One of the most effective tools I use as a physical therapist at Eclipse Wellness is trigger point dry needling. It allows me to perform effective treatment of muscular pain, muscle strains, tendinitis, and many other musculoskeletal conditions. I have found benefit in using dry needling with many patients ranging from athletes to sedentary individuals of all ages.
Previously, physical therapists in Virginia were required to have a prescription to perform trigger point dry needling. Fortunately, this was recently changed and as of July 1st, 2023 we no longer require a prescription. That means that we can provide more treatment options early in the physical therapy process. This allows you to get better faster and back to doing what you love.
More and more people are familiar with trigger point dry needling, but I want to go over a few facts about it because there are still some areas of confusion.
What is Trigger Point Dry Needling?
Trigger point dry needling occurs when “one or more thin, monofilament needles are inserted into a muscle trigger point” per the Mayo Clinic. To understand dry needling, we need to understand a trigger point. According to the Cleveland Clinic, “Trigger points are knotted, tender areas that develop in your muscles.”
Let’s get nerdy for a second and talk about muscular anatomy. Muscles are made up of many bands that run in a parallel direction. Each band has many cross-bridges made up of myosin and actin. These cross-bridges allow your muscles to shorten when contracted and elongate when relaxed. Think of flexing your biceps. The flexing of the muscle causes the cross-bridges to shorten and then energy is required to relax the muscle and go back to its original length. If you want a simple but effective video on the actual anatomy check this out on Youtube.
When you contract your muscle typically, it eventually relaxes and goes back to its original position. However, that process can sometimes be interrupted. If a large part of your muscle does not go back to its original length, then you have a cramp. The muscle stays in a shortened position until you forcefully stretch it out and allow it to relax.
Sometimes, only part of the muscle stays in the shortened position. A small percentage of your muscle remains tightened, but the rest of it keeps moving. Staying in a shorted position decreases oxygen supply to the area and increases acidity of the muscle and surrounding area. This can be painful and difficult to address. If your entire biceps cramps, then you can just stretch it. However, if only a small portion of the muscle is shortened, stretching may not affect it because the rest of the muscle is able to move around it. That part of the muscle is known as a trigger point.
Massage or other soft tissue mobilization can be helpful to address trigger points, but this lacks the precision that dry needling provides. Trigger points can range from 2-10 mm in size according to Physiopedia, which makes massage difficult. Using a thin, monofilament needle can be effective in targeting these small trigger points. In fact, the needles are so thin (often approximately .25 mm) that you probably won’t feel them enter your skin!
The reason that we want to stimulate the shortened muscle tissue is to cause a twitch response. The simplest way to think about this is imagining you are at the doctor’s office and they tap your knee to cause a reflex. If you stimulate muscles with a rapid force, you can cause a reflexive twitch to occur. Using a thin needle to stimulate the muscle can cause a rapid twitch response and subsequent relaxation. Abruptly contracting the muscle creates a strong engagement of the tissue which leads to relaxation because the muscle becomes fatigued. Essentially your muscles are stuck in a semi-contracted state when a trigger point occurs and dry needling causes them to fully contract which allows them to relax. A simpler analogy is that you are resetting a computer back to its baseline and letting it boot back up.
The “dry” needling in trigger point dry needling refers to the fact that no liquid is involved in the process. Trigger point injections are performed by physicians where they inject liquid into a trigger point to help it relax. Dry needles are thinner than needles used for injections or vaccines because there is no need for space in the middle through which liquid can enter your body. This is part of the reason why the needles are so thin that you barely notice them go through your skin.
Once the trigger point is identified, your provider may treat it in different ways. They may simply leave the needle in the trigger point or they may move it around to stimulate the surrounding area. It depends on your provider’s training as well as your preferences.
Part of the reason that I think trigger point dry needling works is that it blends the art and science of healthcare. Research confirms that dry needling for trigger points is effective for pain relief and improving function, but it is up to the provider to locate the trigger point and how exactly they treat it. No two treatments are the same, just as no two patients are the same.
Does Trigger Point Dry Needling Work?
Dry needling is an effective treatment for pain and injury. Usually patients feel some relief after their first session, but they may feel some soreness for a day or two after. The soreness results from the significant twitch of the muscle. Imagine contracting your entire biceps muscle as hard and as quickly as possible. That creates some discomfort similar to an intense workout.
Another reason for the soreness is the release of the acidic chemicals that have built up around the trigger point. The twitch of the muscle decreases the local build up of chemicals, but they have to go somewhere. Your body will slowly absorb them, but it can cause soreness in the surrounding area.
Trigger point dry needling can be helpful after one session, or it may take multiple sessions depending on how your body responds. The important factor to consider is that dry needling by itself is often not an effective treatment. Your body created a trigger point for a reason. If you do not address the movement patterns or load that caused the issue, then the trigger point will return. Dry needling gives you a window of opportunity to utilize exercises to mobilize and strengthen the muscle to prevent it from happening again. Effective physical therapy is not just about temporarily relieving your pain; it should include a long-term solution to keep you out of pain!
Is Trigger Point Dry Needling Safe?
There are risks that come with any medical procedure including trigger point dry needling. Soreness, bleeding, and bruising occurs in anywhere from 20-36.7% of patients according to a recent study. These are considered minor events and typically resolve quickly.
Major adverse events occurred in less than 0.1% of patients according to the same study. This is less frequent than many other common medical procedures including surgeries and injections. It is important for healthcare providers who perform dry needling to do so safely and within their scope of practice.
There are several groups of people who are not appropriate for trigger point dry needling for various reasons. First, those who are afraid of needles. Trigger point dry needling is a tool like anything else, and it should not be a provider’s only tool. I have seen plenty of patients who were apprehensive with needles and we were able to treat their pain in alternative ways. Would dry needling have been more effective? Perhaps. However, if someone is uncomfortable with a treatment, it should not be performed. Logistically, the treatment is also less effective if someone is unable to relax, which is often the case with those afraid of needles.
I do not dry needle pregnant patients for fear of triggering spontaneous labor or risking damage to the fetus. This is not a clear issue as this article articulates, but I tend to err on the side of caution and utilize other treatments for pregnant patients. Patients and healthcare providers can make their own choices based on the risk and reward of treatment as they see fit.
Patients on significant blood thinners should check with their physician before receiving dry needling due to risk for prolonged bleeding. Similarly, patients with active cancer or recent surgery may need to avoid dry needling over the site of the surgery or cancer. Your physician or healthcare provider should be consulted to determine your individual risk.
Who Can Perform Trigger Point Dry Needling?
Trigger point dry needling can be performed by medical doctors, physical therapists, chiropractors, and acupuncturists. Different states have rules about the level of training required before performing dry needling. Virginia requires 54 hours of training for physical therapists before dry needling. This allows for a review of anatomy, needle safety, and other important concepts to maintain patient safety.
I will answer this question the way that I answer most questions for clients: it depends. If you are pregnant or very afraid of needles, then dry needling might not be right for you. However, if you are willing to try it and tired of dealing with pain, then it is worth a shot. In my experience as a physical therapist, trigger point dry needling allows for the most rapid and long lasting reduction of pain and discomfort that I have found from any manual therapy techniques. Of course, dry needling should be followed up with exercises and other techniques to truly be effective.