Trigger Point Dry Needling
Dr. Krebs, Dr. Krefman, Dr. Hasmer, and Dr. Donahue are providing trigger point dry needling (TDN) in Chicago at Chicago Spine and Sports. TDN is the use of solid filament needles inserted through the skin and into the muscle to release painful myofascial trigger points. Dry needling results in the deepest tissue release allowing for improvements in movement and pain.
WHAT IS TRIGGER POINT DRY NEEDLING (TDN)?
TDN is an effective therapy to treat muscular tension and spasm which commonly accompanies conditions such as arthritis, nerve irritation, muscular strain, ligament strains, and herniated discs. It is called “Dry” Needling because there is no solution injected as with a hypodermic needle during a flu shot. With Dry Needling, the needle itself and the effects it produces within the tissue is the treatment.
When an injury occurs from repetitive use or acute trauma, inflammation will be produced from the damaged tissues. The damaged tissues will also go into a protective tension state or contracture to guard against further damage from utilizing the injured tissue. This contracture and inflammation inhibit microcirculation which limits both the oxygen-rich blood reaching the injury and the waste products leaving the injury. The injury site becomes hypoxic (decreased in oxygen), which stimulates the body to produce fibroblasts, a cell that produces fibrosis or scar tissue. This fibrosis and scarring builds up around the muscles and tissues, limiting the tissue’s ability to fully function (lengthen/shorten) and can also cause compression and irritation of nerves (such as carpal tunnel syndrome) – all of which inevitably lead to biomechanical disturbances in gait and function.
TDN uses a small, solid filament needle that is inserted in a contracted, painful, knotted muscle to create a local twitch reflex, which is both diagnostic and therapeutic as it is the first step in breaking the pain cycle as research shows will decrease muscle contraction, reduce chemical irritation, improve flexibility and decrease pain. When a needle is inserted into muscle it will also produce a controlled lesion and will cut between three to fifteen thousand individual muscle fibers. The body considers the needle a foreign invader and will activate the immune system as a response. The cut muscle fibers also produce an inflammatory reaction that your body will respond to locally and all over the body to reduce inflammation systemically.
MECHANICAL EFFECTS OF TDN
Dry Needling may mechanically disrupt a dysfunctional motor endplate.
Needling results in a Local Twitch Response (LTR)
The LTR results in an alteration to muscle fiber length as well as having an inhibitory effect on antagonistic muscles
NEUROPHYSIOLOGICAL EFFECTS OF TDN
Baldry (2001) suggests that dry-needling techniques stimulate A-nerve fibers (group III) for as long as 72 hours post-needling
Prolonged stimulation of the sensory afferent A-fibers may activate the enkephalinergic inhibitory dorsal horn interneurons, which implies that dry needling causes opioid-mediated pain suppression
Another possible mechanism of dry needling is the activation of descending inhibitory systems, which would block noxious stimulus into the dorsal horn
The LTR may also utilize the excessive ACh in the tissue, which previously was triggering increased firing of localized fibers
CHEMICAL EFFECTS
Studies by Shah and colleagues (2001) demonstrated increased levels of various chemicals at sensitized motor end plates, such as Bradykinin, Substance P, and CGRP (regulator of Calcium and Phosphate balance). These chemicals were reduced immediately after an LTR.
CGRP enhances the release of ACh from nerve terminals, which results in increased ACh receptors at the neuromuscular junction
Needle penetration will cause micro-trauma and micro bleeding (localized inflammation) hence the introduction of PDGF into the area to help promote healing
IS TRIGGER POINT DRY-NEEDLING ACUPUNCTURE?
Trigger Point Dry Needling is based on Western medical research and principles, whereas acupuncture is based on Traditional Chinese Medicine. The main similarity is that the same sterile, disposable solid filament needles are used.
WHAT TYPES OF CONDITIONS CAN TDN ASSIST?
Neck/Back Pain
Shoulder Pain
Tennis/Golfers Elbow
Headaches
Hip and Gluteal Pain
Knee Pain
Achilles Tendonitis/Tendonosis
Plantar Fasciitis
Sciatica
Muscular Strains/Ligament Sprains
Chronic Pain
Athletic Performance
FDM
DOES TDN HURT?
You may or may not feel the needle inserted. The specific needle manipulation is intended to produce a local twitch response that can elicit a very brief (less than a second) painful response, which some patients describe as a deep ache or cramping sensation. Again, the therapeutic response occurs with the elicitation of the local twitch response and is a desirable reaction.
WHAT CAN I DO TO PREPARE FOR MY THERAPY?
Eat a light meal 1-2 hours before your visit and wear loose, comfortable clothing that can be rolled up or down to access your areas of concern with the greatest ease.
WHAT CAN I EXPECT AFTER TREATMENT?
We are looking to get improvements even from the first visit, such as increased range of motion, ease of movement, and decreased signs/symptoms.
Many patients report being sore after the treatment in the area treated and the area of referred symptoms. Typically, this soreness lasts between a few hours and two days, and there is occasional bruising. Soreness may be alleviated by applying ice or heat to the area and performing specific stretches for the treated muscle.
