How Do Trigger Points Work?
Trigger points are hyperirritable local points within a taut band of muscle or in the fascia of the muscle. The trigger point is painful to compression and palpation. It can produce a characteristic referred pain, local tenderness and autonomic phenomena (Travell and Simons 1992).
The goal of trigger point dry needling therapy is to desensitize supersensitive structures, to restore motion and promote comfortable muscle function. It is possible that it induces a healing response in the muscle or tendon tissue by producing a local inflammation. It decreases spontaneous electrical activity at trigger points.
The mechanical effect of TPDN is disruption of the integrity of the dysfunctional motor end plate. It may provide a localized stretch to the contracted cytoskeletal structures by rotating the needle. Moving the needle up and down may cause a needle grasp and a resultant local twitch response. The local twitch response may use up acetylcholine (neurotransmitter) in the tissue which was triggering increased firing.
Baldry (2001) suggests that TPDN may stimulate A-nerve fibres for as long as 72 hours after needle insertion. This may activate the enkephalinergic inhibitory dorsal horn interneurons to cause opioid mediated pain suppression. It may also active descending inhibitory systems to block noxious stimulus into the dorsal horn.
Shah (2001) noted that the increased levels of chemicals such as bradykinin (vasodilator) and Substance P (a neurotransmitter and neuromodular) found in the trigger point are immediately changed with a local twitch response during trigger point dry needling therapy.
TPDN causes microtrauma with microbleeding and therefore the release of platelet-derived growth factor into the local tissues to produce inflammation and healing.
Trigger Point Dry Needling Therapy
If a trigger point can be palpated, North Boulder Physical Therapy can dry needle it. By coming to our highly-trained therapists, you can trust that we have the knowledge needed to prevent injury to structures that could be erroneously needled. For example, in treating the rib cage area we’ve refined our techniques to ensure the lungs remain untouched by the needle.
Some needling methods use bones are used as a backstop, while other techniques pinch the muscle and needle through it. Depending on the area and structures present, we carefully choose a method, needle length and angle. This allows us to provide you with the optimal “release” at your trigger points.
What North Boulder Physical Therapy patients like most about trigger point dry needling therapy is that the results are instant. However, if you are averse to needles, we will never use TPDN or try to talk you into dry needling. We’ll offer it and walk you through everything you need to know, but in the end, it’s up to you. If you’d like to proceed, we’ll start slowly and build on subsequent visits.
For headache issues, we can start with needle therapy at the occipitalis, suboccipitals and C2 and then stop (6 points). If you’d like to continue with TPDN at your next visit, we’ll add the upper traps and lev scap, as well as any other trigger points that can be located.
Common Areas for Trigger Point Dry Needling Therapy
- Suboccipital area and cervical spine for headaches and neck pain.
- Scapular area, especially the levator scap, upper trap, teres and rhomboids.
- Lumbar paraspinal muscles and the quadratus lumborum.
- Piriformis and gluts
- ITB and vastus lateralis
- Medial and lateral epicondyles
- Gastrocnemius, peroneals, post tib
- Achilles (tendon for microtrauma)
- Shoulder areas
- Hip adductors/high groin sprains