Dry Needling

Dry Needling / Trigger Point Therapy

 

Dry needling is commonly used by Forster Tuncurry Sports Podiatry as an adjunct therapy in treatment regimes for patients suffering painful musculoskeletal conditions.
Dry needling is frequently used to help release taut bands of muscle that are causing/contributing to symptoms.

 

Dry Needling

 

What Is Dry Needling?

Dry needling involves the insertion of thin filament acupuncture needles into a myofascial trigger point.

 

How Does Dry Needling Work?

The acupuncture needles that are used for dry needling are very thin, and in most cases they are not even felt when penetrating the skin.

When a needle is inserted in to a healthy muscle there is very little discomfort felt. However if a trigger point (TrP) is present in a muscle that is being needled some associated discomfort may be felt. The muscle may feel like it is going to cramp, or the muscle may involuntarily twitch. This ‘twitch response’ is what occurs when deactivation of a trigger point occurs. This deactivation should reduce pain, increase muscle range of motion and restore function.

When the nervous system is appropriately stimulated a series of reactions occur that initiate the body’s natural healing response. Dry needling aims to trigger this response by altering the neurochemical reactions that are associated with pain production and healing. During this response neurochemicals such as Endorphins (a naturally occurring neurochemical that reduce our perception of pain) and Corticosteroids (a group of neurochemicals that are involved in the healing process. They regulate the body’s immune response and anti-inflammatory reactions) are released.

A trigger point involves portions of muscle that remain in a constant state of contraction. This constant state contributes to the motor dysfunction (eg: weakness) experienced by the affected muscle groups. Dry needling aims to inhibit this contraction by sending signals to the nervous system which cause the muscle to relax and decrease the pain & dysfunction experienced.

Trigger Point Anatomy

What is a Trigger Point?

Trigger points (TrPs) are commonly referred to as ‘muscle knots’, and are a very common cause of acute and chronic musculoskeletal pain. They often occur as a result of neuromuscular/motor dysfunctions and in areas of increased musculoskeletal stress. Neuromuscular dysfunctions can refer to; muscle weakness, rigidity, generalised muscle pain.

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. The spots are painful on compression and can produce referred pain, referred tenderness, motor dysfunction, and autonomic phenomena1. Trigger points are often related to the Cumulative Injury Cycle / Pain Cycle.

A trigger point is not considered a muscle spasm as only a part of the muscle fibers are contracted, whereas a muscle spasm involves the entire muscle.

 

An example of reffered pain in relation to a TrP – A person may be experiencing pain in and around the heel and has not been achieving the desired level of improvement from other conservative treatments (eg: orthoses/orthotics, basic stretches etc…). The problem may actually be a trigger point located within a muscle that is referring pain to the area and/or affecting the tension of the surrounding fascia.

 

 

Common Symptoms of a Trigger Point / Tender Point

    • Pain – due to the complex nature of musculoskelal conditions, patient’s pain descriptions can greatly vary. Some of the more common descriptions of pain associated with the presence of TrPs are; burning, aching, cramping-like feelings. The pain experienced often worsens after periods of increased activity, eases with rest, then increases quite quickly again once activity recommences.
    • Decreased range of motion – stiffness and/or difficulty moving a muscle and/or joint may indicate the presence of increased tension within the muscle.
    • Weakness – the presence of increased tension within a muscle contributes to the development of muscle weakness (see Cumulative Injury Cycle).

 

Other Symptoms of some Specific Muscle Trigger Points

  • Weak ankles
  • Leg / calf cramps
  • Sciatica / Sciatic pain
  • Buckling knees
  • Shin pain

 

What causes Trigger Points (TrPs)?

Much of the research and opinions held by health practitioners propose that microtrauma and actue trauma may contribute to the development of TrPs.

Trauma (microtrauma or acute trauma) can develop as a result of any number of the following;

  • Lack of physical activity
  • Sudden changes in physical activity
  • Poor posture
  • Biomechanical abnormalities
  • Occupational and/or recreational activities that place increased stress on the musculoskeletal system

 

Forster Tuncurry Sports Podiatry and Dry Needling / Trigger Points

Thorough biomechanical and musculoskeletal assessments undertaken through FTSPodiatry aim to not only diagnose and treat your presenting condition, our goal is to also address WHY the condition developed in the first place. Symptom relief is always of upmost importance in any treatment regime. However many treatment regimes can fail address the actual cause of your condition. Addressing the underlying cause of a pathology is an essential component of the treatment approach adopted at Forster Tuncurry Sports Podiatry for the short and long term management of your condition.

Not all patients presenting with muscoloskeletal pain will have TrPs, nor do all patients require dry needling (other myofascial treatment modalities are utilised by FTSPodiatry in addition to dry needling). This treatment is only be recommended after thorough examination, and is only performed after gaining patient consent.

Talysha has been successfully incorporating dry needling therapy into patient treatment regimes since 2008, after completing further training in the technique and its applications for use in podiatric soft tissue therapy.

 

Information references:

1. (Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial pain and dysfunction: the trigger point manual. 2d ed. Baltimore: Williams & Wilkins, 1999:5.)

 

The above information is for informative purposes only and should not be used as a diagnostic and/or treatment tool. Dry needling should only be performed by trained/qualifed health practitioners. Talysha Reeve from Forster Tuncurry Sports Podiatry is qualified in the application of dry needling of the lower limb.

Dry needling is NOT acupuncture. Podiatrists at FTSPodiatry are not acupuncturists and do not practice acupuncture. 

The Podiatry Board of Australia acknowledges that podiatrists are qualified to use needling techniques associated with musculoskeletal treatments in the management of podiatric conditions. http://www.podiatryboard.gov.au/Registration-Endorsement/Endorsement-for-acupuncture.aspx

For more information regarding the use of dry needling the Journal of the American Board of Family Medicine has published an article (L. Kalichman, PT, PhD and S.Vulfsons, MD. J Am Board Fam MedSeptember-October 2010 vol. 23 no. 5 640-646) giving a concise overview of the dry needling method and its effectiveness. This can be found at http://www.jabfm.org/content/23/5/640.full

 

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