Trigger Point Dry Needling

Trigger Point Dry Needling (TDN) is a treatment technique that utilizes a thin, solid filament needle (the same as an acupuncture needle) to ‘deactivate’ myofascial ‘trigger points’ in muscles tissue, thereby reducing pain and improving mobility. Physical therapists are now using this technique around the world to effectively treat acute and chronic orthopedic and musculoskeletal conditions. The rationale for dry-needling is based on well-established models of neuropathic pain. This approach has been shown to be more effective that massage techniques that target Trigger Points (e.g. Pressure Point release).¹ TDN can be used to effectively treat a wide range of sports injuries, myofascial pain syndromes, muscle injuries, and overuse pain. Emerging evidence has shown that dry-needling is effective in the management of chronic low back pain, neck pain and whiplash associated disorders.

We find Trigger Point Needling to be especially effective in treating difficult and chronic cases. Even if you have tried other treatment modalities without good results, consider giving TDN a try – You won’t believe the difference it can make!

For those interested in an in-depth scientific understanding of this treatment modality, including a review of evidence for its usefulness click here.

A recent study ² investigating the effect of TDN on cervical mobility and ‘quality of life’ (e.g. physical activity limitation, emotional health, feelings of tiredness, etc) in patients diagnosed with chronic neck pain, demonstrated impressive result. Researchers found significant improvement in the group treated with TDN when compared to a group treated primarily with neck stretching exercises.

Keep in mind, the intervention period of this study was only 2 weeks!.. And the improvement lasted 6 months.

Similar results have been found in multiple studies supporting the effectiveness of TDN for neck pain ³

Frequently Asked Questions

Is TDN similar to Acupuncture?

Trigger Point Dry Needling is a treatment that uses acupuncture needles, but that is where the similarity to acupuncture stops.

Traditional Acupuncture tends to be a more superficial treatment aimed at promoting health and restoring energy to the body. TDN is based on anatomy AND neurophysiology. TDN treats the neuromuscular system to reduce local muscle hyperactivity in order to decrease pain, improve mobility and return the muscle to normal function.

How does TDN work?

The exact mechanisms of TDN are not completely understood. Dr. Janet Travell first described trigger point injections in the early 1940s. She initially began needling the trigger points in an attempt to inject them with analgesics. However, through a long course of practice and observation, she realized that, when well localized/targeted, it was the needle itself, and not the medication that seemed to provide the therapeutic effect. Multiple research studies since then have backed up this observation.

What we know is that when a needle is introduced into a trigger point the muscle reacts with a momentary increase in ‘tone’. Muscle ‘tone’ is the continuous and involuntary input to the muscle by the nervous system. Often, when ‘stimulated’ by the needle, a characteristic ‘local twitch response’ (an involuntary cramp) results in the muscle. This ‘twitch’ is felt by both the patient and the clinician. Research has shown that this hyper-stimulation is consistently followed by a decrease in local muscle tone. It is this ‘deactivation’ that provides an immediate reduction pain and improved mobility.⁴ There are a number of hypotheses as to the reasons why trigger point needling works. Most recent research implicates a neurological response to the technique that increases ‘inhibitory’ input from the central nervous system to the muscle. This inhibitory effect lasts several days and can act as an effective way of ‘re-setting’ the neurological input to the muscle and break into a pain-spasm-pain cycle.

Will TDN Help Me?

Does the Needle Hurt?

Because the needle is very thin, most patients will not even feel the needle penetrate the subcutaneous tissue. However, once it has advanced into the muscle, discomfort can vary. Usually a healthy muscle feels very little discomfort upon insertion of the needle; however, if the muscle is sensitized or has active trigger points within it, the patient may feel some discomfort. The level of discomfort can vary considerably. Some patients will reports a feeling of ‘releasing’ or ‘blood flow’ in the area. Often patients will report local achiness/cramping and/or a referral of symptoms. This cramping can be strong with ‘active’ trigger points. Patients soon learn to recognize and even welcome this sensation, as it results in a ‘deactivation’ of the trigger point and is followed by an immediate sense of reduced pain and restriction. The needle is left in for a very short period of time, just long enough to relax the muscle (usually less than 1 minute). The procedure may be repeated in different areas until the muscle returns to its normal, relaxed state.

How Will I Feel After TDN?

You will know positive change has occurred immediately after the session. Typically patients can perceive a reduction in pain and a significant improvement in mobility right away. You may also perceive a soreness and/or fatigued sensation in the area of the procedure. This feels very similar to the feeling the day after a strenuous workout – known as ‘Delayed Onset Muscle Soreness’ (DOMS). However, this feeling comes on very quickly after the treatment (as opposed to the following day) and usually does not last more than 6-8 hours (by contrast DOMS can last 3-4 days). This should not interfere with your normal activity; in fact, exercise usually decreases this perceived ‘post-needling’ soreness and thus is encouraged. Clients should have no problem participating in strenuous activity after the treatment – there is no ‘down time’ needed to recover.

With more chronic myofascial pain, this procedure may need to be repeated a few times. The chronic injury you thought was there to stay will begin to improve. Movement will no longer be accompanied by pain and you will be able to participate more effectively in other active forms of rehabilitation and recovery – even if these activities use to increase your pain. Often patients who have tried ‘everything’ are blown away.

Whether you’re a fitness enthusiast, competitive athlete or weekend warrior, we have the expertise and systems to get you to, and keep you at, the top of your game.

Over the last twenty years and ten orthopedic surgeries, I’ve worked with a dozen physical therapists in New England. Unequivocally, Jeff Albertson is the best. First, he actively listens when I describe my pain – this is more rare for a PT than it should be. Second, he rigorously deduces the root causes of my pain through detailed, often time-intensive assessment. Jeff runs a custom practice, not one-size-fits-all therapy. Finally, by virtue of this careful, methodical, and compassionate care, I leave my time with Jeff feeling significantly better and more knowledgeable. As someone who suffers from multiple sports injuries, I want momentary pain relief but also ongoing pain management that I can put in practice. No one does this better than Jeff. As an added bonus, he’s also a great conversationalist!

AKShelburne, Vermont

I came to VASTA with hip issues, result of a fracture and early arthritis caused by a really bad car accident I had back on 2013. Since then I went through different procedures but never pain free. I had the opportunity to have PT with the great Mike Woods! and because the work and time invested in my recovery, I owe him getting back to my ability to run, stand straight, walk and do anything I want without pain! At VASTA you can see that therapists work with one person at a time, which help them getting to know their patients and needs very well, creating a specific treatment program and monitoring the progress better. Thanks to you Mike and to the whole VASTA team! I am so grateful for all your support, sense of humor and the kind welcome I got from you all always! Loving what you do and having fun doing it, translates in good service which motivates a patient to reach their goals and getting great results. This is what you get to experience as soon as you put your trust on getting back on track with the VASTA team!! THANK YOU!

NMBurlington

I was out with a couple of friends last night whose daughters also attend Kristina’s youth class. We were all saying what a positive influence Kristina has on the girls and how much they enjoy training with her. It is great for the girls to have a program outside of school sports where they can challenge themselves and build strength and confidence.

TinaShelburne, Vermont

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Tabatabaiee, A., Ebrahimi-Takamjani, I., Ahmadi, A., Sarrafzadeh, J., & Emrani, A. (2018). Comparison of pressure release, phonophoresis and dry needling in treatment of latent myofascial trigger point of upper trapezius muscle. Journal of back and musculoskeletal rehabilitation, (Preprint), 1-8.
Tekin, L., Akarsu, S., Durmuş, O., Çakar, E., Dinçer, Ü., & Kıralp, M. Z. (2013). The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clinical rheumatology, 32(3), 309-315.
Tekin, L., Akarsu, S., Durmuş, O., Çakar, E., Dinçer, Ü., & Kıralp, M. Z. (2013). The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clinical rheumatology, 32(3), 309-315.
Ansari, N. N., Alaei, P., Naghdi, S., Fakhari, Z., Komesh, S., & Dommerholt, J. (2018). Immediate Effects of Dry Needling as a Novel Strategy for Hamstring Flexibility: A Single Blinded Clinical Pilot Study. Journal of sport rehabilitation, 1-23.