Dry Needling can be an effective way to reduce and possibly eliminate trigger points. Trigger points are areas of tightly bound muscle fibers that can cause pain in a localized area or referred pain in another area, either when pressed (latent) or without pressure (active). Trigger points can cause pain, changes in sensation (sensitivity to light touch, temperature changes, numbness, to name a few), loss of range of motion, loss of function, loss of muscle power and can affect the function of other muscles in its functional group. First, let’s review the physiology behind muscle function.
Medical Disclaimer: The Content in this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
Muscles are like ropes.
On a microscopic and even on a larger scale, muscles are like ropes. Imagine the muscles of your body as a series of ropes on pulleys. For a muscle to pull in one direction, it affects or relies on other muscles to pull in the same direction to work correctly. Oppositely moving muscles must be more or less relaxed.
Trigger points affect the movement of muscles
So imagine a muscle that is riddled with trigger points as a rope having knots that prevent its movement through the pulley, while shortening the length of the rope available to use.
This shortened and knotted muscle is not going to move properly: it cannot produce as much force (loss of strength and function), and it cannot move as far (loss of range of motion and function). The muscle may also cause pain that prevents the brain from contracting it as strongly. So, effectively, a muscle that is tightly bound will not be able to produce as much force as one that can easily stretch to its full length.
Functional Grouping of Muscles
Now imagine a series of pulleys that work together to move a large pallet onto a ship of old, where several strong men work together to get the cargo safely on board. Some men are on the vessel, while others are on the pier and dock.
Muscles, just like the men, work in concert with others, few muscle contractions can ever be truly isolated with any movement (even with supported bicep curls, muscles of the rotator cuff must fire/contract to stabilize the shoulder joint, while core muscles contract to stabilize the trunk). As muscles often work together as a functional group, weakness in one muscle can cause other muscles to be over-recruited to compensate for the loss of power with another. This can result in over-use injuries and pain in muscles in other areas, increasing the area of muscles affected often increases the trigger points as well as the areas of pain.
Pain often begets pain, and ironically the more persistent the pain is, the lower our threshold for pain becomes (the less painful stimulus that is required to register as pain in your brain). Yes, it’s a terrible cycle.
Now going back to the cargo being moved onto the ship using pulleys, imagine how as the cargo moves over to the ship, that workers on the dock must relax their pull on the ropes, to avoid fighting with the power of the workers on the ship.
Another component of muscle function that is important to understand is that when one muscle is active, the muscle that opposes it (unless you are stabilizing) must reciprocally relax. This is called reciprocal inhibition. For instance, when doing bicep curls, the triceps is reciprocally inhibited. Now when doing planks, both muscles fire simultaneously (called a co-contraction) to allow you to keep in place. So, going back to dysfunction, if the biceps are functionally shortened through trigger points, strengthening of the triceps can be inhibitied (as the biceps must be “quiet” to strengthen the triceps through their entire range of motion).
Neurological Inhibition seen with trigger points is not always logical
Trigger points can cause the brain to inhibit muscle function in the presence of tightness and pain. The quadratus lumborum is a back muscle that is active with side bending away, trunk stabilization, and hip hiking. Even through it often works in concert with same-sided (ipsilateral) contraction of the glutes (hip abduction, hip extension and sometimes external rotation), it can inhibit the activation of the glutes. This can make the glutes test weak – when in fact they are just being told by the brain to not fire or contract. Dry needling, when applied directly to the quadratus lumborum only and by a properly trained practitioner, can release the inhibition of the glutes, that can then “miraculously” test at full strength even though nothing was done directly to the glutes. Interestingly, the inhibition can also “cross” the pelvis and affect the other side.
So what is Dry Needling, again?
Dry Needling is a technique that can be performed in some states by Physicians, Acupuncturists, Chiropractors and Physical Therapists. Practitioners use an accupunture style needle and insert it directly into a muscle trigger point, going to the heart of the matter. I would by lying to you if I said this is painless. It does not feel great to have this done, however, as both someone who performs and receives dry needling treatments, I have noticed many benefits (see below).
Dry Needling is a method of treatment (modality) that requires additional training, with minimum requirements to practice this modality are determined by each state.
So how does Dry Needling work, exactly?
The magic behind dry needling is hypothesized as there is not yet a proven theory at this time. However, physiological changes within the muscle fibers have been measured pre and post dry needling and I have included a non-comprehensive list, below, based on my coursework with Myopain Seminars (this blog is NOT being endorsed by them). These are based on scientific papers that are too numerous to list. If you would like specifics, please reply what topic/area you would like to have the reference for in the comments.
Changes pre to post needling include:
– An increase in oxygen (pre needling tissue is hypoxic or low in oxygen. Oxygen is required chemically to release the muscle contraction without breaking the muscle fibers apart mechanically, this is often the cause of muscle pain after training)
– A decrease in acidity (Carbon dioxide is a by-product of cells contracting and when stuck within the muscle fibers, this lowers the pH and can cause pain).
– A decrease in pain-mitigating chemicals (chemicals that make us more sensitive to pain leave the area)
– A decrease in inflammatory chemicals and cells (chemicals and cells that cause inflammation: swelling, pain, pressure, etc)
Potential Benefits to Dry Needling:
– The relaxation of muscles seems to be cumulative in nature (I feel with each time I given and receive dry needling that it seems subsequent treatments result in less pain – I give the analogy of clearing a mine field. The challenge can be that we can induce further trigger points with our activities)
– improved muscle function: through increased range of motion, strength/power.
– Increased threshold to pain – it takes more painful input to cause us to experience pain (when in persistent pain, neurological changes actually *increase* – yes, I said increase, our sensitivity to pain)
I would be remiss if I did not include potential side-effects and precautions/contraindications to dry needling.
-Pain w/ muscle releases (the muscle spasms forcibly prior to relaxation)
-Pneumothorax (a punctured lung if needling in the lung fields, a well-trained practitioner knows how to avoid lung puncture).
Precautions (clinician should proceed with caution when dry needling):
– Fear of needles
– Active Cancer (depends on area)
– Immune deficiency
– Excessive adipose tissue (this is a nice way to say morbid obesity, as most areas require the clinician to be able to feel/palpate bony landmarks and if they cannot reach the muscle tissue with a needle, I woudn’t recommend it).
Contraindications (Hard stops, clinician should not perform dry needling):
– Blood clotting disorders (in most cases)
– Areas of lymphedema
– Implants (in areas to be treated)
What do I need to do to receive Dry Needling?
Requirements to practice and receive Dry Needling vary by state. The best way to find out is to contact a Dry Needling practitioner in your area. I recommend Myopain Seminars’ website to find a practitioner in your area. The study in rigorous and they only include practitioners who have completed all 3 levels (3 days each of 10 hour training, that’s 90 hours of training) on their website. If you cannot find anyone in your area on the website, then call a trusted Pain Management, Physical Therapy or Chiropractic Clinic. Generally, if there is someone in the area that practices Dry Needling, those clinics are more likely to know about it than a PCP.
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