If You Have Pain, Try Trigger Point Dry Needling: Answering Common Questions About Dry Needling
by onsite, September 6, 2016
My previous post on the subject of Trigger Point Dry Needling (which you can access by clicking here) discussed why the treatment is effective from a physiological perspective. We also discussed some examples of where the treatment can be performed and how specifically I like to use it to decrease pain and improve function. Because of some of the feedback I commonly hear from patients, as well as some responses to the previous article, I wanted to address a few specific commonly asked questions.
WHY DO SOME PEOPLE STILL HAVE PAIN AFTER TRIGGER POINT DRY NEEDLING?
Sometimes I hear a patient who received one trigger point dry needling treatment telling others or reporting to me that, “Well, the dry needling just didn’t work for me.” My blood pressure goes up immediately when I hear people say this, because Dry Needling “works” on everyone. Physiologically it is going to have the same effect on any individual’s tissues that gets it done. Just like putting a heat pack on sore muscles will increase blood flow in that muscle for anyone who puts heat on, trigger point dry needling will have an effect on the muscle tissue treated on every person who undergoes a dry needling treatment. Some people get a lot of pain relief simply by putting heat on a sore muscle, others don’t get any relief at all. In some cases, simply increased blood flow to the muscle and loosening it up isn’t enough. The same is true for Trigger Point Dry Needling, even though the impact on the musculature and tissues treated is going to be very beneficial, it may not completely alleviate pain or fix the whole problem.
Trigger Point Dry Needling is not magic. It’s not like waving a magic wand over your back to eliminate years of damage or a significant acute injury to the tissue. Often times, there are numerous impairments or problems that need to be addressed before the patient will get the amount of pain relief or functional improvement that they desire. Perhaps an individual still needs to strengthen various muscles, improve joint mobility, or break poor postural habits that have led to them developing pain. But trigger point dry needling is a CRUCIAL treatment to perform initially and perhaps ongoing through this process. This is because receiving dry needling treatment puts your body in the best environment to be successful. If you have several large trigger points in a muscle, no matter how much you stretch and strengthen it, the functional potential of that muscle will be very limited. The patient will be going in circles until the trigger point is released and normal functioning of the neuromuscular system is restored…and TRIGGER POINT DRY NEEDLING does this better than any other treatment. If you have a muscle that is not activating, you can do all the strength training you want, until the nerve is facilitated to “turn back on” you won’t get any stronger. Here is the analogy that I like to use. Think of performing trigger point dry needling treatment like “Pulling the FIRE ALARM” when there is a fire. If the fire alarm isn’t pulled, then we can’t take all the other steps necessary to put out the fire. On the other hand, if the only thing that happens is the fire alarm being pulled without anything done to “put out the fire,” than pulling the fire alarm wasn’t effective. In the same sense, we need to follow up the treatment with targeted postural re-training, strengthening, and restoring normal movement to get the full benefit of the treatment.
So, to the person who says “Dry Needling didn’t work for me,” know that IT DID WORK. However, in most cases simply one or two treatment sessions of just dry needling isn’t sufficient without following through with other important interventions.
HOW IS TRIGGER POINT DRY NEEDLING DIFFERENT THAN ACUPUNCTURE?
The short answer is that other than using the same type of needles, the treatments are COMPLETELY DIFFERENT. Acupuncture is a totally different field of medicine based on unique principles and taught in a much different way. Acupuncture is based on eastern medicine principles focusing on specific points corresponding with Meridian Lines and restoring balance within the body. Acupuncture is used to treat musculoskeletal pain, but is also utilized for helping with pain within internal organs or helping heal various sicknesses. I’ve had a lot of patients say that Acupuncture helped them, and others that told me it did nothing for their symptoms.
Trigger point dry needling is ONLY used to treat musculoskeletal pain (muscle strains, joint ache, ligament sprains, muscle spasms, nerve issues, ect). It’s based on a thorough anatomical evaluation and movement assessment. The needles are often inserted deeper into tissues when compared to acupuncture, based on the depth of the target tissue. I’ve treated hundreds of patients with trigger point dry needling that have received acupuncture, and they all agree that dry needling feels nothing like acupuncture. Acupuncturists often argue that physical therapists should not be able to perform treatment with needles because all they do is go to a weekend intensive course to get certified. However, they don’t mention that physical therapists have 7-8 years of doctoral level education and know the neuromuscular system arguably as good as any medical professional. Physical Therapists already know the body extremely well, the advaThisnced weekend training simply teaches the physical therapist how to use and get comfortable with the needles.
This Video By Dr. Don Reagan one of the leading physical therapists associated with The Functional Movement Systems Group gives a great look at how the treatment is performed and how it is different than Acupuncture.
DOES TRIGGER POINT DRY NEEDLING HURT?
For most patients, yes it is uncomfortable. Especially the first session, the feeling of a muscle twitch response is difficult to describe. I like to describe it to patients as a deep cramping or pressure feeling that comes on quickly. However, the treatment is much less painful than getting injections or having to recover from a surgery. Typically, when a patient has experienced the treatment and knows what to expect, they tolerate it very well. For most patients that are serious about alleviating pain or increasing performance, the uncomfortable aspect of the treatment is worth the benefits it provides.
ARE THERE ANY RISKS OR SIDE EFFECTS WITH DRY NEEDLING?
As with any treatment there are some very rare contraindications. The risks and side effects are extremely small. At the previous company that I worked with we had about 15 therapists throughout the company performing dry needling. Each therapist treated 3-5 patients with dry needling per day, and I was there for 3 ½ years. There was only one negative incident with the thousands of patients treated with dry needling during my time with that company. One of our therapists strayed too far away from the spine when treating a significantly obese patient, which resulted in the needle puncturing a lung. Because the needles are so small and thin, there was no noteworthy injury to the lung tissue. The patient was fine within the hour, but did go to the ER to get a chest X-Ray, which showed know significant injury.
The fact is, the needles used are extremely thin so even if they connect with a nerve, artery, or vein there will be no lasting injury. A patient may feel a shot of pain down the leg with a nerve insult,or have a mild bruise if the needle connects with a vein or artery. In nearly all cases, the worst part of the treatment is mild to moderate muscle soreness for 24 hours or so following the treatment. This typically feels like muscle soreness that someone would have after working out a muscle they hadn’t used in a long time. Once the soreness wears off, patients typically report improved mobility, decreased pain with activity, and overall increased performance. I always tell patients that if you have a significant injury or have been dealing with pain for a long time, we are going to need a stronger stimulus to change the tissues in your body and how they are functioning. A nice gentle massage or simple low level exercises are typically not going to overcome years of overuse or damage to tissues.
If you are in pain and have not tried trigger point dry needling CLICK HERE to talk to me about a free consultation to see if this treatment might be beneficial for you!
Photo Credit: http://www.solutionsphysicaltherapy.com/services/trigger-point-dry-needling/