All About Trigger-Point Dry Needling

Trigger point dry needling is a treatment technique that uses acupuncture needles to release tight muscles with the goal of permanently reducing muscle pain and dysfunction. It bears no relation to the traditional Chinese Medicine technique of acupuncture. Acupuncture works on energy meridians and releases blockages in the energy channels whereas dry needling releases trigger points within the muscle, decreasing tension and relieving muscle pain.

Dry needling deactivates and desensitises myofascial (muscle and connective tissue) trigger points and should stimulate a healing response in the tissue and reduce the biomechanical stress of the muscle treated.

The term “trigger point” was first used in 1942 by American physician and medical researcher Dr. Janet Travell to describe a clinical finding with the following characteristics: Pain related to a discrete point in the muscle or fascia that hasn’t been caused by reasons such as trauma, inflammation, degeneration or infection.
​In other words it’s just part of the muscle or fascia make-up.

An overactive trigger point (TrP) is an area of elevated neurological activity located in muscle/ fascia known as connective tissue, that may refer pain in a localised or peripheral manner. This referred pain manifests in patterns.

The trigger points may feel like lumps in the muscle or connective tissue that are very sensitive to pressure. TrPs can entrap the nerves, blood, and lymph vessels, causing a variety of symptoms such as local and distal pain, muscle imbalances and headaches.

If there is great trauma or repetitive pain over long periods of time, the pain signal may become a reflex through a mechanism called the reflex arc. Instead of a pain signal going up to the brain for interpretation it gets on a “merry-go-round” via what is called the Sympathetic Ganglion. This means that the pain signal only gets as far as the spinal cord where it remains “unread”, fed back to muscle as noxious stimuli that the muscle must protect itself from which means protective spasm. This can go on for years.

Trigger points develop in the muscle in response to various stresses such as postural, repetitive motion, psychological and emotional. The points are more likely to develop in tissue that has neurological dysfunction likely caused by factors such as compression, disc dysfunction, facet joint dysfunction, vascular compression, metabolic stress, biomechanical stress and postural stress.

When muscles develop trigger points, they remain tight. This causes local compression of vascular, neurological and joint/biomechanical structures, hampering the normal function of that tissue. All tissues below the involved nerve will likely be involved. If the muscle is released, the tissues can resume normal function with improved neurological conduction and vascularity.

Spasms reduce blood flow in the muscle, and this means less oxygen and food to the muscle. Muscle fibers die and are replaced by fibrous scar tissue, holding the muscle tight and promoting retention of muscle metabolites causing irritation and continuing muscle spasm.

Elevated biochemicals associated with pain, inflammation, and intercellular signaling have been found close to the site of TrPs, as well as remote from them. This suggests that perhaps TrPs can have far ranging consequences.

Tight muscles can cause imbalances and problems with the optimum functioning of the spine and peripheral joints. As a result other parts of the body may become injured due to incorrect use and overuse. Trigger points are thus capable of becoming a source of both local and distal pain.

Inserting a needle into a TrP impedes the reflex arc and causes the muscle to relax. This can be seen with an electromyogram. Spasms reduce in amplitude and become regular instead of sporadic.

Real time blood micro-sampling studies of TrPs as they have been dry needled show instantaneous biochemical changes in the TrPs following twitch elicitation

Acupuncture needles are used in dry needling. When the needle is inserted, the sensation is usually something like a muscle cramp. This is what is called the “twitch response”. There may also be an accurate referral of pain to the affected areas of the body. There should also be an immediate release of muscle tension in the area that has been treated. There may also be a short period of tenderness, around the site of the needle.
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On the other hand a healthy muscle will feel almost no discomfort at all with the insertion of a needle. The benefits of dry needling frequently include more than just relief from a particular condition. Many people find that it can also lead to increased energy levels, better appetite and sleep, as well as an enhanced sense of overall well being.