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Dry Needling Therapy



What is Dry Needling?

Some people may hear the word “needle” and lose interest. However, dry needling can be a highly effective way to manage muscle tension and pain! Intramuscular Dry Needling (also referred to as Trigger Point Dry Needling) involves using a very thin, solid needle to mechanically disrupt and release myofascial trigger points in skeletal muscle. 




Release What?

Myofascial Trigger Points (MTrPs), also just referred to as trigger points (TrPs), are essentially what we commonly think of as a “muscle knot”. These trigger points are bands of taut muscle tissue that often cause pain, range of motion restriction, and strength deficits. 


  • These taut bands are areas of a muscle that is unable to contract or relax, remaining a constant length with increased diameter. Thus, feeling like a “knot” in the muscle.

  • The muscle’s inability to contract or relax in these areas limits blood flow to the local muscle tissue. This causes a build-up of neurotransmitters, which lowers the pH and can cause painful stimuli.

  • Trigger points can cause pain at the site of the trigger point, and they can also cause “referred pain” which is pain in a different area of the body when pressure is applied to the trigger point. 




Where Do Trigger Points Come From?

Trigger points are generally caused by muscle overload. This can be due to sustained or repetitive low-level muscle contraction, eccentric (lengthening) contractions, and/or maximal and submaximal concentric (shortening) contractions.


  • Essentially, TrPs can develop when muscle use exceeds muscle capacity and normal recovery is disrupted.

  • Sustained postures and long-duration muscle contractions can often lead to TrP formation.

  • For this reason, they can commonly be found in muscles such as the calves and the upper trapezius in the shoulder, both muscle groups having high rates of activity during activities of daily living.




How Dry Needling Works to Fix This:

Inserting a fine needle into the TrP causes a mechanical disruption in the muscle fibers.

  • This occurs by the needle insertion eliciting a local twitch response, which is an involuntary spinal reflex that causes the muscle to contract and relax.

  • This contraction and relaxation allows the muscle fibers to return to their resting length.

  • The twitch response can stimulate mechanoreceptors in the muscle tissue, like a-beta fibers, which are known to correlate with pain relief stimuli.




What Else Happens?

  • Dry needling causes vasodilation to the small blood vessels in the muscle tissue, leading to increased blood flow and oxygenation.

  • Dry needling has also been found to increase pain threshold and decrease sensitization to painful stimuli in the area.




Another form of dry needling is Electrical Dry Needling (EDN).

  • This involves placing one or two needles into the TrP of a muscle group and passing a low-level electrical current through the muscle to stimulate a contraction/relaxation response.

  • This form of dry needling has the same effect on the TrPs as the non-electrical form.

  • In addition to these aforementioned benefits, EDN has been used to combat muscle atrophy by stimulating specific muscles. It is also used to decrease muscle spasticity. 




Big Picture Takeaways:

  • Dry needling can be a helpful form of treatment to release trigger points (TrPs) in the muscle to reduce pain, improve range of motion, and improve strength.

  • However, it should not be used as a stand-alone treatment method to solve mobility or strength impairment.

  • Dry needling is most effective as a way to reduce symptoms, improve mobility, or improve strength, when it is followed-up with mobility or strengthening exercises to maintain the improvements made from the release of TrPs.

  • Simply put: If you only dry needle an area of the body and do nothing else to address the cause of the TrPs, they will likely return. 



Sources

Bron, C., & Dommerholt, J. D. (2012). Etiology of myofascial trigger points. Current pain and headache reports, 16(5), 439–444. https://doi.org/10.1007/s11916-012-0289-4


Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. The Journal of orthopaedic and sports physical therapy, 47(3), 133–149. https://doi.org/10.2519/jospt.2017.7096


Baumann, A. N., Fiorentino, A., Oleson, C. J., & Leland, J. M., 3rd (2023). The Impact of Dry Needling With Electrical Stimulation on Pain and Disability in Patients With Musculoskeletal Shoulder Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus, 15(7), e41404. https://doi.org/10.7759/cureus.41404


“Dry Needling.” Physiopedia, www.physio-pedia.com/Dry_needling. Accessed 14 Dec. 2023. https://www.physio-pedia.com/Dry_needling

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