DRY NEEDLING FOR MYOFASCIAL TRIGGER POINTS
Health care practitioners have used many techniques over the years in order to treat myofascial trigger points (MTrP). Sports therapists and orthopedic medical specialists all aim to address pain and dysfunction related to trigger points in the muscle. One technique that has gained much traction in recent years is the use of trigger point dry needling. Dry needling, also known as intramuscular stimulation (IMS) or intramuscular needling, is a treatment technique that has been utilized by physiotherapists around the world since the 1980’s. While the technique is not taught in entry‐level education, there has been a dramatic increase in dry needling certification programs and continuing education courses in recent years.
According to the Internal Journal of Sports Physical Therapy (C.Unverzagt et al. June 2015) “Myofascial trigger point pain is defined as “pain arising from one or more myofascial trigger points, which are hyperirritable spots in skeletal muscle that are associated with hypersensitive palpable nodules in taut bands.” Typically, MTrPs are painful on compression and may refer pain and sensory disturbances to peripheral areas of the body (aching, burning, tingling). The autonomic nervous system is often disrupted as well, with signs of localized sweating, vasoconstriction or vasodilation and goosebumps.
It is believed that MTrPs are caused by an excessive release of acetylcholine (Ach) from motor endplates (B.C. Dommerholt et al. Curr Pain Headache Rep 2012). This prolonged release of Ach results in chronic shortening of certain muscle sarcomeres, leading to decreased circulation throughout the muscle. This then leads to a lack of oxygen (hypoxia) and local ischemia (lack of nutrition) to the muscle. As a result, our mast cells release mediators such as prostaglandins, bradykinins and histamines, which act to sensitize the nerve fibres to the muscle, causing the specific tenderness and sensitivity to the muscle. A variety of mechanisms contribute to the onset of this problem, such as: trauma (sprains, strains), mechanical factors (poor posture, ergonomics), degeneration (OA, nerve root impingement), emotional (stress, tension, fatigue), nutritional (vitamin and mineral insufficiencies), infection, metabolic and respiratory dysfunctions.
The technique of dry needling is based on a different model than that of Traditional Chinese Acupuncture (TCA). In short, TCA is based on the theory that the human body is controlled by a vital force or energy called “Qi” (“chi”), which circulates between organs along channels called meridians. Acupoints are located along these meridians to improve the flow of Qi and rid the body of congestion and blockages of vital energy (nutrition and circulation). The technique of dry needling is meant to target the localized taut bands within the muscle, with the goal of relieving the sensory, motor and autonomic dysfunctions that can occur. Research shows that the inactivation of the trigger point, via dry needling, is the fastest and most effective means to reduce the pain (by causing an analgesic effect) as compared to other conventional interventions. The localized twitch response, which is commonly evoked with inserting the needle, has been shown to interrupt the actin-myosin bonds responsible for causing the taut muscle bands. Additionally, dry needling of the MTrPs will help to normalize muscle tone and improve the neurological function (the nutrition) to that muscle. Dry needling is only one facet of the treatment plan and should be used in conjunction with stretching, joint mobilizations, neuromuscular re-education, strengthening and activity modifications.
The American Academy of Orthopaedic and Manual Physical Therapists (AAOMPT) released a position statement in October of 2009 stating:
Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.
If you have more questions about this technique, or believe you could benefit from releasing some of those stubborn trigger points, the physiotherapists at Bragg Creek Physiotherapy would love to help you.
Jennifer Gordon (BScPT, GunnIMS, AFCI)
Physiotherapist
Bragg Creek Physiotherapy
www.braggcreekphysio.com
