A Quick look at Dry Needling

Am I somebody who would benefit from dry needling?

That depends…maybe? Reach out to your physical medicine provider to discuss your care options. The purpose of this blog is to help those who want some more information on the practice of dry needling.

Why are my muscles sore?

The usual culprit of muscle pain, or myofascial pain syndrome, is a knot of over-stressed muscle fiber known as a muscle trigger point1. Symptoms of such trigger points may include soreness to a particular muscle region, tight muscle knots, and difficulty sleeping. These myofascial trigger points can even give rise to a phenomenon known as referred pain where pain may be felt in regions with no real damage. Interestingly, the region of referred pain is predictable based on the location of the trigger point. A commonly reported cause for the development of a muscle trigger point includes muscle over-contraction, where you may have over worked yourself at the gym, work, home, etc. If this muscle pain persists, it may be time to give your local physical therapist or chiropractor a call.

Figure 1. A illustration of a taut muscle band with muscle trigger points shown alongside healthy muscle fibers.

Okay. How is this any different than acupuncture?

Trigger point dry needling and acupuncture have a few key differences. Acupuncture3 operates on the principle that the body is controlled by the life force called “Qi”. Qi flows through many major organs along set courses named meridians. For proper health, the Qi must be allowed to freely flow through the meridians. If the the flow of Qi becomes obstructed, then the acupuncturist would needle the specific point, relieving the blockage and returning balance.

With dry needling, needles are not necessarily inserted along meridian lines. During dry needling, needles are placed into muscle trigger points to invoke the body’s response to relax the tight muscle. Both dry needling and acupuncture are safe forms of care, not requiring medication or surgical intervention, for chronic muscle pain.

What is the history of dry needling?

Modern trigger point dry needling, or simply, Dry Needling (DN) attained widespread use after Karl Lewit4 of Czechoslovakia in 1979 found that pain relief was due to puncture by needle and not by anesthetic used. Lewit found the use of dry needling to be effective in the treatment of chronic myofascial pain.

How does dry needling work?

Dry needling invokes a localized effort to relax the over-worked actin-myosin bonds, loosening tight muscles and relieving pain. Research conducted5 on dry needling has confirmed its efficacy in alleviating muscle pains and soreness.

There are many ways a physical therapist, chiropractor, or acupuncturist may treat muscle trigger points. such as massaging, stretching, electrical stimulation, exercising, and strengthening the muscle fibers. Treatment can include administering opiates and anti-depressants. These treatments may relieve pain, although they are much more invasive, and could introduce an unwanted drug dependency, when compared with dry needling.

The Anatomy of skeletal muscle contraction

For a deeper understanding of why this pain may be occurring and how dry needling can help let’s take a deep dive into the anatomy of muscle contraction. Muscle innervation begins when an electrical impulse, sent from the nervous system, reaches a motor neuron which will stimulate the muscle fiber. The electrical message triggers the release of the neurotransmitter acetylcholine. The interaction of acetylcholine with the muscle fiber surface generates an electrical impulse. This electrical impulse is propagated over the fiber surface leading to the “all or nothing effect” of muscle contraction, where the entire muscle will contract, not just some of the muscle fibers.

Where do muscle trigger points come from?

Either from inflammation, muscle damage, or psychological stress the biochemical mechanism which produces healthy muscle contraction is disrupted. There is an excessive release of the neurotransmitter, acetylcholine, leading to a prolonged contraction of the muscle. The distressed muscle fibers known as, sarcomeres, are in a state of hypercontraction. The site of over-contraction leads to bundled up knots of sarcomeres known as muscle trigger points (See figure 1). A muscle trigger point is a painful knot of hard, palpable nodules found in a band of taut muscle fiber. The effects of which can aggravate the surrounding connective tissue, i.e. muscle fascia. Pain receptors, known as nociceptors, detect chemicals given off from these disturbed areas and send it up to HQ where it is perceived as pain.

A deeper look at the science explaining dry needling

The specific mechanism to explain dry needling is still being debated. In theory, the needle breaks the tight muscle trigger point, where rotation of the needle stretches the nearby connective tissue and activates fibroblast cells. These fibroblast cells aid in the repair of the muscle fibers through the release of the anti-inflammatory chemical Adenosine. The taut muscle band can relax and blood flow returns to normal.

Dry needling may also induce a twitch response. This twitching seems to interrupt the hyper contractive activity breaking the trigger point cycle. One paper6 published by the Journal of Orthopedic & Sports Physical Therapy had suggested how dry needling activates certain interneurons that elicit your body’s own form of opioid-mediated pain suppression. The same paper recommended dry needling for pain relief.

References:

1. Unverzagt, Casey et al. “DRY NEEDLING FOR MYOFASCIAL TRIGGER POINT PAIN: A CLINICAL COMMENTARY.” International journal of sports physical therapy vol. 10,3 (2015): 402-18.

2. Figure 1 – Shah, Jay P et al. “Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective.” PM & R : the journal of injury, function, and rehabilitation vol. 7,7 (2015): 746-761. doi:10.1016/j.pmrj.2015.01.024

3. Vickers A, Zollman C. Acupuncture BMJ 1999; 319 :973 doi:10.1136/bmj.319.7215.973

4. Institute, C. R. H. (n.d.). The needle effect in the relief of myofascial pain : Pain. LWW. Retrieved November 22, 2021, from https://journals.lww.com/pain/Abstract/1979/02000/The_needle_effect_in_the_relief_of_myofascial.8.aspx.

5. Vulfsons, S., Ratmansky, M. & Kalichman, L. Trigger Point Needling: Techniques and Outcome. Curr Pain Headache Rep 16, 407–412 (2012). https://doi.org/10.1007/s11916-012-0279-6

6. Kietrys, D. M., Palombaro, K. M., Azzaretto, E., Hubler, R., Schaller, B., Schlussel, J. M., & Tucker, M. (2013). Effectiveness of dry needling for upper-quarter myofascial pain: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 43(9), 620–634. https://doi.org/10.2519/jospt.2013.4668