Trigger Point Dry Needling (TDN)
TDN is an effective therapy to treat muscular tension and spasm which commonly accompanies conditions such as arthritis, nerve irritation, muscular strain, ligament strains and herniated discs.
What is Trigger Point Dry Needling (TDN)?
TDN is the use of solid filament needles inserted through the skin and into the muscle to release painful myofascial trigger points. Dry needling results in the deepest tissue release allowing for improvements in movement and pain. It is called “Dry” Needling because there is no solution injected as with a hypodermic needle during a flu shot. With Dry Needling, the needle itself and the effects it produces within the tissue is the treatment.
When an injury occurs from repetitive use or acute trauma, inflammation will be produced from the damaged tissues. The damaged tissues will also go into a protective tension state or contracture to guard against further damage from utilizing the injured tissue. This contracture and inflammation inhibit microcirculation which limits both the oxygen rich blood reaching the injury and the waste products leaving the injury. The injury site becomes hypoxic (decreased in oxygen) which stimulates the body to produce fibroblasts, a cell that produces fibrosis or scar tissue. This fibrosis and scarring builds up around the muscles and tissues limiting the tissues ability to fully function (lengthen/shorten) and can also cause compression and irritation of nerves (such as carpal tunnel syndrome) – all of which inevitably lead to biomechanical disturbances in gait and function.
TDN uses a small, solid filament needle which is inserted in a contracted painful knotted muscle to create a local twitch reflex which is both diagnostic and therapeutic as it is the first step in breaking the pain cycle as research shows will decrease muscle contraction, reduce chemical irritation, improve flexibility and decrease pain. When a needle is inserted into muscle it will also produce a controlled lesion and will cut between three to fifteen thousand individual muscle fibers. The body considers the needle as a foreign invader and will activate the immune system as a response. The cut muscle fibers also produce an inflammatory reaction that your body will respond to not just locally but all over the body to reduce inflammation systemically.
- Dry Needling may mechanically disrupt a dysfunctional motor end plate
- Needling results in a Local Twitch Response (LTR)
- The LTR results in an alteration to muscle fiber length as well as having an inhibitory effect on antagonistic muscles
- Baldry (2001) suggests that dry needling techniques stimulate A-nerve fibers (group III) for as long as 72 hours post needling
- Prolonged stimulation of the sensory afferent A-fibers may activate the enkephalinergic inhibitory dorsal horn interneurons, which implies that dry needling causes opioid mediated pain suppression
- Another possible mechanism of dry needling is the activation of descending inhibitory systems which would block noxious stimulus into the dorsal horn
- The LTR may also utilize the excessive ACh in the tissue which previously was triggering increased firing of localized fibers
- Studies by Shah and colleagues (2001) demonstrated increased levels of various chemicals at sensitized motor end plates such as: Bradykinin, Substance P and CGRP (regulator of Calcium and Phosphate balance). These chemicals were reduced immediately post a LTR.
- CGRP enhances the release of ACh from nerve terminals, which results in increased ACh receptors at the neuromuscular junction
- Needle penetration will cause micro-trauma and micro bleeding (localized inflammation) and hence the introduction of PDGF into the area to help promote healing
Is Trigger Point Dry Needling Acupuncture?
No, Trigger Point Dry Needling is based on Western medical research and principles, whereas acupuncture is based on Traditional Chinese Medicine. The main similarity is that the same sterile, disposable solid filament needles are used. Although Dr. Mulhall is a Fellow for the International Association of Medical Acupuncture (FIAMA) and also practices acupuncture, he was trained through two separate organizations (The American Dry Needling Institute and KinetaCore) to provide detailed and specific TDN therapy and each therapy is a separate and distinct in their methodology, perspectives and practices.
What Types of Conditions Can TDN Assist?
- Neck/Back Pain
- Shoulder Pain
- Tennis/Golfers Elbow
- Hip and Gluteal Pain
- Knee Pain
- Achilles Tendonitis/Tendonosis
- Plantar Fasciitis
- Muscular Strains/Ligament Sprains
- Chronic Pain
- Athletic Performance
Does TDN hurt?
You may or may not feel the insertion of the needle. The specific needle manipulation is intended to produce a local twitch response that can elicit a very brief (less than a second) painful response some patients describe as a deep ache or cramping sensation. Again, the therapeutic response occurs with the elicitation of the local twitch response and is a desirable reaction.
What can I do to prepare for my therapy?
Eat a light meal 1-2 hours prior to your visit and wear loose, comfortable clothing that can be rolled up or down to access your areas of concern with the greatest ease.
What can I expect after treatment?
We are looking to get improvements even from the first visit such as increased range of motion, ease of movement and decreased signs/symptoms.
Many patients report being sore after the treatment in both the area treated and the area of referred symptoms. Typically this soreness lasts between a few hours and two days and there is occasional bruising. Soreness may be alleviated by applying ice or heat to the area and performing specific stretches for the treated muscle.