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This form of manual therapy has its origins in the work of Dr. Karel Lewit of Czechoslovakia. Dr. Lewit examined the short and long‐term effects of dry needling in the treatment of myofascial pain in test subjects with painful myofascial trigger points (“muscle knots”). He reported pain-relieving effects in subjects engaged by a needle without pain medication. He called this the phenomenon the “needle effect,” where the pain-relieving effects of the needle are distinct from that of the injectable pain modulating substance. Dr. Janet Travell’s trigger point model for needling advocates that inactivation of trigger points (“muscle knots”) via dry needling is the fastest and most effective means to reduce myofascial pain, as compared to other conventional interventions. These trigger points are highly sensitive, can be painful when touched, and may cause referred pain. 1
To understand how this therapy works, we must understand what a trigger point is. A trigger point is a local contracture or tight band in a muscle fiber that can disrupt function, restrict our range of motion, cause local or referred pain, cause local tenderness to touch.
● Decrease tightness and muscle tone
● Increase blood circulation and restore function to muscles that are painful or inhibited
● Reduce local and referred pain by releasing pain-relieving opioid peptides from interneurons in the dorsal horn of the spine.
● Improve motor recruitment of the areas being treated
The skin is prepared with 70% isopropyl alcohol prior to needling. The trigger point is then identified using palpation methods, the skin is gently lifted, a sterile needle is inserted into the “muscle knot”. Areas and muscles treated in one session vary from patient to patient. Dry needling therapy is dependent on the patients’ history, location of pain, and chronicity of their symptoms. The needles may be placed deeply or superficially, for shorter or longer periods of time, depending on what type of pain is being treated and how long it has lasted. Shorter periods of time would mean that needle would stay in the muscle for seconds, while longer periods could mean 10 to 15 minutes. A localized twitch response commonly elicited with dry needling may be observed in some patients. This response is thought to inducing an analgesic (pain-relieving) effect. Dry Needling can be augmented by the use of intramuscular electrical stimulation to elicit muscle relaxation, increase local blood circulation, and decrease muscle tone.
To some, trigger point needling may appear synonymous with Traditional Chinese Acupuncture; nonetheless, the two are uniquely different.
Acupuncture is based on the theory that the workings of the human body are controlled by an energy called “Qi”, which circulates between organs along channels at specific points throughout the body called “meridians”. Qi must flow in the correct strength and quality through each meridian in order to maintain optimal homeostasis in the body. Acupuncture therapy can address non-musculoskeletal conditions like allergies, depression, insomnia, and many other conditions.
Needling is focused on the evaluation of pain patterns, posture, movement impairments, and function of the musculoskeletal system.
A 2005 Cochrane review investigated the effects of dry needling in the treatment of myofascial pain syndrome in the lumbar spine. While the authors noted dry‐needling appears to be a useful adjunct to other therapies for chronic low back pain.2
A systematic review was performed by Teasdale et al. and focused on dry needling in athletes. The author found a statistically significant benefit to dry needling and concluded, “for athletes, this treatment has the ability to have a positive impact on pain, performance, and quality of life,” especially if used in conjunction with stretching, exercise therapy, and other non‐invasive treatments. 3
Trigger point needling is a technique rooted in medical science and can be utilized to treat various musculoskeletal conditions. At Miami Spine + Performance we utilize needling as only one facet of a patient’s care: chiropractic care, stretching, manual therapies, neuromuscular reeducation, strengthening, and other related interventions are used in conjunction with dry needling to achieve lasting results. If you are interested in dry needling, please give us a call!
Contraindications to Dry Needling:
History of an abnormal reaction to needling or injection
Abnormal bleeding tendencies
Compromised immune system (eg. cancer, HIV, hepatitis, etc.)
Allergy to metals or latex