Newsletter - Trigger Point Dry Needling (Dry Needling or Intramuscular Manual Therapy)

What is Trigger Point Dry Needling? And Can It Help Me? 

According to multiple physical therapy state boards, Trigger Point Dry Needling (Dry Needling) or Intramuscular Manual Therapy is “a skilled intervention performed by a physical therapist using a thin filiform needle to penetrate the skin and stimulate underlying neural, muscular, and connective tissues for the evaluation and management of neuromusculoskeletal pain and movement impairments.”

In other words, it is a form of treatment where a physical therapist uses thin ‘dry’ needles pressed through the skin to stimulate a trigger point and thereby help relieve pain caused by muscular tightness and spasms, increase motion and improve our patients’ function.

In recent studies, combining dry needling techniques with other manual and rehabilitative methods has shown to be very effective in the treatment of chronic pain and reducing recovery time.

How Does Trigger Point Dry Needling Work?

A number of theories exist as to how Dry Needling works. The theories that we agree on at Coppola Physical therapy is that dry needling works by disrupting a reflex arc of contracted tissue as well as stimulating biochemical changes to allow improved blood flow and healing to the area.

Another theory held by the Journal of Orthopedics and Sports Physical Therapy “dry needling may release the tight muscle bands associated with trigger points and lead to decreased pain and improved function.”

How Is Dry Needling Performed?

A physical therapist utilizes a very thin filament needle (acupuncture needle). While the physical therapist uses an acupuncture needle the treatment is not considered acupuncture. Dry needling is based on Western physiologic approaches.

According to James Dunning…. Unlike acupuncture, dry needling “does not attempt to move qi (chi) along a meridian, nor does it rely on diagnosis from traditional Chinese acupuncture or Oriental medicine.”

The needle is pressed or inserted into the trigger point and a local twitch response is ideally elicited. This twitch response is an involuntary contraction of the muscle that allows the muscle to relax. Sometimes electrical stimulation is applied to the needle to elicit these twitches to help the muscle relax as well.

What Are Trigger Points?

Trigger points are hyperirritable contractions or knots found in tight bands of muscles. And according to the American Family Physician trigger points are “discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders.”

A patient will present with pain when adding pressure to a taut band which ‘triggers’ a referral of symptoms spread beyond the muscle and often times away from the actual trigger point. Trigger points can affect the local area of pain but also can refer to other parts of the body which can all effect strength, flexibility, and coordination of muscles.

How Long Does It Take To Experience Relief With Dry Needling?

After the dry needling treatment, many people note immediate improvement in symptoms of tightness and pain relief. While many patients experience immediate relief, many cases take 24 to 48 hours and this is often accompanied by soreness from the treatment itself.

What Does Dry Needling Feel Like?

When the needle is pressed into the skin some patients don’t report any pain or feelings while others vary in their reaction. Most people report a slight pin prick feeling while others experience a dull ache as the needle penetrates the tissue. Often times a twitch is elicited when the needle penetrates the trigger point. Most of the aching subsides as the needle remains in place for a few moments.

What Conditions Can Be Treated With Dry Needling?

Dry Needling helps to reduce muscle tension and active trigger points in muscles. Conditions that are most often the cause of trigger points include osteoarthritis, muscle strains and ligament sprains, joint injury, and nerve irritation as in the case of herniated discs in the neck or back.

Commonly treated diagnoses include but are not limited to the following:

• Sciatica
• Osteoarthritis
• Neck pain
• Headaches and migraines
• Shoulder pain
• Frozen shoulder
• Knee pain
• Plantar fasciitis
• Hip bursitis
• Hamstring and lower back injuries
• Chronic pain syndromes
• Carpal Tunnel Syndrome
• Lateral Epicondylitis
• Medial Epicondylitis
• Temporo-mandibular joint dysfunction (TMJ)

To learn more about how we can help you or a family member by using Trigger Point Dry Needling, call us at Coppola Physical Therapy and ask for one of our physical therapists trained in trigger point dry needling. 

Click on the following link to find a Coppola Physical Therapy location near you:  7 Convenient Locations

What Does The Research Say About Dry Needling? 

  1. Dry needling combined with exercise showed significant improvement in pain, motion, trigger point reduction, and function following a total knee replacement (Nunez-Cortes R et. al)
  2. There is moderate evidence that dry needling on trigger points can relieve low back pain when coupled with other therapies (Liu L et. al.)
  3. While additional studies are needed, Kietrys DM et. al. states that “based on the best current available evidence, we recommend dry needling, compared to sham or placebo, for decreasing pain…in patients with upper-quadrant myofascial trigger points (Kietrys DM et. al.)
  4. A study by Koppenhaver S et. al. found improvement in shoulder motion and reduced pain sensitivity after dry needling of the infraspinatus muscle in patients with subacromial pain syndrome (pain in the shoulder). (Koppenhaver S et. al.)
  5. It is noted that very low-quality to moderate-quality evidence suggests that dry needling performed by PTs is more effective than no treatment…in patients presenting with musculoskeletal pain at 12-week follow-up (Gattie E, Cleland JA, Snodgrass S)
  6. In a study by Krey, Borchers, and McCarney the evidence suggests that dry needling to tendons improved outcome measures in patients with tendinopathy. (Krey D, Borchers J, McCarney K)
  7. France et. al. showed significant improvement in cervicogenic headaches (headaches coming from the neck musculature) following dry needling treatments (France et. al.)
  8. A double-blinded, placebo-controlled study by Tekin et. al. showed significant decreases in pain, improved quality of life, and decreased need for medicines… (Tekin et. al.)
  9. Six weeks of dry needling treatment of patients suffering from fibromyalgia noted significant differences in pain, fatigue, outcomes scores, pressure pain threshold, and global subjective improvement in a study by Casanueva et. al. (Casanueva et. al.)
  10. In a study by the International Journal of General Medicine a PT anesthetized then treated with dry needling, sham treatment, and nothing. The dry needling significantly decreased the need for post-surgical analgesics and had the same degree of pain reduction in one month as the control patients achieved in 6 months. (Intl Journal of General Medicine).

Research

  • Núñez-Cortés R et al. Dry Needling Combined With Physical Therapy in Patients With Chronic Postsurgical Pain Following Total Knee Arthroplasty: A Case Series. J Orthop Sports Phys Ther. 2017 Mar;47(3):209-216. doi: 10.2519/jospt.2017.7089. Epub 2017 Feb 3.
  • Liu L et al. Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2018 Jan;99(1):144-152.e2
  • Kietrys DM et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013 Sep;43(9):620-34. doi: 10.2519/jospt.2013.4668.
  • Koppenhaver S et al. Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome. Man Ther. 2016 Dec;26:62-69. doi: 10.1016/j.math.2016.07.009. Epub 2016 Jul 21.
  • Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Mar;47(3):133-149. doi: 10.2519/jospt.2017.7096. Epub 2017 Feb 3.
  • Krey D, Borchers J, McCamey K. Tendon needling for treatment of tendinopathy: A systematic review. Phys Sportsmed. 2015 Feb;43(1):80-6.
  • France et al. 2014
  • Tekin et al. 2013
  • Casanueva et al. 2014. RCT
  • International Journal of General Medicine 2008:1 3–6