Dry Needling: The Precise Trigger Point Therapy
Dry Needling is a very effective form of Trigger Point Therapy. Dry Needling is relevant for both myofascial trigger points and the fascia, where a specially trained practitioner needles a trigger point using sterile acupuncture needles. The pin prick action stimulates the oxygenation of the contracted muscle fibers and the fascia, reduces inflammation, improves blood circulation and thus sustainably reduces the local tension in the tissue with long lasting results. The pin prick into the trigger point produces a short contraction of the taut band, known as the local twitch response. The local twitch response is often described by patients as a pleasant "good pain" with a sense of release.
History of Dry Needling
The needles used in Dry Needling are sterile disposable needles, that are usually 0.16mm – 0.3mm thick and 1.5 cm – 6 cm long in size. The choice of needle depends on the depth of the trigger point within the tissue, and on the dry needling technique that is used. (Source: www.seirin.com)
Dry Needling of the trapezius muscle. During Dry Needling, trigger points which are located manualy first, are treated precisely. (© Copyright – David G. Simons Academy, DGSAⓇ)
Dry Needling Is Not Acupuncture!
Although thin disposable acupuncture needles are used in Dry Needling, the two techniques are quite different. Dry Needling treats specific trigger points that are diagnosed beforehand in the muscle tissue. The goal is to release myofascial trigger points or adhesive soft tissue and fascia. This is different from an Acupuncture treatment in which Acupuncture points lying in different tissue types are punctured in order to achieve different goals.
Dry Needling originated from clinical observations and studies treating trigger points using injections. Over time, evidence has shown that it was not the substance injected that was responsible for the release of the trigger point, but the accurate needling to the area. The work of Karel Lewit (1916-2014), a Czech doctor who published in 1979 the article "The Needle Effect in the relief of Myofascial Pain" in the renowned journal "Pain", as well as the work of Dr. P. Baldry and Dr. C. Gunn in the eighties, served as the benchmark for the development of the Dry Needling concept. In the early nineties Christian Gröbli and Ricky Weismann combined Dry Needling with Travell and Simons's findings of trigger point therapy and developed a systematic Trigger Point Dry Needling concept. That method has since been continually developed and taught by the DGSA. Dry Needling is now an accepted successful technique that is used by practitioners worldwide in pain management.
Different Forms of Dry Needling
Dry Needling refers to both drug-free needling of trigger points in the treatment of myofascial pain and dysfunction, as well as the treatment of other musculoskeletal pain using sterile disposable acupuncture needles. There are basically two different types of Dry Needling:
- intramuscular stimulation (IMS) and
- superficial Dry Needling (SDN).
In IMS, the needle is inserted directly into the trigger point or taut band. This triggers a local twitch response (LTR) of the taut band. The LTR is perceived by many patients as a sensation of muscular release and as a sign that the right trigger point was needled. In addition, there is evidence to support the therapeutic value of the LTR in enhancing the release of fascia related adhesions, as well as to reduce inflammation around the Trigger Point.
In SDN, the needle is inserted superficially obliquely to the skin surface, to about 3-4 mm above the trigger point or painful area. This triggers several reflex analgesic mechanisms via the spinal cord and the brain.
Another method of Dry Needling is the intramuscular electrical stimulation (IMES), where at least two needles are inserted into the taut band and are stimulated by light TENS currents.
The proper technique must always be chosen and adapted according to the patient and his complaints.
Safety and Hygiene During Dry Needling
Dry Needling is a safe treatment technique which requires comprehensive and professinal training with sound knowledge of anatomy and palpation skills. The practitioner must always be aware of the exact tissue or structure where the needle is inserted. Complications can be safely avoided as long as the practitioner follows the recommended safety guidelines and contraindications as well as the principle “in doubt stay out”. Our ultimate goal in our Dry Needling courses is safe and complication-free Dry Needling.
Dry Needling must be applied under hygienic conditions using only disposable sterile needles and a disinfectant to disinfect the needled area.
Before needling the practitioner must examine potential contraindications in each patient, as well as identify relevant anatomical landmarks and be aware of the potential local precautions.