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The latest trend?

Physical therapy (PT) has been around since 1916 and over the years it has evolved into an evidence-informed, doctoring profession that is founded on the art and science of healing. Throughout this time many PT treatment methods have come and gone but the effective interventions (supported by patient testimonial and also by research) tend to endure. Such is the case with Dry Needling (DN), more specifically, Trigger Point Dry Needling. When this technique was first introduced in physical therapy I was intrigued but cautiously optimistic about its potential. I wondered if DN was just the latest trend. The aim of this article is to share my professional opinion on the potential benefits and uses for trigger point dry needling.

The Myofascial Trigger Point

First, we need to talk about what a trigger point is. A myofascial trigger point is a hyperirritable area that can be found as a taut band in muscle that may be painful with compression, stretch, or activity. Many times we feel trigger points as “knots” in our muscles. They may be tender and sore when touched and can lead to pain in nearby areas. This can lead to difficulty performing even everyday tasks. Our bodies are amazing in that we are dynamic and can often adapt and adjust to the different stresses we experience in life. That said there are circumstances (mechanical or neurophysiological) where we may have difficulty handling these stresses and, as a result, we may experience pain and/or dysfunction. This is where trigger points may be involved. Sometimes the dysfunction (injury, disease, muscle weakness, inflexibility, abnormal movement, etc.) occurs first and then leads to the formation of a trigger point. Other times it is believed that it is the trigger point that comes first and its presence leads to dysfunction. It’s like the chicken and the egg conundrum. In the end, it is acknowledged that the trigger point must be treated.

How does it work?

Dry needling is a skilled manual therapy intervention where a solid but thin filament needle is inserted into the skin and muscle directly at a myofascial trigger point. The purpose is to normalize the muscle and diminish pain. DN been shown to inactivate the trigger point and normalize muscle by eliciting a local twitch response. The effect involves shutting down the spinal cord reflex that is related to the persistence of the contractured taut band. Getting a local twitch response with DN also leads to a biochemical change, which helps to reduce pain, and this can be an important step in breaking the pain cycle. The literature and research continues to grow in support of the usefulness and effectiveness of trigger point dry needling. There is evidence that DN improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation. The American Physical Therapy Association and the state of Ohio supports and recognizes DN as being part of the PT’s professional scope of practice.

During treatment most patients do not feel the insertion of the needle. The local twitch response elicits 
a very brief (less than a second) response that patients describe as a little muscle spasm; others feel 
it more like a cramping sensation and it may be painful to some. But, the therapeutic response is a good and desirable reaction. Patients may recognize benefits very soon after treatment, but typically it takes several visits for a lasting effect to take place. After treatment there can be a feeling of soreness in the muscle being treated and in related areas and a modification of activity may be necessary. Typically, the soreness lasts between a few hours to two days and it is recommended to perform gentle stretches and apply heat or ice after being treated. It is also important to remember that DN is a modality that is part of a rehabilitation program. It is frequently used with manual therapy early in the treatment plan and once the pain cycle is broken other treatment options and exercises can be progressed or introduced.

Who can do dry needling?

APTA recognizes dry needling as being part of the physical therapist professional scope of practice. APTA Board Directors Guideline BOD G02-14-18-12 titled Guidelines: Physical Therapist Scope of Practice lists dry needling as one of the interventions provided by physical therapists. DN also falls within the scope of acupuncture practice; but, it is important to note that while there are many similarities and differences between DN and acupuncture, they are not the same thing. Most PTs are not licensed acupuncturist. When performed correctly, trained PT’s utilize DN techniques that are based on Western medicine principles and research.

 What type of problems can be treated with dry needling?

The treatment of muscles has a great effect on reducing pain mechanisms in the nervous system. DN can be used for a variety of musculoskeletal problems especially when muscles are thought to be a primary contributing factor to the symptoms. When myofascial trigger points are present there is often associated impairments in the body, functional limitations, and pain. Such conditions include, but are not limited to radiculopathies, joint dysfunction, disk pathology, tendonitis, neck, back and shoulder pain, arm pain (tennis elbow, carpal tunnel, golfer’s elbow), headache to include migraines and tension- type headaches, jaw pain, buttock pain and leg pain (sciatica, hamstrings strains, calf tightness/spasms), running injuries, pelvic pain.

What are the risks?

Any treatment that has an effect has the potential to have side effects. In the case of dry needling the most common report following treatment is muscle soreness. That said there are certain conditions where dry needling is contraindicated or at least needs to be used with caution. Its best to consult with your physical therapist and/or a licensed health care professional that is educated and trained in trigger point dry needling.

Important tips.

• Understand the purpose and use for dry needling.
• Be aware of your own condition, health, and wellness. There are indications, contraindications, and precautions for dry needling.
• Be clear on your goals. Why do you feel you are a candidate for dry needling? What do you hope to gain?
• Remember that dry needling is not for everyone and that there are still many effective treatment interventions available.
• The best advice is to consult with your physical therapist and/or a licensed health care professional that is educated and trained trigger point dry needling.

Conclusion

The aim of this article was to share my professional opinion on the potential benefits and uses for trigger point dry needling. There is a growing body of information and knowledge on the topic and I believe that it is an important treatment option that can be a useful and effective component of a physical therapy program. Suffice it to say, it looks like dry needling is an intervention that will stick around.

Contact us if you have any questions or would like to schedule an appointment.

Resources:

1. Liu L, Huang Q, Li P, et al. Review article (Meta-analysis): 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 [serial online]. May 1, 2015;96:944-955. Available from: ScienceDirect, Ipswich, MA. Accessed June 24, 2015.
2. Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews: PTR [serial online]. August 2014;19(4):252-265. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed June 24, 2015.
3. KIETRYS D, PALOMBARO K, TUCKER M, et al. Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis. Journal Of Orthopaedic & Sports Physical Therapy [serial online]. September 2013;43(9):620-634. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed June 24, 2015.
4. Ong J, Claydon L. Systematic review with meta-analysis: The effect of dry needling for myofascial trigger points in the neck and shoulders: A systematic review and meta-analysis. Journal Of Bodywork & Movement Therapies [serial online]. July 1, 2014;18:390-398. Available from: ScienceDirect, Ipswich, MA. Accessed June 24, 2015.
5. Dommerholt J, Huijbregts P. Myofascial Trigger Points : Pathophysiology And Evidence-Informed Diagnosis And Management [e-book]. Sudbury, Mass. : Jones and Bartlett Publishers, c2011.; 2011.
6. Dry Neeling in Physical Therapy Practice. http://www.apta.org/StateIssues/DryNeedling/ClinicalPracticeResourcePaper/
7. APTA: Physical Therapists & The Performance of Dry Needling http://www.apta.org/StateIssues/DryNeedling/ResourcePaper/
8. Dommerholt J, Bron C, Franssen J. Myofascial trigger points: an evidence-informed review. Journal Of Manual & Manipulative Therapy (Journal Of Manual & Manipulative Therapy) [serial online]. December 2006;14(4):203-221. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed June 24, 2015.
9. Pecos-Martín D, Montañez-Aguilera F, Plaza-Manzano G, et al. Effectiveness of Dry Needling on the Lower Trapezius in Patients With Mechanical Neck Pain: A Randomized Controlled Trial. Archives Of Physical Medicine & Rehabilitation [serial online]. May 2015;96(5):775-781. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed June 24, 2015.
10. Gerwin, R. D., Dommerholt, J., & Shah, J. P. (2004). An expansion of Simons’ integrated hypothesis of trigger point formation. Current pain and headache reports, 8(6), 468-475.