How Do Trigger Points Work?
These are hyperirritable local points within a stretched band of muscle or in the fascia of the muscle. A trigger point is painful to compression and palpation. It’s often responsible for characteristic referred pain, local tenderness and autonomic phenomena (Travell and Simons 1992).
Using TPDN desensitizes these extremely sensitive structures, restoring motion and making muscle use more comfortable. It’s also possible that because TPDN produces local inflammation, it can lead to a healing response in the muscle or tendon by decreasing spontaneous electrical activity at trigger points.
As for the mechanical effect, trigger point dry needling disrupts the integrity of the dysfunctional motor end plate. It may also 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 twitch response, using up acetylcholine (neurotransmitter) in the tissue which was triggering increased firing.
According to Baldry (2001), trigger point dry needling therapy may stimulate A-nerve fibers for as long as 72 hours after needle insertion and activate the enkephalinergic inhibitory dorsal horn interneurons to cause opioid mediated pain suppression. It may also cause descending inhibitory systems to block noxious stimulus into the dorsal horn.
Shah (2001) noted that a local twitch response during TPDN increased levels of bradykinin (vasodilator) and Substance P (a neurotransmitter and neuromodular), both found in the trigger point.
Trigger point dry needling therapy causes microtrauma with microbleeding, leading to platelet-derived growth factor being released into local tissues. This produces inflammation and promotes healing.
Trigger Point Dry Needling Therapy
If a trigger point can be palpated, NB Physical Therapy in Westminster 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 NB 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