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Trigger Point Dry Needling

Jessica Stepien, P.T., D.P.T.

fig01 Figure 1. Trigger point complex. Image courtesy of Medscape.com, 2011, available here.

Trigger point dry needling, also known as intra- muscular stimulation, is a technique using a solid filament needle to treat hyperirritable spots of the skeletal muscle. These hyperirritable spots are called trigger points and are typically associated with palpable nodules in taut bands of tissue. (Figure 1) Physical therapists insert a dry needle, without medication or injection, in trigger points to treat myofascial pain.1

As far back as the 16th century, myofascial pain syndromes have been recognized by medical practitioners as causing sensory, motor, and autonomic symptoms and dysfunctions. Myofascial pain syndromes are associated with the palpable nodules or taut bands known as myofascial trigger points. Dr. Janet Travell is recognized for bringing attention to myofascial trigger points in the mid 1900’s. Dr. Travell started her medical career in cardiology and later shifted to musculoskeletal conditions due to her interest in muscle pain and the impact of referred pain on patient’s dysfunction. Myofascial origin of pain was discovered through an injection of hypertonic saline into trigger points which produced referred pain patterns. Initially, injection of an analgesic medication into the trigger points produced a decrease in a patient’s symptoms, pain, and the sensitivity to touch of the trigger points.2 After further research, it was discovered that the actual insertion and stimulation of the muscle with a dry needle produced pain relief without the need for medication. Thus, the development of trigger point dry needling began. (Figure 2)

The perpetuating factors of myofascial pain syndromes are low level musculature contraction, unaccustomed eccentric contraction, muscle overloads, and muscle fatigue. These factors can be caused by, but not limited to, mechanical dysfunctions such as forward head postures, joint hypermobilities, ergonomic stressors, poor body mechanics, and scoliosis.

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Maintaining movement and range of motion in all of our joints is essential to aging well. Here is a medical journal article which reports the most common cause of disability in the US is bone and joint arthritis. The number of people diagnosed with arthritis is increasing 1 million per year. Your motion and mobility will directly affect the health of your joints!

MMWR Morb Mortal Wkly Rep. 2010 Oct 8;59(39):1261-5.

Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation — United States, 2007-2009.

Abstract

Arthritis is a large and growing public health problem in the United States, resulting in costs of $128 billion annually, and continues to be the most common cause of disability. With the aging of the U.S. population, even assuming that the prevalence of obesity and other risk factors remain unchanged, the prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation (AAAL) is expected to increase significantly by 2030. To update previous U.S. estimates of doctor-diagnosed arthritis and AAAL, CDC analyzed National Health Interview Survey (NHIS) data from 2007–2009. This report summarizes the results of that analysis, which found that 22.2% (49.9 million) of adults aged ≥18 years had self-reported doctor-diagnosed arthritis, and 9.4% (21.1 million or 42.4% of those with arthritis) had AAAL. Among persons who are obese, an age-adjusted 33.8% of women and 25.2% of men reported doctor-diagnosed arthritis. Arthritis and AAAL represent a major public health problem in the United States that can be addressed, at least in part, by implementing proven obesity prevention strategies and increasing availability of effective physical activity programs and self-management education courses in local communities.

Physical activity in the US decreases with age. 42% of children obtain the recommended 60 minutes of physical activity and 8% of adolescents. 30 minutes a day is recommended for adults and less than 5% of adults are achieving this. If you would like any help, please let us know!

This article demonstrates that hypomobility (not enough motion) leads to Osteo Arthritis. Increasing mobility can put the brakes on this degeneration. There is a window of opportunity to stop and even reverse degenerative changes. If boney changes have become established then it’s too late to have much effect on them. It’s critical for people with joint hypomobility to increase mobility as early as possible.