Trigger Point Dry Needling

Physical therapist dry needling

LoHi Physical Therapy: Trigger Point Dry Needling

Trigger Point Dry Needling (TDN) involves the insertion of small needles into trigger points (TrPs) in muscles in order to relieve pain and restricted range of motion.  It is called “Dry” Needling because there is no solution injected as with a hypodermic needle.  At LoHi PT, your physical therapist may perform this as part of your comprehensive physical therapy program.

What Can I Expect During a TDN Session?

You will be in a comfortable position lying either on you back, stomach or side. The therapist will insert the needle into your skin using a “tapping” method. You may feel nothing at all when the needle goes in, or you may feel a slight stinging sensation. The therapist will then insert the needle into the muscle where the TrP is. When the needle contacts the TrP, there should be a “twitch” or muscle contraction. When the twitch response happens, you will probably feel it. It may just be a mild twitch, or it may feel like a “cramping” of the muscle. Sometimes it feels like a deep ache, or perhaps a burning sensation.

You might experience referred pain in a distant area of your body. It’s a good thing if you do experience referred symptoms, especially if it’s a “familiar” pain for you. This means that we’ve needled an active trigger point which is causing some of your symptoms.  After the twitch, the muscle “lets go”. You may receive needling to several different areas during the session.

After the needling, we will usually lengthen the muscles and have you perform active movements. We may do other manual therapy procedures before or after the needling. You might be instructed in or review some exercises to do at home to help continue the effect of the needling.

You may find that the needling is less uncomfortable than some of the usual manual soft tissue techniques. Any discomfort is usually fairly short. If the procedure is ever too uncomfortable and you wish to stop, inform the therapist and we will stop.

The following day:  It’s normal to feel some soreness for a day or two after needling. The soreness is usually similar to the type of muscle soreness that you might get after exercise. It’s usually helpful to apply some heat to the area later in the day (heating pad or hot bath), in addition to doing the stretches and other exercises advised by your therapist. It may also be helpful to drink a lot of water.  The good news is you will also experience improved range of motion and decrease of the symptoms that you had prior to the treatment.  

What is a Trigger Point?

A myofascial trigger point (TrP) is a tender “knot” in the muscle tissue. Most of us have these tender areas in various places in our bodies. You might feel a tight band of tissue for example in the upper trapezius muscle in your upper shoulder. In the middle of that tight band, you might feel a small hard nodule. That’s a trigger point. The nodule will be painful when you press on it. The trigger point may cause referred pain. That upper trapezius TrP may cause pain in your head. (See the picture below.) Often, the trigger point that causes symptoms might be quite distant from the painful area. For instance, the gluteus minimus muscle in the hip can cause pain all the way down the leg. (See below.) This may cause “sciatic” type of pain.   


What Causes Trigger Points?

Usually it happens when there is some kind of stress on the muscle. This may be from a sudden overload in a traumatic injury like a fall, a car accident or lifting something improperly. Or, it may happen over a long period of time for example from chronic postural stresses such as sitting at a computer. Most of us have movement patterns which are not as efficient as they could be. We tend to overuse certain muscles, and under use others.

Also, TrPs can be caused or perpetuated by irritation of the nerves that supply the muscle.  This might happen near the spine where the nerves exit from the spinal column. There may be a degenerated or herniated disc, or some arthritis in the joints of the spine. The muscles around the spine are likely to tighten and develop trigger points. If the spinal nerves become compressed or irritated, the muscles that the nerves supply become more irritable and likely to develop TrPs.  For this reason, we will evaluate and treat the spine, even for extremity pain.  If you have pain in your shoulder, elbow or hand there is probably also a problem in your neck. If you have hip, knee or foot pain you will usually benefit from treatment of your low back.

Interested in learning more about dry needling? Click on the links below for additional resources.

Move Forward PT

Journal of Orthopedic & Sports Physical Therapy

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