Dry Needling

INTRODUCTION TO TRIGGER POINT DRY NEEDLING

The physical therapists at 360 Physical Therapy & Wellness in Fulton, MD are experts in performing trigger point dry needling. Dr. Rajat Kumar has been performing this advanced treatment technique for almost 8 years and our team uses a comprehensive approach to reduce pain and improve range of motion and overall musculoskeletal function for individuals experiencing chronic pain, low back pain, neck pain, and those who have undergone surgery but haven’t yet fully recovered. 

Trigger point dry needling is a safe technique used to address pain and limitation. Treatment involves the skilled insertion of a thin filament needle at a specific angle, speed, and depth to allow for the relaxation and release of the trigger point. In some individuals, the response is immediate, whereas others may need to be treated for 4-6 sessions before noticing results.  When performed properly, side effects and risk for injury is negligible. 

Trigger points can form directly as a result of muscular injury, trauma, or overuse. Many individuals may experience these tender, taut bands after a surgery like a knee or hip replacement or following a rotator cuff repair.  Others may notice them in response to over-training or exercise beyond the body's natural capacity or tolerance. The reason for development of trigger points can vary from person to person. 

At 360 Physical Therapy & Wellness, our certified professionals use hypodermic needles to deactivate trigger points in muscles, thereby decreasing pain and improving function and performance. We will use a combination of treatments including dry needling, instrument assisted soft tissue mobilization, massage, and myofascial release. 

Furthermore, we use a specialized, hands-on, one-on-one approach that includes specific exercises and movements to best address limitations and impairments. In contrast to most other practices, a unique program is created for each individual consisting of the most effective exercises specific to that individual’s needs. 

Trigger point dry needling for neck pain, back pain, and shoulder pain is a common technique and is shown to produce both short-term and long-term benefits. Trigger point dry needling for fibromyalgia has been proven effective in reducing pain, fatigue, and associated depression. 360 Physical Therapy & Wellness in Maple Lawn is your dry needling expert in Howard County, Maryland.

Click Here to schedule an appointment now and keep reading to learn more about trigger point dry needling!

WHAT IS TRIGGER POINT DRY NEEDLING?

Trigger Point Dry Needling (TPDN) is a skilled intervention used by approved, licensed physical therapists that uses a thin filament needle to penetrate the skin and stimulate underlying myofascial trigger points and connective tissues to manage pain and improve underlying movement impairments. 

TPDN is also known as intramuscular stimulation and is “a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system” and it “improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation,” as outlined by the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT).

A trigger point describes a taut band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch, often described as a “knot”, and can refer pain or a tingling sensation to distant parts of the body. Physical therapists utilize dry needling with the goal of releasing the trigger points, thereby relieving pain. 

Research supports that trigger point dry needling for low back pain can be an effective treatment for reducing pain, number of trigger points, and sensitivity. 

TPDN can be divided into two categories—deep and superficial. Superficial dry needling is used to assess an individual’s response to TPDN. Deep dry needling is used after a trigger point is identified. The goal of deep dry needling is to inspire tissues to relax and alleviate the pain referral pattern stemming from the identified trigger point(s). 

The main differences between deep and superficial dry needling is:

a) the depth of penetration; and

b) whether or not a local twitch response (LTR) is desired.

A local twitch response (LTR) is triggered by a sudden change in pressure over a trigger point. The presence of an LTR indicates that there is a good chance the muscle being examined has an associated trigger point. LTR is a rapid reflexive contraction (“twitch”) of the muscle fibers.

Superficial dry needling stimulates mechanoreceptors to reduce tension and associated pain and improve range of motion. Superficial dry needling includes placing needles between 5-10 mm in length over the trigger point for a period of 30 seconds. It is not associated with eliciting an LTR. Superficial dry needling can be used in place of analgesics and can address damage from scar tissue.

Deep dry needling includes using needles that are greater than 10 mm in length. This form of dry needling has been shown to deactivate trigger points by eliciting a local twitch response. The LTR has been associated with improved functioning and reduced pain within the trigger point and distally in the referred pain sites.  

Several studies support that trigger point dry needling for temporomandibular joint (TMJ) disorder is beneficial in reducing pain and inflammation and improving jaw opening and range of motion.

HOW DOES IT WORK?

To perform trigger point dry needling, your physical therapist must have the proper education and training as defined by state regulatory boards. Dry needling practice in Maryland is recognized to be within scope of the physical therapist’s practice. 

Dry needling is commonly connected with the traditional Chinese healing practice of acupuncture. Similarities between the two exist in terms of skin penetration with a thin filament needle for therapeutic benefits. Where they differ though is in the origin, philosophy, and theories. 

Acupuncture, performed by acupuncturists, is based on preserving the ancient theories and tenets of traditional Chinese medicine, while dry needling takes on a more modern, scientific approach. 

Dry needling, performed by physical therapists, is based on western neuroanatomy and modern scientific study of both the musculoskeletal and nervous systems. The physical therapists at 360 Physical Therapy & Wellness will perform dry needling in a series of carefully executed steps. 

First, the specific pain and trigger points will be identified by performing manual therapy techniques. Once identified, the needle is placed at the site of the identified trigger point. A plastic guide tube is then used help tap the needle in place. The guide tube is removed, and the needle is then inserted into the muscle tissue and surrounding fascia. 

Once a needle is in its place, the physical therapists can manipulate it, adjusting the depth of the needle, if necessary. The goal is to release the trigger point, end muscle spasms, and reduce pain within the affected muscle and tissue. 

When the filament needle is inserted into the center of a trigger point, blood pools around the needle allowing the contracted muscle fibers to relax and provides those fibers with fresh oxygen and nutrients. This process also flushes away additional acidic chemical which leads to the decompression of the local blood and nerve supply.

In general, there is minimal pain associated with trigger point dry needling and patients say they feel light pressure applied to the area. Small twitches are common, but a positive response and will disappear quickly. 

It is common to be sore for an hour, up to a day, after treatment, though this is your body’s natural response in healing. Dry needling can cause excessive soreness and bruising, which is why it is important to employ highly skilled and trained physical therapists to perform this type of intervention.  

Most patients can expect to see positive results from trigger point dry needling within four sessions.

When comparing the effects of trigger point dry needling to placebo treatments, a recent study shows that dry needling is effective in decreasing pain and improving musculoskeletal function. Read on to learn how trigger point dry needling is an effective treatment for the following conditions: 

• Low back pain: Chronic back pain is one of the most of the common musculoskeletal pain conditions treated in the United States and is one of the leading specific causes of disability worldwide. Trigger point dry needling (TPDN) is a unique and effective treatment option for those suffering with low back pain. 360 Physical Therapy & Wellness offers TPDN in combination with manual physical therapy to reduce pain and improve quality of life for those living with chronic low back pain. The small filiform needles are used to deactivate myofascial trigger points with a goal of reducing localized and referred pain, tenderness, motor dysfunction.

• Tennis elbow: If you suffer from tennis elbow or golfer’s elbow in Fulton, MD, contact one of the therapists at 360 Physical Therapy & Wellness today to learn how our effective and conservative physical therapy treatments can help relieve your pain. Tennis/Golfer’s elbow is an injury that typically results from overuse and repetitive movements where the tendons of the forearm become inflamed and pain develops on the outside of the elbow. Trigger point dry needling for tennis elbow has been shown to be an effective intervention reducing inflammation and assisting with pain management. The small filiform needles are inserted into the trigger points of the lateral muscle (Extensor Carpi Radialis Brevis) in the forearm moving up toward the elbow. The needles can also be inserted into the lower triceps, depending on severity of the injury. Trigger point dry needling for tennis elbow assists to reset the healing process, increase local blood flow, and reduce pain.

• Plantar fasciitis: Plantar fasciitis is one of the most common causes of heel pain. It is often caused by tightness in the muscles of the foot and even the calf. When these muscles get tight, they pull at the insertion of the muscles and fascia on the heel bone, causing inflammation.  At 260 Physical Therapy & Wellness, our therapists strongly recommend trigger point dry needling for plantar fasciitis. Trigger point dry needling helps to reduce the stiff, tight muscles in the foot and calf that contribute to plantar fasciitis. It can stimulate the production of new, healthy tissues by increasing blood flow to the affected area. Needling in a painful trigger point of the foot provokes a “twitch” response from the muscle and allows it to relax, reducing pain and swelling and improving circulation. Clinical trials have shown that trigger point dry needling for plantar fasciitis is an effective alternative treatment to other invasive and painful therapies.

• TMJ disorder: Individuals suffering from TMJ disorder find it difficult to talk, chew, or yawn, and have frequent headaches and/or neck pain. Many times, TMJ disorder is left untreated, but many physical and manual therapy treatments are available to alleviate pain, stiffness, and improve joint mobility. Included in these effective treatments is trigger point dry needling. Trigger point dry needling for TMJ disorder can target very specific muscles in your jaw that are contracting and causing your jaw to misalign. This technique releases the muscle spasm to return your jaw to a relaxed state, reducing the incidence of associated headaches and neck pain. A 2012 study showed that deep dry needling in the trigger point in the external pterygoid muscle (where the jaw meets the skull) can be effective in the management of patients with myofascial pain located in the jaw.

• Hip pain: Dry needling for hip pain, hip bursitis, or tendinitis is an alternative treatment to steroid shots that is considered safe and just as effective. Within the hip, the term bursitis is often used as a catch-all term for pain felt in the outer hip and/or thigh. Pain in this area can be caused by bursitis, but can also be a result of muscle tears, strained tendons, and trigger points in the muscles surrounding or leading to the hip.

Dry needling for hip pain includes inserting the needles in various locations surrounding the hip, including the muscles around the side and back of buttock, the muscles of your thighs and of the low back. Trigger point dry needling for hip pain is shown to improve range of motion, decrease pain, and improve physical function.

• Knee pain: Trigger point dry needling is found to be effective in releasing muscle tension and restoring normal flexibility and function, especially when it comes to pain and inflammation of the knee. The physical therapists at 360 Physical Therapy & Wellness in Fulton, MD are highly specialized in performing trigger point dry needling for knee pain. Knee pain, bursitis, or tendinitis can be a result of overuse, trauma or injury, or prolonged post-surgical rehabilitation. A common occurrence is lateral knee pain, typically resulting from trigger points in the vastus lateralis (your outer-most quadriceps muscle). Trigger point dry needling helps to release this muscle and the referred pain, not only to your knee, but also to your hip. Dry needling for osteoarthritis of the knee is beneficial in helping to reduce pain and inflammation and improved flexibility, especially when combined with other physical therapy interventions.

• Shoulder impingement: The goal of the trigger point dry needling for shoulder pain is to produce a muscular twitch and then relaxation of the painful knot in the shoulder. Dry needling for shoulder impingement can be combined with other treatments as part of a comprehensive plan at 360 Physical Therapy & Wellness. Shoulder impingement syndrome causes a pinch in the supraspinatus tendon of the shoulder when you try to bring your arm overhead. This pinch leads to inflammation, pain, weakness, and loss of mobility and function. If it’s not addressed, shoulder impingement can cause damage that may require surgery. Dry needling can help shoulder impingement by locating the trigger points that contribute to shoulder pain and dysfunction. It helps to reduce stiff, tight muscles in the shoulders, upper back, and neck. Dry needling for shoulder impingement helps by reducing overactive muscle tone and associated inflammation, and by reducing pain in the affected area. Dry needling for shoulder impingement has been shown to improve range of motion.

BENEFITS OF TRIGGER POINT DRY NEEDLING

The exact reason why TPDN is an effective intervention for pain management is still relatively unknown. Many studies have begun to explain the effectiveness of the body’s response by identifying what happens within three response systems—mechanical, chemical, and neurophysiological. 

MECHANICAL RESPONSE: In response to trigger point dry needling, the body produces inflammatory responses that work to repair the lesion created by the needle. As the body begins to repair the new lesion, it can then repair the pain-inducing damaged tissue.

CHEMICAL RESPONSE: Similarly, as previously noted, as the needle is placed in and around the trigger point, oxygen is rushed to the site, which normalizes the immediate chemical environment and allows acidic chemicals to be flushed out of the area, which improves overall function and reduces pain.

NEUROPHYSIOLOGICAL RESPONSE: And finally, TPDN within the neurophysiological system, that having to do with the nervous system, activates the body’s production of pain-relieving chemicals, such as endorphins. Conversely, it reduces the amounts of cortisol produced in the body.

Benefits of Trigger Point Dry Needling include:

• Reduced pain

• Alleviates trigger points

• Improved muscle and joint stiffness

• Increased joint range of motion

• Improved flexibility and movement patterns

Additionally, trigger point dry needling can ease muscle spasms, tightness, and/or tenderness. It can also help to control pain following trauma, sports-related injuries, and can assist with damage from scar tissue and post-surgery recovery. 

Combining trigger point dry needling with a comprehensive physical therapy treatment plan, musculoskeletal function is restored much more quickly. 

CONTRAINDICATIONS

Trigger point dry needling is not recommended for everyone. We have identified the groups below that should choose an alternative treatment to dry needling as it is deemed unsafe for the following populations:

• Individuals with blood disorders or abnormal bleeding

• Local or systemic infections

• Pregnant women

• Individuals with varicose veins

• Compromised immune system

• Diabetes

• Children under 12

• Individuals with a fear of needles

WHAT SHOULD I DO AFTER TREATMENT?

After a dry needling session, it is recommended to drink lots of water to help in reducing soreness. You may also consider the following:

• Perform a light work out and/or stretch.

• Light massage

• If you are sore, you can ice the treated area

You may want to avoid certain activities up to 24 hours after treatment to reduce soreness, bruising, or lightheadedness. These activities include strenuous exercise or movement in the muscles that have been treated.

CONTINUED RESEARCH

Studies have been published on the effectiveness of trigger point dry needling since the late 1970s. Despite years of research and good clinical results, many of these studies have lacked strong evidence due to issues such as small sample sizes or high dropout rates. Many of these studies were not randomized, and therefore could not be conclusive in identifying dry needling as an effective treatment over other physical therapy methods. Additional research and more controlled studies are needed to determine effectiveness of trigger point dry needling. 

Currently, a variety of controlled studies are being performed to determine and document the short-term and long-term benefits of dry needling for various conditions. Preliminary studies currently underway include:

• Dry needling for shoulder pain

• Dry needling for headache, cervicogenic headache, and migraines

• Dry needling for neck pain

• Dry needling for Parkinson’s disease 

Studies identifying trigger point dry needling for Parkinson’s disease are fascinating and provide hope to those living with the nervous system disorder. There is no cure for Parkinson’s disease, so pain management is key to improving quality of life. A small sample study was performed with positive results showing that trigger point dry needling had short effect in reducing spastic muscles and releasing associated trigger points in 75% of patients with Parkinson's disease.

At 360 Physical Therapy & Wellness, our goal is to make sure you have the quality of life you deserve. We will work with you to identify the best course of action to improve recovery time and decrease pain. Contact our physical therapists today to discuss the benefits of trigger point dry needling and if this intervention is right for you.