Dry Needling Theory and Application
Kristina Carter, DPTPivot Physical TherapyFormerly Tidewater Physical TherapyMay 20, 2017
Understand the definition of a trigger pointUnderstand the benefits of dry needling and who it may helpMini-case studyObserve a dry needling treatment
Invasive procedurePrecautions/contraindicationsSolid filiform needle inserted directly into the trigger pointVary in length and diameterAlmost every muscle is “needle-able”Goal is relief of pain through the release of the trigger point
1960’s researched myofascial pain syndromeChronic pain caused by multipleTrPsReferred pain patternsRecent advances in imaging have validated her hypotheses
Pain related to a discrete, irritable point in skeletal muscle or fasciaThe 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 painThe great “mimicker”
What is a trigger point?
Unaccustomed eccentric exercisePoor postureRepetitive activity in untrained muscles
How do Trigger Points develop?
Muscle weaknessInhibitionIncreased motor irritabilityAltered motor recruitmentRestrictions in ankle ROM were corrected after manual release of latentTrPsin the soleus (Grieve et al. 2011)
Effects of Trigger Points
Active vs Latent Trigger Point
Active Trigger Point
Latent Trigger Point
Taut bands reproduce their symptoms and is recognized as familiar painPain is often referred from the palpated tissue and follows referred pain patterns
Taut bands are present but they are not always painful upon palpation and do not refer painContribute to decreased ROM in effected areaCan turn into activeTrPs
ExcessiveacetycholineSustained depolarizationImpedes local blood flowAs seen on MRE and US
Pathophysiology of a Trigger Point
HeatColdUltrasoundElectrical stimulationCorrection of muscle imbalancesPNFMyofascial release with external pressure applied to the tissue
Invasive procedureSolid filiform needle inserted directly into the trigger pointGoal is a local twitch responseInvoluntary spinal cord reflexEndogenousopoidactivationRestoration of normal tissue length
Relief can be immediateVery specific to muscle—can help in confirmingdiagnosisCan be active immediately afterCan be used in conjunction with other traditional therapies
Benefits of Dry Needling
College football player with history of MCL tear 10 months prior to evaluationTwo recent episodes of medial hamstring pain following sprinting in preseason practiceNo weakness with MMTMedial hamstring very reactive to palpation or quick stretchTrPsfound in pes anserine muscles—WHY?
Residual valgus laxity from MCL tear caused increased load on pes anserine muscles as they cross the kneeTreated with dry needling and bracing/taping to reduce instabilityAble to participate with no time loss after two dry needling sessions