In our experience, we’ve found Dry Needling to be a powerful treatment for musculoskeletal and referred pain.
Dry Needling is often confused with Acupuncture- the Traditional Chinese Medicine therapy based on the philosophy of Meridians. In Acupuncture philosophy, “qi” or life-force flows through seven vertical channels in the body, and interruption of this flow is responsible for ill-health. By inserting needles into acupuncture points, the normal flow of qi is restored, and this returns the body to health. While acupuncture as a discipline has been proven effective at relieving pain from certain conditions, the philosophy itself departs from normal scientific Western medicine, in that it is not described in terms of anatomy, physiology and pathological basis of disease.
In response to this, Western medicine has developed a practice known as Dry Needling, in which needles are inserted into myofascial trigger points, connective tissue spasm or just in to the skin to stimulate nociceptors (pain nerves). Interestingly, there is a high degree of correlation (71% as reported by Melzack et al.) between locations of known trigger points, and classical Acupuncture points for the relief of pain.
The term “trigger point” 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 nodule 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 harbouring the trigger point.
- The pain cannot be explained by findings on neurological examination. Definition from Wikipedia
Dr Travell and a colleague, Dr David Simons were researching the role of myofascial trigger points in unexplained pain, and found that by injecting these trigger points with anaesthetic, they could effectively relieve a patients pain, local and referred. To further analyse the effect, Drs Travell and Simons investigated the effect of using needle insertion without the injection of anaesthetic, and found the results to be comparable. This suggests that the needle itself is the agent of change, rather than the pain relief provided by the anaesthetic. Thus the treatment can be effectively conducted with a “Dry Needle” as opposed to an injection. In recent times we’ve adopted the use of the acupuncture needle instead of the hypodermic needle, as they are thinner and cause less discomfort to the patient, and less tissue damage or bruising.
Dry needling practice varies depending on the intent, and the cause of the pain.
Structural needling involves insertion of a needle into the trigger point, with the intent of causing a fasciculation (twitch). Though evidence is still inconclusive about the physiological basis of the treatment effect, it is thought that by stimulating this fasciculation, the muscle fibre will then undergo a “refractory period” where it’s tightly contracted state will release. This allows capillaries to reopen, and causes blood flow back through an area that had been congested by the pressure of the protective muscular spasm, resulting in contraction with inadequate oxygen, leading to development of chemicals such as lactic acid. By reducing this spasm, new blood flow can flush this “metabolic junk” and allow normal muscular resting state.
Peri-structural needling involves inserting a needle only as deep as the layer of fascia overlying the painful structures. By reducing the spasm in the fascia and connective tissue, we restore more normal flexibility and function to the muscles underlying. Research has found this method to be about as effective as the deeper, structural needling, though often many more needles are used to achieve the same effect.
Superficial needling (transverse) is the method used to treat referred pain from primary nerve impingement/pathology. These are things like sciatica, headache, and arm pain from disc bulge in the neck. In this scenario, a patient experiences pain in a limb with out any actual injury to the painful area, due to compression of the nerve (centrally) supplying the skin in that region. By inserting the needle transversely into the skin, and applying several needles throughout the region of referred pain, we maximise the number of nociceptors being stimulated. After some time (this treatment often takes 15-20mins, as opposed to 3-5min for structural), the continuous noxious stimulus is inhibited by the brain (descending pain inhibition) by modulating the activity in the dorsal horn of the spinal cord. This results in relief of the referred pain.
Generally, we find Dry Needling to be a powerful treatment for musculoskeletal and referred pain. While it is not every patient’s cup of tea (due to needle phobia), for those who endure it there is often significant relief of pain, which last much longer than simply using other manual techniques such as massage or trigger point release with manual pressure. So if your therapist suggests it may help you, give it a go!