Trigger Point Dry Needling: Applications & Evidence
Trigger Point Dry Needling (TDN) has been used around the world for decades, and in more recent history has become an important tool for Physical Therapists. During this procedure a solid filament needle (like those used in acupuncture) is inserted into the muscle to help relieve pain. The needle is targeted towards myofascial trigger points, areas of hyperirritability in the muscle, that cause local and referred pain throughout the body. The use of the needle allows the therapist to get more precision deep into the muscle than they can by using traditional manual therapy techniques. TDN is used to loosen and lengthen tight muscles, and is an effective treatment for acute and chronic pain, rehab from injury and in some cases, can even help with injury prevention.
The needle used for TDN is very thin, and often patients will not feel it puncture the skin. Once in the muscle the therapist pistons the needle up and down to elicit a localized twitch response. The twitch response helps to relieve pain by facilitating tense muscles to release and help restore their normal structure. Eliciting this response is crucial to breaking up the pain cycle. A study by Shah et Al. in 2008 concluded that biochemicals associated with pain, inflammation and intercellular signaling are elevated in the areas of active trigger points.1 Further studies have found that the local milieu of trigger points changes with the occurrence of local twitch response.2 During this involuntary response the patient may feel some tightness or cramping which ranges in severity depending on the location on the body, and can vary from patient to patient.
TDN has a wide range of applications from pain management to rehab of sports related injuries. A great number of the musculoskeletal pain problems we see in the clinic may respond to the use of dry needling. When used in conjunction with the other manual therapy techniques we employ at Cioffredi & Associates, TDN is very effective. Some of the conditions it can be used to help treat include neck and back pain, sciatica, headaches, rotator cuff injuries, shoulder impingement, carpal tunnel, and foot pain (to name a few). For athletes, dry needling can be used in the treatment of muscle pulls and strains, hamstring pain, shin splints, knee pain, Achilles tendon pain, hip flexor strains, rotator cuff tendonitis and tennis elbow.
Athletes at Louisiana State University have been enjoying the benefits of TDN for many years. Their staff Physical Therapist, Ricky Lane, is trained in this technique and employs it as a component of his treatment. Jack Marucci, director of athletic training for the football program at LSU, says that TDN “has given us a competitive edge. It’s been a great partnership with Ricky, and dry needling is now part of our standard of care.”3 Dry needling is now commonly used for athletes of all levels from the Little League up to Olympic level athletes, though as mentioned previously, its application extends well beyond the world of sports. The doctors that first mapped out the myofascial trigger points in the body used this treatment on President John F. Kennedy to successfully relieve his long standing back pain.3
Some may think that TDN sounds a lot like acupuncture, however they are quite different. TDN and acupuncture come from different schools of thought. While they both use a solid filament needle, TDN is directed at releasing trigger points (areas of hyper irritability in muscles), relieving muscle tension and pain, and restoring proper movement/function in conjunction with physical therapy. In traditional Chinese Medicine, acupuncture uses needles inserted into meridians to restore the energy balance (or “qi”) to the body.
Trigger Point Dry Needling is an effective and safe method for treating trigger points when employed by a trained Physical Therapist or Physician. While not a cure in and of itself, the use of TDN as an additional tool helps therapists to break the pain cycle and bring longstanding relief to patients. The therapists at Cioffredi & Associates have undergone numerous hours of training in TDN by KinetaCore Physical Therapy Education, a leader in TDN training that has certified 1500 therapists to date across North America.
1. Shah, Jay P., Elizabeth A Gilliams. “Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome.” Journal of Bodywork and Movement Therapies 12 (2008): 371-384.
2. Vulfsons, Simon, Motti Ratmansky, and Leonid Kalichman. “Trigger point needling: techniques and outcome.” Current pain and headache reports 16.5 (2012): 407-412.
3. Baton Rouge Physical Therapy – Lake. “Innovative technique keeps the Tigers and their town roaring.” Accessed online April 25, 2013 http://www.kinetacore.com/physical-therapy/Innovative-Technique-Keeps-The-Tigers-Their-Town-Roaring/subpage271.html