transmission of pain messages to the brain.
4. Improves Muscle Extensibility and Contractibility. Once again, the deactivation of trigger points is mostly to thank here! By releasing taut bands found within muscle, muscled spasms can be decreased, and increased range of motion can be achieved. Improved joint mechanics and using the “twitch response” to our advantage can allow for improved recruitment and activation of appropriate muscles.
Absolute Contraindications to Dry Needling Treatments
This type of therapy should be avoided in patients under the following circumstances:
In a patient with needle phobia.
Patient unwilling - fear, patient belief.
Unable to give consent - communication, cognitive, age-related factors.
Medical emergency or acute medical condition.
Over an area or limb with lymphedema as this may increase the risk of infection / cellulitis and the difficulty of fighting the infection if one should occur.
Inappropriate for any other reason.
Relative Contraindications to dry Needling Treatments
Abnormal bleeding tendency
Compromised immune system
Patients with epilepsy
Procedure Post (After) Treatment:
Re-assess Range of movement for restriction and pain
Give patient a focused stretching programme / exercise
Identify activities to the patient that may reactivate the trigger point and advise accordingly on mitigation / avoidance or adaptation.