Trigger point dry needling
“Dry needling (DN) is a skilled intervention used by physical therapists that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. A trigger point describes a taut band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch and can refer pain to distant parts of the body. Physical therapists utilize dry needling with the goal of releasing/inactivating the trigger points and relieving pain” – American Physical Therapy Association: Physical Therapists & The Performance of Dry Needling An Educational Resource Paper, 2012
Myofascial Trigger points
A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia.(1,2) These can be tender on palpation and can create referred muscle pain, which can feel like aching, boring, and sometimes sharp pain; some myofascial trigger points even creating muscle pain without being palpated or compressed.(1,2)
Myofascial trigger points are associated with muscle pain, loss of flexibility and range of motion, as well as functional weakness of a muscle.(2,3)
Treatment Using Trigger Point Dry Needling
I include the use of trigger point dry needling in treatment following a thorough assessment of your problem or injury. With you, I create a treatment plan, focused on your physiotherapy goals; this can include other therapies such as manual therapy, manipulation, exercise and education.
Treatment is focused on treating the source of pain and dysfunction, and not simply treating the “victim” of your pain in isolation.
Effects of Dry Needling
Dry needling has been demonstrated to have a significant effect on muscle tone and myofascial trigger points. This occurs through mechanical, electrophysical, chemical and neurophysiological mechanisms. Most of these effects are dependent on eliciting a local twitch response at the trigger point.(4–7)
“Trigger point dry needling appears to reduce myofascial pain, regardless of body region, at various points in time.” – Boyles et al, Journal of Manual and Manipulative Therapy, 2015(8)
Dry Needling can be especially effective for muscle pain and myofascial pain syndromes when combined with other physiotherapy techniques and treatments, including hands on care, exercise and education.(9)
Dry Needling treatment has been shown in the research to have positive effects on numerous musculoskeletal pains. This includes:
- Temporomandibular Joint Pain and Dysfunction (TMD)(10–12)
- Mechanical Neck Pain(7,13)
- Shoulder Pain(13,15)
- Low Back Pain(16)
- Plantar Fasciitis and Heel Pain(17,18)
- Muscle pain created by myofascial trigger points(8)
Other areas that demonstrate significant improvement clinically include:
- Rotator Cuff
- Lateral or Medial epicondylosis (Tennis Elbow, Golfer’s Elbow)
- Achilles Tendinopathy
- Hip Pain or Arthritis
- Knee Pain or Arthritis
- Radiculopathies (nerve pain)
What to Expect:
Dry needling is a technique performed with acupuncture needles, but over the trigger points of your painful muscles. The needle used for this technique with very fine and there is no injection with dry needling. Dry needling does not require the needles to stay in once the local twitch response is triggered; therefore the treatment of each muscle is done very quickly. The areas that require treatment do require the skin to be exposed for dry needling treatment, so depending on the area to be treated, shorts, a tank top or gown may be necessary to wear to provide access.
After your treatment, it is common to have some local aching over the area of treatment, which usually dissipates between 4-8 hours after the treatment. Bruising can also occur, but this is less common.(20) Improvement in pain and mobility is typically noted immediately following treatment, however more chronic conditions can take up to 4-6 treatments to notice lasting changes. Some fatigue on the same day of treatment can also occur.
It is recommended to avoid strenuous activity or strength training on the same day following treatment until you know how your body and muscles respond to the dry needling treatment. Light activity, range of motion exercises and/or heat may be recommended for you following your treatment; this is discussed at your appointment.
How to Best Prepare for your Dry Needling Treatment:
· Have a snack or light meal prior to your treatment
· Be well rested if possible
· Be well hydrated
· Avoid getting dry needling if you are sick or have a fever
· Avoid alcohol and cigarettes prior to a needling session
Advise your physiotherapist of the following:
· All medical conditions
· Medications you are taking
· Past surgeries including any pacemakers, implants or joint replacements
· History of bacterial endocarditis or heart valve replacement
· Allergies to surgical steel or skin prep chemicals
1. Simons DG, Travell JG, Simons L. Travell & Simons’ myofascial pain and dysfunction: the trigger point manual. 2nd ed. Vol. 1. Baltimore: Williams & Wilkins; 1999.References:
2. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R. 2015 Jul;7(7):746–61.
3. Moraska AF, Schmiege SJ, Mann JD, Butryn N, Krutsch JP. Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. Am J Phys Med Rehabil. 2017 Sep;96(9):639–45.
4. Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic effects of dry needling. Curr Pain Headache Rep. 2013 Aug;17(8):348.
5. Huang Y-T, Lin S-Y, Neoh C-A, Wang K-Y, Jean Y-H, Shi H-Y. Dry needling for myofascial pain: prognostic factors. J Altern Complement Med N Y N. 2011 Aug;17(8):755–62.
6. Kietrys DM, Palombaro KM, Mannheimer JS. Dry needling for management of pain in the upper quarter and craniofacial region. Curr Pain Headache Rep. 2014;18(8):437.
7. Mejuto-Vazquez MJ, Salom-Moreno J, Ortega-Santiago R, Truyols-Dominguez S, Fernandez-de-Las-Penas C. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014 Apr;44(4):252–60.
8. Boyles R, Fowler R, Ramsey D, Burrows E. Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther. 2015 Dec;23(5):276–93.
9. Segura-Perez M, Hernandez-Criado MT, Calvo-Lobo C, Vega-Piris L, Fernandez-Martin R, Rodriguez-Sanz D. A Multimodal Approach for Myofascial Pain Syndrome: A Prospective Study. J Manipulative Physiol Ther. 2017 Aug;40(6):397–403.
10. Diracoglu D, Vural M, Karan A, Aksoy C. Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: a double-blind, randomized, placebo controlled study. J Back Musculoskelet Rehabil. 2012;25(4):285–90.
11. Gonzalez-Perez L-M, Infante-Cossio P, Granados-Nunez M, Urresti-Lopez F-J. Treatment of temporomandibular myofascial pain with deep dry needling. Med Oral Patol Oral Cirugia Bucal. 2012 Sep 1;17(5):e781-785.
12. Fernandez-Carnero J, La Touche R, Ortega-Santiago R, Galan-del-Rio F, Pesquera J, Ge H-Y, et al. Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. J Orofac Pain. 2010 Winter;24(1):106–12.
13. Liu L, Huang Q-M, Liu Q-G, Ye G, Bo C-Z, Chen M-J, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015 May;96(5):944–55.
14. France S, Bown J, Nowosilskyj M, Mott M, Rand S, Walters J. Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: a systematic review. Cephalalgia Int J Headache. 2014 Oct;34(12):994–1003.
15. Arias-Buria JL, Fernandez-de-Las-Penas C, Palacios-Cena M, Koppenhaver SL, Salom-Moreno J. Exercises and Dry Needling for Subacromial Pain Syndrome: a Randomized Parallel-Group Trial. J Pain Off J Am Pain Soc. 2016 Oct 5;
16. Koppenhaver SL, Walker MJ, Su J, McGowen JM, Umlauf L, Harris KD, et al. Changes in lumbar multifidus muscle function and nociceptive sensitivity in low back pain patient responders versus non-responders after dry needling treatment. Man Ther. 2015 Dec;20(6):769–76.
17. Cotchett MP, Munteanu SE, Landorf KB. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Phys Ther. 2014 Aug;94(8):1083–94.
18. Morihisa R, Eskew J, McNamara A, Young J. DRY NEEDLING IN SUBJECTS WITH MUSCULAR TRIGGER POINTS IN THE LOWER QUARTER: A SYSTEMATIC REVIEW. Int J Sports Phys Ther. 2016 Feb;11(1):1–14.
19. Casanueva B, Rivas P, Rodero B, Quintial C, Llorca J, Gonzalez-Gay MA. Short-term improvement following dry needle stimulation of tender points in fibromyalgia. Rheumatol Int. 2014 Jun;34(6):861–6.
20. Brady S, McEvoy J, Dommerholt J, Doody C. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther. 2014 Aug;22(3):134–40.
21. American Physical Therapy Association: Physical Therapists & The Performance of Dry Needling An Educational Resource Paper, January 2012; http://www.apta.org/StateIssues/DryNeedling/ResourcePaper/