Technique is decades old but trending in Tennessee
Dry needling has been utilized by physical therapists in Tennessee since 2011. In Tennessee, physical therapists are required to have completed a minimum of 24 hours of CEUs and treat only the muscles specifically trained in each course. Many continuing education courses are designed in an upper and lower extremity progression. Course complexity also advances with head, neck and torso muscles. Most courses track progress with a certification denoting proficiency in all muscles and clinical reasoning for treating trigger points. Courses use existing research and musculoskeletal anatomy in relation to nearby tissues and systems to ensure the safety of the patient.
Dry needling is most commonly used to treat myofascial trigger points. According to Dr. Janet Travell, MD, who gave this definition in the 1950s - trigger points are "areas of hyper irritable spots in the skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is tender when pressed and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena."
Dry needling was first coined by Karl Lewitt, a Czech physician, in 1979. Lewitt emphasized the benefits of the needle in comparison to the injection of substances...wet" needling.
Most all of us are harboring trigger points. A common site most can relate to are the "knots" or hard spots up on top of our shoulder blade/neck area. This would be in the Trapezius or Levator Scapulae muscle. These are the muscles someone is common to want to press on or rub to relieve tension and associated pain or tenderness. The contractile components in the muscle cell have not released and thus the muscle is remaining in a constant state of contraction. This contraction then develops an area of hypoxia and increase in nociceptive agents in the tissues.
The needles used in dry needling are the same as the needles used in acupuncture. They come in varying gauges and lengths. Trigger point depth and patient sensitivity should be among the decisions on size type of needle used. Most patients experience little or no discomfort with the needle insertion.
Patients are usually placed in a supine or prone position for the delivery of dry needling. The therapist is able to isolate the focal point of the trigger point by palpating across or perpendicular to the muscle fiber orientation to find a taut band, and then along that taut band to the spot of greatest muscle tone and generally patient tenderness. The needle is then inserted, moved to the trigger point and a local twitch response, or involuntary jump of the muscle, is desired to eliminate that trigger point. There can be multiples of twitch responses within a given muscle. This trigger point elimination should result in a decrease in involuntary tone of the muscle and decrease in local and referred pain should be lessened. Decreased pain with active movement is often an immediate benefit the patient appreciates. Post treatment soreness is common with the twitch response. This soreness can last from hours to a couple of days.
Conditions treated using dry needling are referred pain in an extremity with or without radiculopathy, painful joint movement with or without advanced degenerative changes, as well as headaches from muscle tension. When muscle tension is the trigger for migraine headaches, management of the migraine patient can often benefit from dry needling.
Trigger points, or involuntary muscle tension can alter joint mechanics. This alteration can lead to painful joint mobility and an increase in joint articular compressive forces. Elimination of trigger points can allow for more normal joint mechanics and improved range of motion. Treatments should then be followed with physical therapy for proper flexibility and strengthening regimens. These treatments may involve passive joint and muscle stretching and home exercises. Postural awareness and corrective postural exercises, neuromuscular movement re-education also can enhance the long-term elimination of trigger points.
Jim Hambrick has been a physical therapist for 32 years. He has been co-owner of Rehab Etc for 27 years. Rehab Etc operates Physical Therapy clinics in Memphis, Bartlett, Collierville, Oakland and Nashville Tennessee.