WHAT IS "TRIGGER POINT DRY NEEDLING?"
What is all the hype about this tool called “dry needling?” Since trigger point dry needling (DN) is a technique we commonly use at our physical therapy clinic in Green Bay, we thought a blog to answer some of your questions would be helpful!
Trigger point dry needling uses small, solid filament type needles which are inserted into myofascial trigger points (the painful knots in muscles) to stimulate a healing response with the goal of reducing pain and dysfunction.
It has been shown that our bodies can develop areas of hypersensitivity and tightness as a response to various stressors (i.e., postural, repetitive movements, intense exercise, emotional stress etc.).
Have you ever had a stressful day at work and feel like your traps are glued to your ears? Or how about the distance runner who keeps flaring up their Achilles tendinitis because of tightness/overuse of their calf muscles. Or the CrossFit athlete who did high volume dead lifts and their back, glutes and hamstrings feel like rocks (and not in a good way haha). I bet you those muscles are FULL of active trigger points.
On that point, let’s talk briefly about what an “active” trigger point is, and why it is something we want to alleviate as quickly as possible.
Active vs. Latent Trigger Points
A Latent Trigger Point simply means a myofascial restriction (or knot) in a muscle tissue that elicits some type of discomfort. However, the discomfort remains local, or in the muscle tissue that you are applying some type of compression (think foam roller or lacrosse ball). It does not travel to different areas in the body.
A Latent Trigger Point simply means a myofascial restriction (or knot) in a muscle tissue that elicits some type of discomfort. However, the discomfort remains local, or in the muscle tissue that you are applying some type of compression (think foam roller or lacrosse ball). It does not travel to different areas in the body.
An Active Trigger Point is a different story. These active trigger points are restrictions in the muscle tissue that, when a force or compression is applied (again, back to the foam roller or lacrosse ball usage), it elicits pain somewhere else in the body. For example, do you get headaches? Or how about pain in the front of your shoulder? Looking at both pictures below, you can see that these can be caused from active trigger points. The upper trap refers up your neck and to your temple area. The infraspinatus (a rotator cuff muscle) refers to the front of your shoulder can be part of the issue if you have shoulder pain! Therefore, it’s incredibly important to work with clinicians that understand this concept and don’t focus solely on the point of pain.
*xx marks the area of the active trigger point in your upper trap. The red reflects the referral pattern.
*xx marks the area of the active trigger point in your infraspinatus. The red reflects the referral pattern.
It’s also very important to understand that, while trigger point dry needling is an effective tool, it is just that, a tool. It is not, nor should it be a standalone treatment. If you simply receive dry needling as a treatment and then don’t do anything afterwards, the muscle tissue will just result back to normal (which is typically painful trigger points). For dry needling to be effective, we utilize it at the beginning of our visits, and are typically done with it after 5-10 minutes. We then spend the rest of the time in the gym performing strength and stability exercises, which is what allows dry needling to be most effective (manual therapy paired with strengthening is the way)!
FAQ
How does dry needling work and what does the needle do?
When performing intramuscular dry needling in Green Bay, we are looking to elicit that twitch response (of the muscle. This twitch response is a quick contraction reflex of the muscle that can be both diagnostic and therapeutic.
Research has shown that when the twitch response is elicited, the tissue will have a decreased muscle spasm, reduced chemical irritation, improved flexibility and can provide short term pain relief. This can often immediately improve range of motion, improve function, and decrease or eliminate pain. Eliciting a twitch response is not imperative and often will not occur when performing needling aimed at other structures in the body besides muscles and trigger points. Outside of muscular trigger point dry needling, needles can also be placed into other tissues including tendons, ligaments, around scars, or near nerves. Depending on the patient’s particular pathology, the aim of trigger point dry needling may be different and therefore the desired physiological response is also different.
What type of pain does trigger point dry needling treat?
For myofascial pain, the technique is used to treat several areas. The most common trigger points lead to these issues (there are many more not listed):
Neck/Scapular Pain
Stress induced or postural induced muscle tension
Sciatica/Piriformis Syndrome
Low/Mid Back Pain
Headaches & Migraines
Pain in your Shoulders, Hips, Knees, Ankles, etc. (joints)
Golfer’s or Tennis Elbow
Plantar Fasciitis
Achilles Tendonitis
Why is it called “dry” needling?
It is called “dry” needling because no solution is injected into the tissue, as is the case with an injection with a hypodermic needle. The needles we use are acupuncture needles which are solid point, stainless steel, one-time use needles (no garage tattoo needles here!)
Is dry needling like acupuncture?
With trigger point dry needling, we do use acupuncture needles. However, that’s the only similarity. The two techniques are very different. DN is based on Western medical research and principles, whereas acupuncture is based on Traditional Chinese Medicine in which the purpose is to alter the flow of energy (“Qi”) along traditional Chinese meridians for the treatment of diseases.
So, needles are placed at precise points along these interconnected pathways that map the whole body, including your head, trunk, and limbs. The goal of placing needles into acupuncture points is to direct the flow of vital energy to trigger your body’s healing response and restore physical, emotional, and mental equilibrium.
Dry needling gets to the source of your pain — the myofascial pain caused by restrictions of your muscle tissue or the fascial layer of connective tissue that surrounds and supports the muscle. We identify the knots or taut bands that are causing you problems and place needles with the intent of producing a local twitch response. It’s the twitch response that leads to the resolution of this trigger point and therefore the reduction of your pain (but remember, we don’t need a twitch response for dry needling to be effective).
Does it hurt?
Each patient describes the processes of being needled differently depending on what tissues are being treated, pain tolerance, and degree of dysfunction. Most patients describe dry needling as a “deep ache, burn, and/or occasionally sharp” depending on the amount of active trigger points in their tissue. Typically, patients report not feeling the needle penetrate the skin and to most, the treatment is very tolerable. It honestly “just depends.” That’s helpful, isn’t it?
Once the needle has been inserted into the skin/muscle, we will work the needle around trying to get the muscle to twitch. These twitches are called the “local twitch response” (LTR) and means that we are positively affecting the desired tissue. These twitches can be sudden, startling, and sharp, but the LTR is what the therapist is hoping to see. When copious localized twitches are present in a muscle, this validates the patient’s dysfunction and pain, and serves as a great diagnostic tool for the clinician when differently diagnosing our patients.
If you have copious amounts of twitches, you may be sorer then if you did not have any at all. We typically tell patients that it will feel like you just worked out hard or that you got “frogged” in the treated muscle.
What should I expect after dry needling therapy?
Soreness is common after a dry needling session. It’s like the soreness you feel after a hard workout. The soreness typically resolves within 24-48 hours. You can help reduce it with heat, proper hydration, massage, and gentle stretching. You can continue to exercise but note you may feel weaker or sorer if you workout within the same day of being dry needled. ALWAYS consult with your therapist about the logistics of returning to your exercise/sports routine after being dry needled.
LOOKING FOR MORE HELP?
Still have questions? Give us a call at 920-309-6588 to see if dry needling may be something that could help you!
*This is helpful information, but it is general information. This is NOT medical advice. If you already have any injury, pain, tightness, etc., please seek help from a licensed and qualified healthcare provider like us, performance physical therapy in Green Bay. A complete solution for what you’re dealing with needs to be customized to all the different factors driving your pain, and those factors will be at least slightly different for each person. These strategies may help, but they’re not likely to be a complete solution for each individual reading this now or in the future.