Trigger Point Dry Needling

What is Trigger Point Dry Needling (TDN)?
Dry Needling involves multiple advances of a filament needle into the muscle in the region of a "Trigger Point'. The aim of Dry Needling is to achieve a local twitch response to release muscle tension and pain. Dry needling is an effective treatment for chronic pain of neuropathic origin with very few side effects. This technique is unequalled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits. The needle used is very thin and most subjects do not even feel it penetrate the skin. A healthy muscle feels very little discomfort with insertion of this needle. However if the muscle is sensitive and shortened or has active trigger points within it, the subject will feel a sensation like a muscle cramp -'the twitch response'. The patient also may feel a reproduction of "their" pain which is a helpful diagnostic indicator for the practitioner attempting to diagnose the cause of the patient’s symptoms. Patients soon learn to recognize and even welcome this sensation as it results in deactivating the trigger point, reducing pain and restoring normal length function to the involved muscle.

Is it acupuncture?
TDN is a treatment that uses acupuncture needles, but that is where the similarity to acupuncture stops. Acupuncture tends to be a more superficial treatment that focuses on restoring energy or "Qi" to the body. It is thought there are blockages that can be restored by properly placing needles along energy channels called meridians. TDN directly treats the neuromuscular system affecting muscle tightness, joint mobility, and symptoms of pain and irritation. Testing active trigger points with an EMG needle has shown that there is increased spontaneous electrical activity at this active trigger point. Kind of like buzzing or uncontrolled electricity causing the nerve muscle connection to trigger the muscle to be tight. This tightness can cause the joint decrease in movement and many times will restrict the joint enough to limit normal functional activities of the whole body. Relatively new research has reported that there are numerous inflammatory and pain producing chemicals at an active trigger point causing pain and dysfunction of the muscle, consequently affecting the local nerves and joints.  The dry needle has been shown, when causing a twitch response in the active trigger point and muscle fiber, to decrease or completely reduce that spontaneous electrical activity and reduce or completely eliminate the irritating chemicals in that active trigger point.  This release can immediately improve range of motion, decrease pain and improve function. Patients often feel a significant cramping sensation from the twitch response but then feel an immediate improvement of their symptoms.

Utilizing trigger point dry needling in physical therapy practice allows the patient and the therapist a hastened return to strengthening and exercises that result in a faster return to function and improved maintenance of that dysfunction.

What type of problems can be treated with dry needling?
 Dry needling can be used for a variety of musculoskeletal problems. Muscles are thought to be a primary contributing factor to the symptoms. Such conditions include, but are not limited to neck, back and shoulder pain, arm pain (tennis elbow, carpal tunnel, golfer’s elbow), headache to include migraines and tension-type headaches, jaw pain, buttock pain and leg pain (sciatica, hamstrings strains, calf tightness/spasms). The treatment of muscles has the greatest effect on reducing pain mechanisms in the nervous system.

What is Myofascial Pain?
Myofascial pain syndrome is a disease of the muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and by sensory abnormalities (tenderness and referred pain). It is classified as a musculoskeletal pain syndrome that can be acute or chronic, regional or generalized. It can be a primary disorder causing local or regional pain syndromes, or a secondary disorder that occurs as a consequence of some other condition. When it becomes chronic, it tends to generalize, but it does not change to fibromyalgia. It is a treatable condition that can respond well to manual and injection techniques, but requires attention to postural, ergonomic, and structural factors, and toxic or metabolic factors that impair muscle function.

Gerwin, Robert D. "Classification, epidemiology, and natural history of myofascial pain syndrome.(Author abstract)(Report)." Current Pain and Headache Reports 5.5 (Oct 2001): 412(9). Academic OneFile. Gale. BCR Regis University. 27 Oct. 2008

What is a Trigger Point?

Classic Definition
The term "trigger point" (TrP) was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:

• Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
  
• The painful point can be felt as a tumor or band in the muscle and a twitch response can be elicited on stimulation of the trigger point.
  
• Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.
  
• The pain cannot be explained by findings on neurological examination.

http://en.wikipedia.org/wiki/Trigger_point

Is the procedure painful?
Most patients do not feel the insertion of the needle. The local twitch response elicits a very brief (less than a second) painful response. Some patients describe this as a little electrical shock; others feel it more like a cramping sensation. Again, the therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.

Are the needles sterile?
Yes, we only use sterile disposable needles.

What side effects can I expect after the treatment?
Most patients report being sore after the procedure. The soreness is described as muscle soreness over the area treated and into the areas of referred symptoms. Typically, the soreness lasts between a few hours and two days.

What should I do after having the procedure done?
 Our recommendations vary depending on the amount of soreness you have and on the individual response to the treatment. Recommendations may include applying heat or ice over the area, gentle stretches and modifications of activities.

How long does it take for the procedure to work?
Typically, it takes several visits for a positive reaction to take place. Again, we are trying to cause mechanical and biochemical changes without any pharmacological means. Therefore, we are looking for a cumulative response to achieve a certain threshold after which the pain cycle is disturbed.

Do all physical therapists do this procedure?
The American Academy of Orthopaedic Manual Physical Therapists has taken the position that TDN is within the scope of physical therapist practice.  Physical therapists must have the necessary training in order to do this procedure and at Anacortes Physical Therapy, Annette Coates, MPT is the only therapist in our clinic that performs this technique.  She travelled to Australia to receive this training from Global Education for Manual Therapists (GEMt).  http://www.gemtinfo.com/physical-therapy/AAOMPT-Officially-Accepts-TDN/subpage27.html

How do I get a referral for this technique?
Anacortes Physical Therapy is offering TDN as part of a trial on a limited time basis.  Inclusion in the trial includes an initial evaluation/assessment and four treatment sessions at no cost to the patient or their insurance if they qualify for inclusion.  The initial evaluation will help determine if TDN is appropriate for the patient and to get informed consent for the technique.  To be included in this trial, the patient must have a medical diagnosis that is appropriate for TDN and a referral from their physician specifically stating they are referred as part of the TDN trial.