Trigger Point: if you’re an active person, have worked out before, spent a day in the yard, or sat a desk for too long, chances are that you’ve probably felt this thing called a trigger point. Trigger points are about as normal to life as a cell phone, breakfast, and breathing. It’s a natural physiological response to movement and stresses. If you’ve had “trigger point” or a tight and tender area in your muscle, you’ve also probably wondered how you could get rid of these nagging little things. Lucky for you, the purpose of this article is to do just that!
Several interventions have been proposed for the treatment of “myofascial trigger points.” Trigger points don’t just hurt (some do), but they have also been shown to contribute to motor impairments such as altered muscle activation patterns and accelerated muscle fatiguability. One of the interventions used by Doctors of Physical Therapy to seek and destroy these pain points is the use of dry needling. We’ll get to what dry needling is in a sec, but first let’s look at what a trigger point is!
The standard definition for a myofascial trigger point is a spot within the skeletal muscle that is painful when compressing, stretching, overloading, or contraction of the tissue. We tend to develop these due to stresses placed on our muscles, altered movement patterns, overload, or in response to an injury elsewhere. They can be painful and they can also disrupt the full function of the muscle.
Myofascial trigger points are classified as either active or latent.
- Active trigger points tend to prevent full lengthening of a muscle, cause weakness in a muscle, pain with direct compression of the area, or mediates a local twitch response of muscle fibers within the area.
- Latent trigger points are painful only when compressed.
Biological Changes in Tissue
We might not know what these tender areas are, but what we do know is that biologically these areas are different from the surrounding tissue/muscle. Active and Latent trigger points exhibit a different chemical surrounding them when compared to non-tender areas. These local changes show pro-inflammatory substances (substance P-IL-1Beta and tumor necrosis factor (TNF)-alpha, as well as high activity of receptors sensitive to pain (nociceptors).
There are several needling treatments proposed for myofascial pain.
Wet needling – is the injection of a substance into the tender spots with either a saline solution or with a dextrose solution.
Dry needling – is a technique that consists of inserting a needle into the muscle’s tender spots until a twitch response is observed.
So, here is a picture of the needles used. They come in different sizes. The use of these will vary depending on the depth and size of the target tissue.
A twitch response is described as a brief, sudden contraction of the muscle during the insertion of the dry needle.
It suggested that this could be a spinal cord reflex linked to the sensitivity of dysfunctional motor endplates. Motor endplates are the synapses between a motor nerve and the muscle. It is believed that these synapses become dysfunctional and cause individual spots within the tissue to become contracted and irritated.
It is important to mention that a twitch response is not necessary to show improvements in pain and function! Studies have shown improvements in outcomes without eliciting a twitch response. So for all of you out there who get disappointed when you don’t get a twitch or even get a “cavitation” when being manipulated – the benefit is till there.
So what is the purpose of dry needling?
Myofascial trigger points are associated with both sensory and motor symptoms. It seems as though the therapeutic effects can be due to mechanical or neurophysiological (sensory) changes. There are multiple mechanical effects described in the literature. For this article, we are going to mention a couple of mechanisms defined in the literature. We go over these in detail during the certification process, but it might be too much for us to wrap our minds around at this time.
Mechanical Effects – Inserting a needle into soft tissue creates a lesion, which in turn activates the physiological process of remodeling injured and inflamed tissue in and around the needle site. By doing this, we can reduce tissue tension, normalize local inflammation, and replace injured tissue with healthy tissue just as you would when you fall and scratch your knee.
Neurophysiological – Inserting a needle into an area of pain stimulates receptors within the tissue→ transmitting that signal into the brain → blocking pain signals from reaching the brain. This mechanism is known as the Gait Control Theory of pain.
These are just two potential mechanisms. Others have reported different mechanisms that fall within these two categories. We don’t want to overwhelm you with all this information so we’ll just stop there with just some basics. We know that dry needling helps decrease pain and improve range of motion which in turn helps to expedite healing and recovery. Using this technique, combined with specific exercises, can help improve and progress towards your ultimate goal of being strong and pain-free.
Post needling induced pain or post needling.
Post-dry needling soreness can occur as a response to myofascial trigger point dry needling treatment. Patients may experience soreness that may last anywhere from 24 to 72 hours. This soreness is most likely due to neuromuscular damage when inserting the needle. This does vary form person to person and it is always taken into consideration for subsequent needling sessions. In terms of safety of the dry needling, it is an extremely safe process if done by health professionals such as Doctors of Physical Therapy or others who are certified in dry needling. There are only few potential risks which are covered before every getting needed to make it is the right treatment for you. Additionally, negative occurrences from dry needling are very rare, which gives the governing bodies like the Florida Department of Health confidence in making it legal to do! However, it is of great importance and law for clinicians to have a thorough understanding of anatomy and become certified to be able to use this technique.
Remember! This is just one tool that we use to get patients/clients out of pain! Typically, we would incorporate dry needling early on and throughout the plan of care as needed. Usually, the process takes anywhere from 10-15 minutes. Afterward, we carry on with exercises, resistance training, or other manual treatment that is needed. Like everything! It depends on the patient and their symptoms!
We hope that his blog gives you more understanding in what trigger points are and how dry needling can be a safe and effective solution.
If you’d like to learn more about dry needling or how we can help you overcome pain and stay active, we invite you to talk to with one of us personally!
Just click the link below to start the process!
- The standard definition for a myofascial trigger point is “a hyperirritable spot within the skeletal muscle that is painful when compressing, stretching overloading, or contraction of the tissue.”
- Trigger points have shown to contribute to motor impairments such as altered muscle activation patterns and accelerated muscle fatigability.
- Myofascial trigger points are classified as either active or latent.
- Dry needling – is a technique that consists of inserting a needle into the muscle’s tender spots until a twitch response is observed
- It is important to mention that a twitch response is not necessary to show improvements in pain and function!
- Myofascial trigger points are associated with both sensory and motor symptoms. It seems as though the therapeutic effects can be due to mechanical or neurophysiological (sensory) changes.
- Post-dry needling soreness is a common complication of myofascial trigger point dry needling treatment. Patients may experience soreness that may last anywhere from 24 to 72 hours.
- We use dry needling as an adjunct to other interventions to get you back to becoming a stronger and resilient athlete.