Dry needling is an advanced and specialized therapeutic approach for the treatment of myofascial pain.
This method is an invasive procedure in which a filiform needle is inserted into the skin and muscle directly at a myofascial trigger point ,in order to desensitize and deactivate this point,which causes widespread pain, weakness and disturbance of the normal muscle function.
What is a trigger point
Clinical definition: A hyperirritable spot in skeletal muscle that is associated with a hypesensitive nodule in a taut band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena.
The term “trigger point (trigger point)” was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following features:
• The pain associated with discrete, irritable point in the skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasia 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 harboring the trigger point.
There are several histopathological mechanisms for the development of trigger points, but there are many available scientific data. Several researchers agree that acute trauma or microtrauma may lead to the development of a trigger point. Lack of exercise, prolonged poor posture, lack of vitamins, sleep disorders, problems in the joints ,may predispose to the development of minor injuries. The occupational or recreational activities , that produce repetitive pressure to a specific muscle or group of muscles , cause chronic stress in muscle fibers, thereby cause the activation of specific points.
Patients who have trigger points often report regional, persistent pain that usually results in decreased range of motion of these muscles. These points ,often affect the muscles, that are used to maintain body posture ,as the muscles of the neck, shoulder, and pelvic area, including the upper trapezius, scalene, sternocleidomastoid, levator scapula, and quadratus lumborum.. Although the pain is usually associated with muscle activity, however it can be fixed and does not follow a dermotome distribution. Patients report few systemic symptoms, and related items, such as joint swelling and neurological deficits are generally absent in the physical examination.
In the head and neck area, the myofascial pain syndrome with the trigger points ,may appear, as tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and torticollis. The pain in the upper extremity is often referred, and the pain in the shoulders may resemble visceral pain or mimic tendonitis and bursitis.
In the lower limbs, the trigger points may include pain in the quadriceps and calf muscles and restrict the mobility of the knee and ankle. The hypersensitive spots in the gluteal muscles , often reproduce severe pain in the lumbar spine.
How does dry needling method work
The exact mechanisms of dry needling are not known. There are mechanical and biochemical effects. When one end of the needle hits a trigger point, the muscle reacts with a local twitch response .This local contraction is involuntary. It has been shown that the elicitation of local twitch response is the most important aspect to achieve a successful therapeutic outcome for the deactivation of trigger points. There are many hypotheses for why this method works.
The needle and the subsequent local twitch response, may mechanically disrupt the normal contraction of the trigger point. The needle stimulates certain neurological sensors in the body and modulates pain signals .This process can cause positive local biochemical changes and can lead to increased blood flow.
Getting local twitch responses with dry needling is the first step in breaking the pain cycle.
How long does it take for the process to work
In some cases, the reduction of pain and the mobility improves directly. Usually, it can take several treatment sessions for a lasting positive effect.