TDN Overview

Trigger Point Dry Needling

What is Trigger Point Dry Needling?

Trigger point dry needling is a treatment technique, which uses small filament type needles to release tight muscles with the goal of permanently reducing muscle pain and dysfunction. Also known as; trigger point therapy, Trigger Point Needling, TPDN, TDN, triggerpoint, dry needling and IMS (intramuscular stimulation).  Physical therapists/physiotherapists are now using this technique around the world to effectively treat acute and chronic orthopedic and musculoskeletal conditions. TDN can help you more efficiently treat your patients and improve your outcomes. To access the upcoming trigger point dry needling courses and TDN Training please see our schedule under the "Training" Tab.

What is Dry Needling?

Dry needling is the use of a solid needle for deactivation and desensitization of a myofascial trigger point which should stimulate a healing response in that tissue and reduce the biomechanical stress of the muscle treated. http://en.wikipedia.org/wiki/Dry_needling

What is Myofascial Pain?

Myofascial pain syndrome is a disease of the muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and by sensory abnormalities (tenderness and referred pain). It is classified as a musculoskeletal pain syndrome that can be acute or chronic, regional or generalized. It can be a primary disorder causing local or regional pain syndromes, or a secondary disorder that occurs as a consequence of some other condition. When it becomes chronic, it tends to generalize, but it does not change to fibromyalgia. It is a treatable condition that can respond well to manual and injection techniques, but requires attention to postural, ergonomic, and structural factors, and toxic or metabolic factors that impair muscle function.  Gerwin, Robert D. "Classification, epidemiology, and natural history of myofascial pain syndrome.(Author abstract)(Report)." Current Pain and Headache Reports 5.5 (Oct 2001): 412(9). Academic OneFile. Gale. BCR Regis University. 27 Oct. 2008

What is a Trigger Point?

Classic Definition

The term "trigger point" was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:

• Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
• The painful point can be felt as a tumor or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
• Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.
• The pain cannot be explained by findings on neurological examination.  http://en.wikipedia.org/wiki/Trigger_point

Scientific View

Spontaneous Electrical Activity (SEA)

“Results: All subjects demonstrated objective signs of spontaneous electrical activity, spike activity and local twitch responses at the myofascial trigger point sites within taut bands. The frequency of these signs was significantly greater at myofascial trigger points than at control sites (P<0.05). “

Hong C-Z, Torigoe Y. Electrophysiological characteristics of localized twitch responses in responsive taut bands of rabbit skeletal muscle fibers. J Musculoskel Pain 1994;2(2): 17-43.

Biochemical Milieu

“We have confirmed that biochemicals associated with pain, inflammation, and intercellular signaling are elevated in the vicinity of active MTrP’s. Furthermore, subjects with active MTrP’s in the upper trapezius have elevated levels of these biochemicals in a remote, unaffected muscle, suggesting that these conditions are not limited to localized areas of active MTrP’s.”

Biochemicals Associated With Pain and Inflammation are Elevated in Sites Near to and Remote From Active Myofascial Trigger Points.(Author abstract)(Report).Jay P. Shah, Jerome V. Danoff, Mehul J. Desai, Sagar Parikh, Lynn Y. Nakamura, Terry M. Phillips and Lynn H. Gerber. Archives of Physical Medicine and Rehabilitation 89.1 (Jan 2008): p16(8). Reading Level (Lexile): N/A.

Edo's View
Trigger point dry needling is a treatment that addresses dysfunction of the neuromuscular system. Trigger points develop in the muscle secondary to various stresses, i.e. postural, repetitive motion, psychological, emotional etc and are more likely to develop in tissue that has neurological dysfunction likely caused by compression, disc dysfunction, facet joint dysfunction, vascular compression, metabolic stress, biomechanical stress, postural stress etc. When muscles develop trigger points, they neurologically remain tight causing local compression of vascular, neurological and joint/biomechanical structures hampering the normal function of that tissue. All tissues distal to the involved nerve will likely be involved. If you adequately release the muscle, the tissues then are allowed to assume normal function with improved neurological conduction and vascularity.

To the patient
TDN is a treatment that uses acupuncture needles, but that is where the similarity to acupuncture stops. Acupuncture tends to be a more superficial treatment that focuses on restoring energy or "Qi" to the body. It is thought there are blockages that can be restored by properly placing needles along energy channels called meridians. TDN directly treats the neuromuscular system affecting muscle tightness, joint mobility, and symptoms of pain and irritation. Testing active trigger points with an EMG needle has shown that there is increased spontaneous electrical activity at this active trigger point. Kind of like buzzing or uncontrolled electricity causing the nerve muscle connection to trigger the muscle to be tight. This tightness can cause the joint decrease in movement and many times will restrict the joint enough to limit normal functional activities of the whole body. Relatively new research has reported that there are numerous inflammatory and pain producing chemicals at an active trigger point causing pain and dysfunction of the muscle, consequently affecting the local nerves and joints.  The dry needle has been shown, when causing a twitch response in the active trigger point and muscle fiber, to decrease or completely reduce that spontaneous electrical activity and reduce or completely eliminate the irritating chemicals in that active trigger point.  This release can immediately improve range of motion, decrease pain and improve function. Patients often feel a significant cramping sensation from the twitch response but then feel an immediate improvement of their symptoms.

Utilizing trigger point dry needing in physical therapy practice allows the patient and the therapist a hastened return to strengthening and exercise that results in a faster return to function and improved maintenance of that dysfunction.