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Trigger Point Dry Needling Therapy - Indications, Contra-indications, and Mechanism of Action

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Dry needling therapy is a method employed by physical practitioners to aid in alleviating muscle pain, stiffness, spasms, and tightness in the body.

Medically reviewed by

Mohammed Wajid

Published At December 1, 2022
Reviewed AtDecember 14, 2022

Introduction:

Dry needling, like acupuncture, has been an alternative and complementary treatment method used since the early 1900s to help patients manage their pain, discomfort, and overall health concerns. What exactly is dry needling? How does it differ from acupuncture? Why would you want this as part of your holistic health plan? Let us explore the answers to these questions and some other benefits you can experience by using this natural treatment method in conjunction with your other healthcare services.

Dry needling is a technique that uses thin needles to penetrate the skin and stimulate the muscle that can be underlying. Filiform filaments are inserted into the knot area that forms whenever muscles become irritated or injured. This stimulation can help to release muscle tension, relieve pain, and improve the range of motion.

Dry needling can be beneficial for a variety of people. It can help with muscle pain, trigger

points, and tension headaches. It can also be helpful for people who have myofascial pain syndrome or fibromyalgia.

What Is Dry Needling?

Dry needling can be known as intramuscular stimulation (IMS), myofascial trigger point dry needling (MTrP), or just trigger point dry needling (TrP). It is an invasive procedure that involves inserting a thin needle into the skin and muscle to reach the trigger point.

Trigger points are highly sensitive and painful when touched. Trigger points are characterized by excess acetylcholine, a neurotransmitter that stimulates muscle contraction or movement. Pain from the trigger points is due to restricted blood flow leading to hypoxia (lack of oxygen), causing mild and chronic pain, stiffness in the area, muscle weakness, and restricted range of motion.

What Are the Benefits of Dry Needling?

Dry needling has numerous benefits . It can help relieve pain, increase range of motion, and improve functionality. Additionally, it is a safe treatment that works well in a variety of conditions like

  • Joint problems.

  • Reliefs tendinitis.

  • Disk problems.

  • Tendinitis.

  • Relief of night cramps.

  • Spinal problems.

  • Relief in pelvic pain.

  • Temporomandibular joint (TMJ ) problems.

  • Helps with migraine and headaches.

  • Postherpetic neuralgia (lasting pain in the area of your skin where you had shingles).

  • Phantom pain (pain that feels like it is coming from a body part that is no longer there).

  • Myofascial pain (a disorder in which pressure on sensitive points in the muscles causes pain in seemingly unrelated body parts).

  • Muscle weakness.

  • Migraine.

  • Carpal tunnel syndrome.

What Are the Indications of Dry Needling?

Dry needling is indicated for myofascial pain with the presence of muscle taut or trigger points. It is also beneficial for managing strains, tendinopathies, and osteoarthritis.

What Are the Absolute Contraindications of Dry Needling?

  • Patient with needle phobia.

  • People who do not understand the treatment process.

  • A patient who is unwilling to do the treatment.

  • In acute medical conditions or cases of a medical emergency.

  • In the case of lymphedema because it increases the risk of infection.

  • Over a cardiac pacemaker.

  • Practitioners with adequate knowledge.

Relative Contraindications:

  • In the first and third trimesters of pregnancy

  • In the case of diabetes.

  • In abnormal bleeding tendency.

  • In immunocompromised patients.

  • In an allergic patient.

  • In vascular disease.

How Is Dry Needling Done?

Dry needling is done in the following ways:

  • The needle is inserted into the skin and quickly removed in dry needling.
  • This can cause a brief sensation of pressure or cramping.
  • Dry needling is usually done by a physical therapist, chiropractor, or another trained healthcare provider.
  • The number of needles used and the session length depends on the individual's condition.

What Are the Techniques Used in Dry Needling?

  1. In and Out Technique: A fine needle is inserted into the trigger area and removed, so the needle does not stay so long. Some procedures like pistoning or sparrow pecking dry needling work on in and out insertion technique.

  2. Non-Trigger Point Technique: As the name suggests, the practitioner inserts the needles directly or near the trigger points or muscle knots that generate pain. For example, trigger points in your neck may cause pain in the shoulder. This technique works on the idea that pain is generated due to greater nerves or muscular issues, which is why they are not focused on the pain area.

How to Differentiate Deep Dry Needling from Superficial Dry Needling?

Superficial needling is dry insertion of the needle as much as 10 mm into the subcutaneous tissue; its advantages include ease of administration, reduced danger of significant tissue upheaval, reduced risk of nerve and visceral damage, and patient comfort.

Deep needling is the insertion of dry (does not contain any medication) needle beyond the subcutaneous muscle into the deep muscle to reach myofascial trigger points.

What Are the Mechanisms of Action?

Dry needling has been confirmed to straight away increase pressure discomfort range and limit movement, decrease muscular tonus, and decrease pain in patients with musculoskeletal conditions. Its recommended mechanisms of action include:

  • LocalTwitch Response: Dry needling can elicit a local twitch response(LTR), a brisk contraction of a taut band of skeletal muscle fibers elicited my snapping palpation of a trigger point in that band. The LTR alters muscle fibers' size and tension and stimulates mechanoreceptors like beta fibers.

  • Effects on Blood Flow: Sustained contraction of taut muscle bands in trigger points may cause ischemia (an inadequate blood supply to an organ or part of the body, especially the heart muscle). Dry needling causes small vasodilation within the blood, leading to increased muscular blood circulation and oxygenation.

  • Neurophysiological Results: Dry needling may produce regional and central nervous reactions to displace hemostasis in the site regarding the trigger point, which reduces central and peripheral discomfort.

Are There Any Side Effects of Dry Needling?

Dry needling is a relatively new pain treatment and is not without its share of controversy. Some swear by its efficacy; others claim it is a placebo. The jury is still out on dry needling, but some potential side effects should be considered.

The most common side effect of dry needling is bruising or bleeding at the needle site. This is usually minor and resolves quickly.Other potential side effects include:

  • Fainting, dizziness, nausea, headache, muscle soreness, and skin irritation. These side effects are rare and typically resolve quickly.

  • Dry needling only is performed by a trained professional. There have been reports of serious injuries, including punctured lungs and collapsed veins, when untrained individuals have performed dry needling. While considering dry needling for pain alleviation, discuss the risks and benefits with a doctor.

How Does Dry Needling Differ From Trigger Point Injection?

Both treatments relieve discomfort related to trigger points or muscle tissue knots. However, dry needling uses sterile needles to stimulate the tissue, while trigger point injections inject local anesthetic and steroids into the affected area to alleviate pain and restore function.

In Dry Needling

  • Clean, sterile, dry needles are employed. No liquids or medicines are injected.

  • The patient can keep them after treatment, as they are often safe to push.

  • It can be executed by any healthcare practitioner that is qualified.

In Trigger Point Injections

  • Local anesthetic and steroids are inserted into the impacted area.

  • Clients are observed for a long time after the treatment is done. Patients are advised not to drive after the treatment for safety reasons.

  • It can only be done by pain management professionals and doctors (orthopedic).

Are There Differences Between Acupuncture and Dry Needling?

  • Acupuncture and dry needling are both forms of therapy that involve inserting needles into the body.

  • Acupuncture is a traditional therapy used for hundreds of years to deal with various health conditions. Dry needling is a recent development based on the principle of a trigger point release.

  • One key difference between acupuncture and dry needling is the philosophy behind each approach. Acupuncture is based on balancing energy within the body, while dry needling is focused on relieving pain by releasing tight muscles.

  • Another difference is the type of needles used. Acupuncture needles are much thinner than dry-needling needles and are often made from materials such as stainless steel or gold. Dry needling needles are usually made from solid filaments and are thicker to penetrate deeply into muscle tissue.

  • Finally, acupuncture typically involves inserting needles at specific points along energy meridians, while dry needling can be done anywhere there is a muscle trigger point.

Conclusion:

Dry needling is a relatively new therapy quickly gaining popularity among healthcare specialists. This therapy involves inserting needles into the skin to stimulate trigger points or knots of muscle mass stress. Dry needling may decrease pain, improve range of motion, and minimize stress and anxiety. It is suitable if one considers dry needling as a treatment choice; make sure to consult a qualified healthcare professional.

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Mohammed Wajid
Mohammed Wajid

Physiotherapy

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