Trigger Point Dry Needling
I recently had the opportunity to attend a Trigger Point Dry Needling course in Englewood, CO. It was an amazing experience, both in terms of meeting some great local clinicians in addition to expanding my clinical repertoire and ability to help the people of Kiowa County feel and move better. I am ecstatic to announce that this will be a service that the Rehabilitation Department at Weisbrod Memorial County Hospital will be offering starting in August of this year. I thought this made for an excellent topic for my first article series, which will consist of 4 parts on this incredibly useful, yet often-misunderstood, treatment modality.
What is Trigger Point Dry Needling?
Trigger point dry needling (TPDN) involves inserting a very thin needle directly into a trigger point. There is no substance or medication on the needle (hence, “dry”). A trigger point is a taut band of muscle, typically called a “knot”, that reproduces a person’s pain or symptoms when pushed on. The purpose of TPDN is to release these trigger points, and subsequently decrease a person’s pain and improve their day-to-day physical function.
So, it’s like acupuncture?
The type of needles used are the only similarity. Acupuncture is a traditional Eastern-medicine practice that aims to use thin needles inserted very superficially into a person’s skin in order to realign a person’s energetic balance and restore wellness. TPDN has its origins in “Western-medicine” in the early 20th century, and the needle is inserted through a person’s skin and into the layer of muscular tissue below. The aim of TPDN is quite concrete, to generate a rapid decrease in a person’s musculoskeletal pain in order to improve movement and function.
How does it work?
When the millimeter-thin needle makes contact with an irritated band of muscle, something called a “twitch response” is elicited. This twitch response from the trigger point causes a release of chemicals from your body at that site and effectively acts as a “reset button” in order to get people out of a pain state. It is in this state that movement patterns and postural habits can be retrained in order to let a person enjoy full, long-term resolution of their symptoms.
Is it safe?
When performed by an appropriately trained clinician (typically physical therapist, physician, or chiropractor), TPDN is extremely safe. Clinicians who can perform TPDN have undergone additional training as well as possess a detailed understanding of the anatomy of the body- hence you can be sure the needle will arrive at its intended destination (and not any nerves or blood vessels nearby). Needles are sterile prior to use and are not reused whatsoever. The area to be treated is sterilized prior to the needle going into the skin and gloves are worn by the provider. Any risks of infection or other complications from this procedure are practically nonexistent.
Does it work?
In my personal and professional experience, YES! TPDN can be incredibly effective for releasing muscles that are either too large or too deep to be released by any other means. Often times, even pain relating from joint dysfunction can have a large muscular component which can be successfully treated using TPDN. It is one of the most effective tools for decreasing pain and improving muscle tissue quality available. That being said, this type of treatment must be reinforced with the appropriate exercise and lifestyle interventions to help an individual realize full symptomatic resolution.
What kind of problems can be treated using TPDN?
TPDN can be successfully used to treat a wide variety of musculoskeletal conditions. The most commonly seen in our clinic include plantar fasciitis, achilles tendon pain, knee and hip osteoarthritis, sciatica, low back pain, frozen shoulder and rotator cuff issues, and tension headaches and neck pain. TPDN is an invaluable tool is the early stages of a treatment plan to rapidly decrease pain so that further retraining and strengthening can occur.
How many sessions does it take?
The aim of utilizing TPDN during a physical therapy plan of care is to rapidly decrease pain early on, not create a situation where an individual is reliant on TPDN over the long-term to provide relief from pain. I prefer to use TPDN as little as necessary, usually over 2-6 sessions, and transition to more active means of recovery when a patient is able to.
Why has my doctor not recommended this treatment for me in the past?
Trigger Point Dry Needling is relatively new and research regarding its mechanisms of action and efficacy for various musculoskeletal problems continue to be generated each year. However, what we do know remains very encouraging. It is likely that your physician simply wasn’t aware that TPDN existed as a treatment modality or that it could be used for such a wide variety of conditions.
Does it hurt?
While by no means comfortable, the sensation of TPDN can be described as either “dull pressure” or “cramping”. Due to the extremely thin structure of the needle, most folks aren’t even aware of its presence. When an irritated band of muscle is stimulated, the muscle will twitch mildly and then release, usually resulting in a sensation of relaxation or decreased muscular pain.
Is it covered by my insurance?
With most insurance companies, TPDN is considered “Manual Therapy”, which physical therapists can bill for. Hence, it is no different from any type of other soft tissue release or joint mobilization technique that you may expect to receive while in PT. Before beginning any physical therapy course of treatment, I urge folks to get in contact with their insurance providers and inquire about what their physical therapy benefits are.
Enter Mrs. Johnson, a 65 year old woman who enjoys playing with her grandchildren, performing tasks around her home, and helping her husband out with ranching duties from time to time. While throwing a ball around with her grandchildren, she felt a sharp pain in the front of her shoulder. When that pain refused to go away weeks later with rest or medication such as Advil or Tylenol, she decided to make an appointment with the Rehabilitation Team at Weisbrod Memorial County Hospital. Because she has Medicare, she can make an appointment without having to first go see her primary care doctor.
After a thorough examination and evaluation, the knowledge clinician at KCHD were able to identify several range of motion and strength deficits related to her problem, as well as multiple trigger points around her shoulder and shoulder blade which reproduced her pain when touched. Starting at the second session, Mrs. Johnson had 20 minutes of trigger point dry needling performed to release these irritated and over-active muscles throughout her shoulder complex. The rest of the treatment session was focused on pain-free exercises to help gradually build flexibility, strength, and function of her shoulder.
Although she was first scared that the needles would hurt worse, she began to look forward to her PT sessions because she noticed she was able to move her shoulder more and more and with less pain each week. By her sixth treatment session, she excited to see that her shoulder was nearly pain free. However, she still felt she couldn’t raise her arm above her head as easily as she would like.
Her main goals now had to do with getting back her shoulder range of motion and strength so that she could again help her husband with ranching tasks in addition to play with her grandchildren without constantly worrying about her shoulder. Her physical therapy sessions now began to reflect those goals. Mrs. Johnson no longer required any dry needling or manual therapy “reset”, so the bulk of the treatment session could be focused around exercises and drills to get her stronger.
While trigger point dry needling compromised an important part of Mrs. Johnson’s early rehabilitation, it was not the “end-all” treatment modality. In most real life situations, dry needling is an incredibly useful tool for “resetting” a patient’s pain perception and decreasing pain rapidly. However, where physical therapy shines is the prescription of individualized exercises and movement/posture recommendations which will enable a person to stay pain-free and active over the long haul.
I hope you enjoyed reading this series as much I’ve enjoyed writing it! To set up an appointment with Dr. Tim or to schedule a free phone consultation to learn more about how physical therapy can
help you, call (719)438-5401.