Manual Trigger Therapy & Dry Needling

Introduction

Myofascial trigger points are a major cause of chronic musculoskeletal pain. However their significant role in pain management wasn’t been identified for a long time. Low back pain may be related to trigger points in the abdominal muscles, while headaches can be related to trigger points in the neck muscles and facial muscles. The referred pain is a characteristic feature of myofascial trigger points. It forms the basis for its name “Trigger Point “, since it relates to one area triggering pain elsewhere.

There are several ways to treat trigger points. Manual Trigger Point Therapy, Dry Needling and the combination of these two techniques, have been shown to be highly effective. Here in perfecto physios we utilise both the techniques to treat trigger points.

Manual Trigger Point Therapy includes specific manipulations to the muscles, fascia and connective tissues. Dry Needling includes the use of sterile disposable acupuncture needles to improve circulation and blood flow to the affected muscle trigger point areas. This helps to promote healing and reduce pain. The more accurate the treatment is on the affected trigger point, the better the results.

How does it work?

The Dry Needling procedure involves advancing of a very fine filament needle into the muscle in the area of the body which produces pain and typically contains a ‘Trigger Point’. There is no injectable solution and typically the needle that is used is very thin.
Most patients will not even feel the needle penetrate the skin, but once it has and is advanced into the muscle, the discomfort can vary. Usually a healthy muscle feels very little discomfort upon insertion of the needle; however, if the muscle is sensitive and shortened or has active trigger points within it, the subject may feel a sensation much like a muscle cramp — which is often referred to as a ‘twitch response’.

What is the Cause of a Trigger Point?

A Trigger Point in the muscles or fascia tissues lead to myofascial pain causing an entire muscle to be painful, tight, weak, and more easily fatigued. The cause is multi-factorial. It is built on a combination overworking or overstressing muscles, poor posturing, static or sustained postures, overuse, misuse, underuse and/or direct trauma of muscles. Trigger Points can be either the cause or a contributing factor of a wide variety of painful conditions that you have.

What Kind of Needles Are Used?

Dry needling involves a thin filiform needle that penetrates the skin and stimulates underlying myofascial trigger points and muscular and connective tissues. The needle allows a physical therapist to target tissues that are not manually palpable.

Physical therapists wear gloves and appropriate personal protective equipment (PPE) when dry needling, consistent with Standard Precautions, Guide to Infection Prevention for Outpatient Settings. The sterile needles are disposed of in a medical sharps collector.

Trigger point dry needling is a treatment technique used by physical therapists around the world.  There are several dry needling techniques, based on different models, including the radiculopathy model and the trigger point model, which are discussed here in detail. Special attention is paid to the clinical evidence for trigger point dry needling and the underlying mechanisms. Comparisons with injection therapy and acupuncture are reviewed. Trigger point dry needling is a relatively new technique used in combination with other physical therapy interventions.

Why Dry Needling?

In cases when dry needling is used by physical therapists, it is typically 1 technique that’s part of a larger treatment plan.

Physical therapists use dry needling with the goal of releasing or inactivating trigger points to relieve pain or improve range of motion. Preliminary research 2 supports that dry needling improves pain control, reduces muscle tension, and normalizes dysfunctions of the motor end plates, the sites at which nerve impulses are transmitted to muscles. This can help speed up the patient’s return to active rehabilitation.