Dry needling is an invasive procedure whereby a solid filament needle is inserted into the skin and muscle directly at a myofascial trigger point.
Myofascial trigger points may consist of multiple contraction knots which are thought to be due to an excessive release of acetylcholine from select end plates.
They are tender nodules in a taut band in the muscle.
They are generated by overuse, overstretching, or overloading of a muscle.
There are 2 types-Active and Latent.
An active trigger point can spontaneously trigger local pain in the vicinity of the trigger point or can refer pain or paraesthesia to more distant locations.
They cause muscle weakness, range of motion restrictions and several autonomic phenomena.
Latent triggers do not cause pain without being stimulated, but they alter muscle activation patterns and contribute to limited range of movement.
Factors such as trauma, temperature changes, poor posture can contribute to latent triggers.
Muscle dysfunction can be the primary or secondary contributing factor to many neuromusculoskeletal conditions and pain cycles.
What happens when an injury occurs from repetitive use or acute trauma?
Inflammation will be produced from the damaged tissue. The damaged tissue will also go into a protective tension state or contracture to guard against further injury.
This contracture and inflammation inhibits microcirculation which limits oxygen reaching the injury and waste products leaving the injured site. The injured site becomes hypoxic (decreased in oxygen) which stimulates the body to produce fibroblast cells that produces fibrosis or scar tissue.
This fibrosis and scarring builds up around the muscles and tissues limiting the tissues ability to fully function i.e. lengthen and shorten, it will cause nerve compression and irritation (pain), and biomechanical disturbances in function and sporting ability. This holds the muscle tight and causes continued spasm and pain.
Some examples of these musculoskeletal conditions include;
Repetitive stress injuries, tendonitis, muscle strains.
Back, neck and head pain.
Rotator cuff impingement
Iliotibial band syndrome
Sacroiliac joint dysfunction
Patellofemoral joint dysfunction.
Golf and Tennis elbow
What happens with dry needling?
When the needle is inserted into the myofascial trigger point, it deactivates and desensitizes the trigger point.
It results in a local twitch response (an involuntary spinal reflex) which is both diagnostic (only occurs when we hit the trigger/ taut band) and therapeutic as it is the first step in breaking the pain cycle as research shows will decrease muscle contraction, reduce chemical reaction, improve flexibility and decrease pain.
The exact mechanisms of dry needling are unknown, there are several hypotheses:
Dry needling and the subsequent local twitch response may mechanically disrupt the contracted nature of the trigger point. Since trigger points are associated with dysfunctional motor endplates, it is conceivable that needling damages or even destroys motor endplates and causes distal axon denervation.
Motor neurones may become stuck in a feedback loop/reflex arc, facilitating muscle spasm, this reflex may have continued for years, introducing a new stimulus (the needle) impeded the reflex arc and has the effect of relaxing the muscle.
When a needle is inserted into muscle it will also produce a controlled lesion and cut between 3000 to 15000 individual muscle fibres. The body considers the needle as a foreign invader and will activate the immune system as a response. The cut muscle fibres also produce an inflammatory reaction that your body will respond to not just locally but all over the body to reduce inflammation systemically.
It also causes an increase in blood flow to the muscle.
It causes the activation of descending inhibitory systems which would block noxious stimulus into the dorsal horn.
Ultimately we are trying to change the chemical makeup of the muscle and break a pain cycle.
The muscle will feel much softer and relaxed with an almost immediate increase in movement and muscle length.
Is dry needling painful?
Most people do not feel the insertion of the needle.
A healthy muscle feels very little to no discomfort.
When we hit the trigger, the local twitch response elicits a brief pain and cramping and /or deep aching sensation. Elicitation of local twitch response and recognizable referred pain is a good and desirable reaction because it confirms a possible source of dysfunction. People soon learn to recognise and welcome this sensation as it results in deactivating the trigger point, reducing pain and restoring normal length and function to the involved muscle.
How long does it take for the procedure to work?
In some cases improved mobility and decreased pain is immediate.
Typically the muscle feels achey and bruised for a few days – pain relief, stretching and icing may be recommended.
There is occasional bruising.
Usually an increase in flexibility is immediate. It can take a few days to see an improvement with your pain.
You may be tired after the treatment and may need to rest after, this depends on the release achieved and how long the muscle has been in the pain cycle.
It may take a few sessions to gain a lasting positive effect.
We are trying to cause mechanical, biochemical and neurological changes, therefore we are looking for a cumulative response to deactivate trigger points, disrupt pain and restore optimal muscle function.
Rare side effects may be nausea, dizziness or fatigue.
ey have increased energy levels, better appetite and sleep. get back to normal life and enjoy