Trigger Point Dry Needling (TDN) is an effective therapy to treat muscular tension and spasm which commonly accompanies conditions such as arthritis, nerve irritation, muscular strain, ligament strains and herniated discs.
What is Trigger Point Dry Needling (TDN)?
TDN involves the use of solid filament needles inserted through the skin and into the muscle to release painful myofascial trigger points. Dry needling results in a deep tissue release, allowing for improvements in movement and pain. It is called “dry” needling because no solution is injected, unlike a hypodermic needle used during a flu shot. With dry needling, the needle itself—and the effects it produces within the tissue—is the treatment.
When an injury occurs from repetitive use or acute trauma, inflammation is produced in the damaged tissues. These tissues also enter a protective tension state, or contracture, to guard against further damage. This contracture and the resulting inflammation inhibit microcirculation, limiting both the oxygen-rich blood reaching the injury and the removal of waste products. The injury site becomes hypoxic (lacking oxygen), which stimulates the body to produce fibroblasts—cells that generate fibrosis or scar tissue. This buildup of fibrosis and scarring around muscles and tissues limits their ability to fully function (lengthen and shorten) and can also cause compression and irritation of nerves (e.g., carpal tunnel syndrome)—all of which inevitably lead to biomechanical disturbances in gait and function.
TDN uses a small, solid filament needle inserted into a contracted, painful, knotted muscle to elicit a local twitch response. This response is both diagnostic and therapeutic, as it is the first step in breaking the pain cycle. Research shows it can reduce muscle contraction, decrease chemical irritation, improve flexibility, and relieve pain. When the needle is inserted into the muscle, it also produces a controlled lesion, cutting between three to fifteen thousand individual muscle fibers. The body recognizes the needle as a foreign invader and activates the immune system in response. These cut muscle fibers produce an inflammatory reaction, which your body responds to not just locally but also systemically, helping to reduce inflammation throughout the body.
Mechanical Effects
- Dry Needling may mechanically disrupt a dysfunctional motor end plate
- Needling results in a Local Twitch Response (LTR)
- The LTR results in an alteration to muscle fiber length as well as having an inhibitory effect on antagonistic muscles
Neurophysiological Effects
- Baldry (2001) suggests that dry needling techniques stimulate A-nerve fibers (group III) for as long as 72 hours post needling
- Prolonged stimulation of the sensory afferent A-fibers may activate the enkephalinergic inhibitory dorsal horn interneurons, which implies that dry needling causes opioid mediated pain suppression
- Another possible mechanism of dry needling is the activation of descending inhibitory systems which would block noxious stimulus into the dorsal horn
- The LTR may also utilize the excessive ACh in the tissue which previously was triggering increased firing of localized fibers
Chemical Effects
- Studies by Shah and colleagues (2001) demonstrated increased levels of various chemicals at sensitized motor end plates such as: Bradykinin, Substance P and CGRP (regulator of Calcium and Phosphate balance). These chemicals were reduced immediately post a LTR.
- CGRP enhances the release of ACh from nerve terminals, which results in increased ACh receptors at the neuromuscular junction
- Needle penetration will cause micro-trauma and micro bleeding (localized inflammation) and hence the introduction of PDGF into the area to help promote healing
Is Trigger Point Dry Needling Acupuncture?
No, Trigger Point Dry Needling is based on Western medical research and principles, whereas acupuncture is based on Traditional Chinese Medicine. The main similarity is that the same sterile, disposable solid filament needles are used, but each therapy is a separate and distinct in their methodology, perspectives and practices.
What Types of Conditions Can TDN Assist?
- Neck/Back Pain
- Shoulder Pain
- Tennis/Golfers Elbow
- Headaches
- Hip and Gluteal Pain
- Knee Pain
- Achilles Tendonitis/Tendonosis
- Plantar Fasciitis
- Sciatica
- Muscular Strains/Ligament Sprains
- Chronic Pain
- Athletic Performance
Does TDN Hurt?
You may or may not feel the insertion of the needle. The specific needle manipulation is intended to produce a local twitch response that can elicit a very brief (less than a second) painful response some patients describe as a deep ache or cramping sensation. Again, the therapeutic response occurs with the elicitation of the local twitch response and is a desirable reaction.
What Can I Do To Prepare For My Therapy?
Eat a light meal 1-2 hours prior to your visit and wear loose, comfortable clothing that can be rolled up or down to access your areas of concern with the greatest ease.
What Can I Expect After The Treatment?
We are looking to get improvements even from the first visit such as increased range of motion, ease of movement and decreased signs/symptoms.
Many clients report being sore after the treatment in both the area treated and the area of referred symptoms. Typically this soreness lasts between a few hours and two days and there is occasional bruising. Soreness may be alleviated by applying ice or heat to the area and performing specific stretches for the treated muscle.