Trigger Point Dry Needling for Low Back Pain

As a physical therapist who has practiced for over 8 years, if you asked me what technique has provided the most benefit to my clients, I would say trigger point dry needling (dry needling for short). I began dry needling in 2017, not long after graduating and I have seen fantastic results since then. Dry needling has become much more mainstream than it was 8 years ago, but there is still a lot of confusion regarding the technique and the reason for utilizing it. Most clients that I see are familiar with dry needling, but their only frame of reference involves the actual insertion of the needle. They do not know why dry needling is utilized and they especially do not understand the context with which physical therapists utilize it. I wanted to offer my thoughts on how I utilize dry needling with a condition we are probably very familiar with: low back pain.

What is Trigger Point Dry Needling?

As Hillary Duff once sang in "Come Clean": Let’s go back...Back to the beginning. If you want to check out a more detailed explanation of trigger point dry needling, check out my blog I wrote here. A quick and dirty explanation: trigger points develop in muscles when there is some movement limitation. Muscles are a series of cross-bridges that lengthen and contract. Sometimes a part of the muscle gets stuck and stops lengthening and contracting. The surrounding area builds up inflammation due to the lack of movement. This causes pain and further limits movement. 

How do you fix a trigger point? Massage and sustained pressure can cause trigger points to decrease. Unfortunately, trigger points can be very small or very deep, leading to difficulty with effective treatment through massage. Dry needling utilizes a very thin needle to stimulate the trigger point. If you contact a trigger point with a needle, you cause a reflexive twitch response that can reset the muscle. Think about the doctor tapping your knee to make your foot kick out. Dry needling causes something similar, which causes a reset of the muscle and can help the trigger point resume normal movement.

This is a very simplified explanation of trigger points and dry needling, but some basic understanding is important before going further. A lot of back pain can be due to trigger points. Sometimes a trigger point is the driver of pain. Sometimes trigger points develop due to faulty movement patterns surrounding an injury. In either case, addressing the trigger points with targeted dry needling is often the best course of action in my experience.

What is Low Back Pain?

This seems like an obvious question, but the answer is quite complicated. If you Google the causes of low back pain, you get a bunch of different answers. Google AI gives you approximately 100 reasons for low back pain, which is not that helpful. Maybe you should see a physical therapist rather than rely on AI? Sorry, I could not resist.

To understand low back pain, we need to look at it through the concept of first principles. This involves looking at the most basic level of facts and figuring out what the absolute truths are for a problem. Pain is your body’s response to a stimulus that it does not like. Get punched in the back? Pain. Pick up a box that is too heavy and strain a muscle? Pain. Sit for 5 hours on a cramped flight? Pain. All of those pains are caused by the musculoskeletal system. How do we treat muscular pain? Look for trigger points that cause pain in the muscle. How do we treat the trigger points? Dry needling. Sometimes pain can come from the ligaments and tendons in your low back. Treating ligaments and tendons is difficult and requires a long time. It is beneficial to address the surrounding muscles with, you guessed it, trigger point dry needling to allow the ligaments and tendons to heal with less stress.

Trigger point dry needling can help address muscular pain from acute injuries such as a muscle strain from picking up a heavy box. It can also address chronic tightening of muscles from an old injury. One of the most common misconceptions involving low back pain is that it is purely due to “core weakness” or weakness in general. The truth, as it always is in healthcare, is that it depends. If you lift a 50 pound box and hurt your back because you could not handle that load, you should probably get stronger. However, immediately after the injury, you are not having pain because your muscles are weak. You are having pain because your muscles tightened up to protect you. Trigger points can develop quickly and now it hurts to bend over and tie your shoes. Getting out of pain is not a strength issue at this point, but rather it is a mobility issue. Your muscles are unable to relax to allow you to bend forward. Dry needling can help clear up trigger points that are limiting movement and allow you to gradually reintroduce movement.

How Do I Use Trigger Point Dry Needling to Help Low Back Pain?

Trigger point dry needling gives a targeted approach to tight or painful muscles. Compared to inefficient massage, a well-placed needle can have much more effective results. Dry needling by itself can address trigger points, but you need to follow up with structured physical therapy to prevent re-occurrence. Effective dry needling should decrease the physical limitations to movement. Now we need to mobilize in ways that minimize the mental limitations and guarding created by your fear.

Here is a sample progression if a client came to me with low back pain with bending forward: Dry needling to the muscles of the low back, followed by massage, then stretching (such as a child’s pose movement) on the table, then standing stretches and mobility, ending with dead lifts or similar exercises to load the movement. We want to structure your movements from least to most threatening and find your sticking point. If I perform dry needling, manual therapy, and some light mobility on the physical therapy table, but you cannot handle standing stretches, that is your limit. Your home exercises should include seated or lying down stretches that your body can tolerate from a physical standpoint but are also not overly threatening. Eventually we would progress to standing movements that involve increased load from gravity as well as increased fear depending on your injury history. Finally, we want to load the movements to further decrease your fear as well as injury risk in the future. Going back to an earlier example: the best way to prevent injury when lifting a 50 pound box is by dead lifting 60 pounds with no problem.

This has been a very brief summary of how I use trigger point dry needling at Eclipse Wellness in Sterling, VA. As I mentioned in the beginning, it is important to not just understand what dry needling is, but also why I utilize it. Dry needling is just targeted massage. It allows me to access areas that are difficult to reach with my hands. It gives us an opportunity to move in ways that were previously unattainable. We can get mobile and strong in those positions to decrease pain and prevent it from happening again. Dry needling can be intimidating, but once you see it as another tool in the hands of an expert, you should feel comfortable.

Questions? Reach out to me at danny@eclipsewellnessnova.com if you want to chat or schedule a physical therapy appointment. If you prefer to watch a YouTube video, check out my video on trigger point dry needling for low back pain.