Rob Stanborough, PT, DPT, MHSc, MTC, CMTPT, FAAOMPT
Dry Needling (DN) is a technique used to treat trigger points by a variety of professionals. It is used by physical therapists in in number of countries and currently in 35 states. It is called “dry” needling because it does not incorporate medication. Instead, the muscle is systematically examined so the trigger point can be palpated and isolated. A solid filament needle is inserted to the depth of the palpated trigger point to elicit a local twitch response, indicating the palpation and treatment was accurate. Once it twitches, that trigger point is gone.
I have written about trigger points in previous columns. Janet Travell, MD to JFK defined trigger points as hyper-irritable spots found in a taut band of a muscle. They’ve been written about in medical literature as early as the 1800’s but as with most things, we know a lot more now than we did then. Trigger points are not only painful but limit the length of a muscle, strength of a muscle, can alter the firing patterns of a muscles and can therefore be a significant cause of dysfunction. Physical therapists use DN primarily as a tool to treat dysfunction.
Trigger points can develop with muscle overloading in a sustained poor posture, repetitive movements, or unaccustomed activities, such as boarding windows for a hurricane or eccentric activities, such as coming down from a ladder. The overloaded produces a microscopic contracture within the muscle. Basically the tiny contractile elements run out of energy, hindering blood flow making the tissue “ischemic”. This means it lacks blood, oxygen and other nutrients. It is also unable to adequately remove waste products, which cause pain and dysfunction.
Trigger points can be treated in a number of ways. Manual pressure can be applied with or without contractions, and modalities can be used such as DN. The key to restoring function is to rid the muscle of the trigger point, restore length/strength and prevent further problems or compensations i.e. postural corrections or improper muscle balance. If not corrected, trigger points can and will return.
Trigger points and their referred pain are major sources of headaches, shoulder pain, feelings of numbness or tingling, low back pain, hip pain, pelvic pain, chronic pain and more. Having said that, I must say, not every ache, pain or limitation is a trigger point. Trigger points are, however, problematic because the nervous system becomes hyper-sensitize, which is called Central Sensitization, but that will have to be the topic for next month’s column.
If you think you have trigger points, a “knot” in your neck, shoulder, back, leg, or elsewhere that won’t go away, DN or other treatments may help. Consulting with your PT can help. He/she should be able to identify, isolate and treat the trigger point, easing or elevating the pain and restoring function. And as with most dysfunctions, early intervention is better than later. Trigger points can get worse over time so don’t wait.
Rob Stanborough has been a DN Senior Instructor of Dry Needling for Myopain Seminars since 2010, (www.myopainseminars.com). He is currently the only Physical Therapist permitted to perform DN in the state of FL. He is president and co-owner of First Coast Rehabilitation (www.firstcoastrehab.com), as well as co-author of Myofascial Manipulation:Theory & Application, 3rd ed by Proed Inc. He has presented on the topic of soft tissue dysfunction in a variety of venues. Read previous columns posted on www.firstcoastrehab.com.