Within physiotherapy there are many treatment techniques that have been successfully established, evolved and developed throughout history to adapt to the particular needs of each patient. Many of these techniques are new and innovative, and we want you to know a little more about them. In this article we will explain everything about dry needling.
What is dry needling?
Dry needling is a semi-invasive technique that uses acupuncture needles for the treatment of myofascial pain syndrome, a syndrome produced by trigger points. It is semi-invasive, since the needles penetrate the skin, pressing and contracting the trigger point to deactivate it and thus reduce the pain they produce.
What are trigger points or myofascial pain syndrome and its treatment PGM
In the following video we explain what trigger points are and the various treatment techniques:
As you have seen, trigger points are weak areas of the muscle and very sensitive to palpation, which usually form in the muscles that maintain our posture. They originate when several sarcomeres (regions of the muscle fiber where muscle contraction occurs) remain permanently contracted (due to the continuous release of a neurotransmitter called acetylcholine that prevents the fibers from relaxing), which decreases blood flow. This decrease in blood flow does not allow proper nutrition or proper cleaning of cell waste; in addition to causing the pain to radiate and spread.
Trigger points have specific characteristics that have been extensively studied and can be of different types or in different states. These points can appear for various reasons: a cold current that directly affects the muscle, a repetitive movement, maintaining the muscle for a long time in a shortened position, a blow or even an injection.
Different types of trigger points
There are different types of trigger points, or they can be in different states. Below we will list and briefly explain each of them:
- Active trigger point: It is always painful and has a local spasm response to pressure. It does not allow the complete stretching of the muscle and weakens it, in addition to reproducing the pain in areas far from the point where it is palpated.
- Latent trigger point: only hurts when palpated.
- Central trigger point: closely related to muscle fibers that do not work well. It is located near the center of the muscle fiber.
- Key trigger point: responsible for the activation of one or more trigger points in the same area where the pain radiates, which are called satellite trigger points. When the key trigger point is disabled the satellite trigger points are also disabled.
- Satellite trigger point: trigger point that is activated by a key trigger point.
- Primary trigger point: it is activated by a repetitive movement or by an acute or chronic overload without the mediation of another muscle in its activation.
What are the principles of dry needling?
As we have already said, dry needling uses an acupuncture needle directly on the trigger point. It is important to note that no type of substance is infiltrated.
The essential thing is to locate the trigger point. Any mechanical stimulation such as compression, contraction, or stretching of a muscle that causes referred pain suggests the presence of an irritable trigger point.
The needle, once located at the trigger point, can be considered a palpatory tool for lengthening the physiotherapist’s fingers thanks to the so-called “rod” effect: the needle enters and leaves the trigger point, and with the same needle the changes in the firmness of the tissues pierced by the needle, and even feel if the needle has hit the location of the tissue or not.
Although the mechanism of action of dry needling is not known, it represents one of the most effective techniques for treating trigger points.
Dry needling techniques
There are 2 large groups of techniques in dry needling:
1. superficial dry needling
It consists of the introduction of the acupuncture needle into the skin and subcutaneous cellular tissue that cover the trigger point to a maximum depth of 1 cm, without penetrating the muscle. After the superficial puncture, we will carry out a conservative treatment on the trigger point (explained below) to raise the pain threshold and work more easily on the trigger point. On occasion, stimulation of the needle may be necessary once it has been introduced into the subcutaneous tissue.
2. deep dry needling
It consists of the needling of the trigger points located in the deep muscles, for this reason the needles must be inserted until they reach the trigger point. The size of the needle to be used is determined by the depth of the muscle in which the trigger point is located.
Within the deep needling we can find different techniques that differ from each other, especially in the level of aggressiveness. Once the needle is inside the trigger point, its stimulation will be necessary, which can be done, among other ways; inserting and withdrawing the needle from the trigger point or rotating it. After the puncture technique, another superficial treatment must be carried out (such as cold spray, mobilizations, massage, muscle contractions, etc.) in order to improve the effectiveness of the technique.
What is dry needling and what is it used for in physiotherapy
In this video we show you how dry needling is performed and its benefits in the treatment of myofascial trigger points:
Complementary techniques to trigger point dry needling
Dry needling cannot be understood as a simple puncture on the trigger point, it is necessary to apply different complementary techniques that will improve the effects of dry needling. Below we will name and briefly explain some techniques that can be used together with the needling:
spray and stretch
A cold spray is applied to the patient’s skin in the path of referred pain and the muscle is stretched. This maneuver helps deactivate residual trigger points and achieve full range of motion.
Voluntary contraction and release
Voluntary contraction of the treated muscle followed by relaxation and stretching results in increased range of motion and deactivation of the trigger point.
This technique consists of manual pressure on the trigger point in a muscle to decrease muscle tension.
Reasons for failure of dry needling trigger point treatment
Dry needling is a very valid technique when it comes to treating points, however, there is a certain percentage of failure that is important to know. we are listed ten reasons for the failure of invasive trigger point treatment, and they are as follows:
- Not addressing the factors that perpetuate the problem, such as bad postural habits.
- Treat a latent trigger point instead of an active one, the real cause of the problem.
- Treating the area of referred pain instead of the trigger point, this will only temporarily relieve symptoms.
- Insert the needle close to the trigger point and even into the taut band but miss the exact spot.
- Using too fine a needle that can be pushed aside by contraction nodes.
- Infiltrate an irritating solution (bearing in mind that sometimes doctors treated trigger points by injecting different substances).
- Insufficient hemostasis (control of bleeding), which can irritate the trigger point.
- Not attending to other trigger points that can affect the patient’s pain.
- Forgetting to ask the patient to carry out active mobility throughout the course of the muscle.
- Failure by the patient to perform home exercises, such as self-massage, postural corrections or stretching.
Almost all the reasons why there is no progress in pain are due to poor execution of the technique, misdiagnosis and lack of patient cooperation. It is important that you do not try dry needling yourself, who should perform this technique is a physiotherapist trained in this technique, otherwise you can hurt yourself.
The application of the dry needling is correct, but it still does not work. What other factors may be prolonging the presence of trigger points?
Depending on the intensity, we deal with temporary pain well, even if the pain is intense but in a very short space of time we are able to accept it in a more or less comfortable way. But continuous pain, even if it is less intense, is a real torment and affects us both physically and psychologically. The pain caused by trigger points can be perpetuated over time if we do not take into account the following aspects:
Tensions due to muscle retractions or body asymmetries force different muscles into a continuous situation of mechanical stress, and therefore the formation of trigger points.
Low levels of vitamins B1, B6, B12, folic acid, iron, and severe anemia may mean that dry needling treatment may only provide temporary pain relief.
Depression and anxiety, for example, can delay recovery from trigger points.
Chronic infections (viral or bacterial), allergies, radiculopathies or chronic visceral diseases can prevent recovery from trigger point pain.
Dry needling is a technique currently performed frequently in physiotherapy despite the fact that it is closely related to the ancient acupuncture, so much so, that a large number of acupuncture points and myofascial trigger points coincide, which has created many discussions between physiotherapists and traditional Chinese medicine practitioners, but the goals and philosophy behind the use of dry needling by physical therapists is not based on the theories or principles of ancient traditional Chinese medicine, modern dry needlingis based on neuroanatomy and modern Western scientific study of the musculoskeletal and nervous systems. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates active rehabilitation.
Therefore, a variety of musculoskeletal problems or dysfunctions, including acute, chronic injuries, headaches, neck/back pain, tendonitis, muscle spasms, “sciatica”, hip/knee pain, muscle strains, fibromyalgia, “Tennis/golfer’s elbow,” PFS, overuse injuries, and others can heal in a short time if your physical therapist applies dry needling.