I have had many people ask about trigger point dry needling as a treatment and how and why it works. Dry needling has been used, with great success, in the treatment of various cases involving soft tissue dysfunction and is something that I regularly implement in my treatment plans.
Dry needling utilises the insertion of very fine needles into muscle trigger points (TP’s) in order to elicit a healing response. In order to completely understand how dry needling is effective we must first look at TP’s themselves.
Trigger points, more commonly known as ‘knots’, are the band-like, painful points in muscles. Common features of TP’s, include being found in a taut band of muscle, being pressure sensitive and twitching when needled. On top of this, TP’s also have been shown to have increased electrical activity at rest. They also contain higher concentrations of inflammatory and pain-mediating cells, than regular muscle tissue (Shah et al, 2008).
There are two types of TP’s, active and latent. The main difference between the two is that active TP’s will reproduce the intensity and type of pain, which you feel when you have an ache, or pain. Whereas, you will only become aware of latent TP’s when they are poked or prodded.
So, active TP’s are clearly significant, but what about latent TP’s? Are they worth treating? Or should they be left alone because they are not truly causing a perceived issue yet? Taking a look at some of the evidence surrounding this paints a much clearer picture.
A study conducted by Xu et al (2010) identified the following conclusions:
- Non-painful pressure becomes sensitised and therefore painful, in tissue with latent TP’s as compared to normal tissue.
- Increased incidence of muscle cramping in tissue with latent TP’s
A separate study, by Lucas et al (2004), looked at muscle activation, in muscle containing trigger points. It was confirmed that latent TP’s altered the activation patterns of, not only the individual muscle, but those further along the limb too. Treatment, involving dry needling, which removes latent TP’s, resulted in normalisation of the activation patterns.
Finally, a study conducted by Ge, Arendt-Nielsen & Madeleine (2012) looked into latent TP’s again, but this time in their role in muscle fatigability. They found that latent TP’s accelerated the development of muscle fatigue!
These results suggest that latent TP’s, though not painful, have a significant impact on muscle timing, consistency of movement patterns and muscle fatigue. This certainly feeds back and has implications regarding function and performance.
Putting these pieces of research together builds a solid case for the treatment of latent TP’s, as well as justifying the role of regular assessment and treatment of both latent and active TP’s in the athletic population.
For those of you who made it this far, and are thinking “There is no way someone is sticking needles into me!” I would urge you to speak to a health care practitioner to get the full picture. They can explain the process and address any and all of your expectations from treatment. Plus, there have been a significant amount of studies looking into possible adverse reactions from dry needling, completed by professionals, and the conclusion is that safety is not an issue (Vincent et al, 2004).
That being said, if you decide it is not for you, there are plenty of other methods to achieve great results!
Disclaimer: NEVER attempt acupuncture or dry needling on yourself or anyone else unless you are a qualified and certified health practitioner. Though the risks are minute for professional’s, negative health consequences are likely if undertaken by an untrained individual.
by Jack Connelly (Roar Physiotherapist)