Dry Needling

MYOFASCIAL TRIGGER POINTS and DRY NEEDLING

History:

Anytime our body has been injured, the muscular tissue around the injury is almost always contributing towards the pain we feel, and in many cases is indeed the injured structure. The work of Janet G. Travell, M.D. (Cardiologist, personal physician of former President John F. Kennedy) and David G. Simmons, M.D. contributed to the understanding of how our muscles form tight knots, called myofascial trigger points, and how these trigger points relate to chronic and acute pain. Through their research, the medical field has learned how these trigger points are formed, how to identify trigger points clinically, and most importantly treatment strategies for trigger points.

Karl Lewitt, M.D. was the first medical practitioner to publish the “dry needling” technique in 1979. Dry needling is a term used because there is no injection of medicine involved, which would be considered “wet needling”. Dry needling is the practice of deactivating the myofacial trigger point by inserting a small solid filament needle directly, and specifically, into the contracted muscular tissue to elicit a localized twitch response(LTR). A LTR is an uncontrollable, short-arc spinal cord reflex that resets the muscle back to a normal relaxed state. Multiple LTR’s are typically required to completely deactivate the trigger point and recent research suggests eliciting a LTR is required for the desired effects.

Myofascial trigger points are usually treated conservatively at first, targeting the involved structure with appropriate stretching and strengthening exercises as well as hands-on manual therapy techniques to improve muscle tissue quality.

FAQ

The solid filament needle used typically causes very little discomfort or pain, however the localized twitch response elicited during the technique can be quite uncomfortable and sometimes painful. Fortunately, the dry needling technique takes very little time to complete, usually 1-2 minutes per treatment, and the pain relief from the technique is worth the short duration of discomfort during the technique.

Dry needling targets muscle trapped in a contracted position and by eliciting a natural physiological response resets the tissue to a normal resting state. This will decrease pain associated with that tissue, improve force production of the tissue, improve flexibility of the tissue, and improve kinematical movement patterns of the joint associated with that tissue.

Dry needling can be used to help alleviate pain with a multitude of conditions and disorders: Chronic pain, tension-type and musculogenic headaches, myofascial pain syndrome and fibromyalgia, acute injuries, and many more. Dry needling is becoming a popular treatment for high performance athletes and in fact physical therapists trained in dry needling are utilized by many major league sports teams, the U.S. Army Special Forces, and the U.S. Olympic Tennis Team.

When the dry needling technique is coupled with appropriate rehabilitation of the involved tissue, the benefits will last indefinitely. If the injury was caused secondary to poor posture or repetitive injury, lifestyle changes are also required to stop stressing the tissue beyond it’s physiological limits.

Yes. The trained practitioner has excellent knowledge of human anatomy and is able to perform the technique on virtually any muscular structure without compromising the surrounding structures. Special attention is used if the patient is on prescription blood thinners (coumadin, warfarin)or if the muscular tissue is overlying the thoracic cage. There are certain situations where dry needling is inappropriate: if the muscle is underneath an open sore or scab, if infection is present, if the practitioner cannot isolate the targeted muscle, or if there are prosthetic structures near the muscle (i.e. breast, calf, or other implants).

No. The research behind myofascial trigger points, the conception of the dry needling technique, the training in dry needling, and the rehabilitation of the involved structures are all completely independent of eastern Chinese medicinal practices, including acupuncture. Unless the practitioner performing the technique is a certified acupuncturist, it would be erroneous to consider dry needling as acupuncture.