Trigger Point Needling

Posted on by Kensington Physio
04 Aug

Dry needling, does it work?  Who is it used on and why?  Should you be nervous if it is advised?  Evidence for its use….

This is a review of the available literature investigating myofascial trigger points and the use of needling.

Enjoy the read and please feel free to contact me at sue.donnelly@kenphysio.com should you have any questions.

Many thanks,

Sue

Senior Physiotherapist

What are myofascial trigger points?

  • Trigger points are highly localized hyperirritable spots in a palpable, taut band of skeletal muscle fibres.
  • When stimulated they often result in referred pain and a local twitch response
  • Based on studies in the US 30-85% of patients presenting in primary care setting or pain clinic their source of pain was myofascial trigger points. (Fishbain et al, 1986)
  • Painful trigger points are often referred to as myofascial pain syndrome – and are often seen in the arm and neck
  • Despite their common occurrence they often go undiagnosed by both physicians and physiotherapists which leads to chronic conditions

 

What is Dry needling?

  • A treatment that involves a very thin needle (acupuncture needle) being pushed through the skin to stimulate a trigger point
  • It may release tight muscle bands which are associated with trigger points and thus lead to decreased pain and often improved function
  • This type of therapy is based on the traditional reasoning of western medicine rather than the rationale of acupuncture despite
  • The original principle was put forward by Travell and Simons (1999) and also researched by Lewit (1979)who emphasized that the needling effect is distinct from that of any injected substance.
  • In addition numerous randomized controlled clinical trials and one systematic review reported no difference between injections of different substances and dry needling in the treatment of myofascial trigger point symptoms.

 

What happens when a trigger point is dry needled?

  • A twitch response often occurs when the needle is inserted into a trigger point and is often seen as a sign the treatment will be helpful
  • The theory behind the advantageous benefit of a local twitch response is thought to be related to rapid depolarization of the involved muscles fibres which results in local twitches.  Once this spontaneous electrical activity subsides, the pain and dysfunction decrease dramatically

 

Effectiveness of Dry needling in the management of Myofascial trigger points?

  • Cummings and White, showed in their systematic review of 23 randomized controlled trials of needling therapies (dry and injection type) stated that  the direct needling of myofascial trigger points seems to be an effective treatment but the hypothesis that needling therapies have efficacy beyond placebo is neither supported nor  refuted by the evidence from clinical trials.  (Cummings and White, 2001)
    1. Any effect from these therapies is probably due to the needle or the placebo effect rather than the injection of either saline or an active drug
    2. Dry needling should be combined with other techniques such as exercise to most effectively manage myofascial pain
  • The most recent systematic review included 7 RCTs of acupuncture and dry needling for  the management of myofascial trigger points (Tough et al, 2009)
  • In this the results:
    1. Evidence from one study suggested that direct myofascial trigger point needling was effective in reducing pain compared with no intervention
    2. Two studies provided contradictory results when comparing direct needling of myofascial trigger points versus needling elsewhere in muscles
    3. Evidence from the other 4 studies failed to show that needling directly in the myofascial trigger points is superior to various nonpenetrating sham interventions
  • Of note as regards many of these studies significant methodological limitations of original studies included in the review (Tough et al, 2009)
    1. Often the myofascial trigger points were identified clearly, they were not confirmed as the full source of pain.
    2. Sample sizes were generally small, thus likely to be a source of error
    3. Location, depth of insertion, individual treatment times and overall number of treatment sessions varied greatly
  • Recent Cochrane systematic review of 35 RCTs assessed the efficacy of acupuncture and dry needling for management of low back pain (Furlan and Van Tulder, 2005)

    1. It concluded that there is evidence of pain relief and functional improvement of chronic low back pain with the use of acupuncture compared with no treatment or sham therapy
    2. Positive effects were only reported immediately post treatment or in a short term follow up
    3. In terms of long term follow ups one study, 30 years ago looked at the effect of needling and reported significant improvements when compared with the control group.  (Gunn et al, 1980)
    4. Myofascial trigger point needling combined with paraspinal needling at the same segment level for treating myofascial pain syndrome in the elderly patients in particular but further studies are required
  • Ultimately further research is required to investigate whether needling of myofascial trigger points has an effect beyond placebo but marked improvements certainly occur among patients who are treated with needling for myofascial trigger point pain.

 

Most common adverse effects of dry needling

  • Post needle soreness
  • Local bleeding at the needle site
  • Bruising
  • Syncopal responses
  • Effects are generally reported as clearing up within a week after treatment

 

Most importantly (TAKE HOME MESSAGEFOR YOU!)

  • Dry needling is considered a very safe, effective treatment when carried out by a trained professional such as a GP or physical therapist
  • If you feel like you could benefit from dry needling or indeed acupuncture in the management of a musculoskeletal condition please do not hesitate to contact the team at Kensington Physio and Sports Medicine. 

 

REFERENCES

  1.  Dry Needling in the Management of Musculoskeletal Pain.  Kalickman and Vulfsos, JABFM, Spetember-October 2010, Vol 23, No 5
  2. Male and Female Chronic pain patients catergorised by DSM-111 psychiatric diagnostic criteria.  Fishbain et al, Pain, 1986; 26; 181-97
  3. Travell and Simons’ myofascial pain and dysfunction; the trigger point manaual.  Simons, Travell, Simons, Vol 1, 2nd ed. Baltimore: Williams & Wilkins, 1999
  4. The needle effect in the relief of myofascial pain.  Lewit, K, Pain 1979; 6, pages 85-90
  5. Needling therapies in the management of myofascial trigger point pain; a systematic review.  Cummings and White, Arch Phys Med Rehabil, 2001; 82, pages 986-92
  6. Acupuncture and dry needling in the managemet of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials.  Tough et al, Eur J Pain, 2009; 13: pages 3-10
  7. Acupuncture and dry needling for low back pain.  Furlan and Van Tulder, Cochrane Database Syst Rev, 2005 (1): CD001351
  8. Dry needling of muscle motor points for chronic low back pain: a randomized clinical trial with long term follow up.  Gunn et al, Spine, 1980, 5; pages 279-91

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