What is Trigger Point Dry Needling?

Sep 02, 2023

Many people that come to see me ask this question because it is a fairly new procedure. Trigger point Dry Needling (TrpDN) hasn't been around for centuries like Traditional Chinese Acupuncture (TCA) but it can be very effective. TCA and TpDN are uniquely different. TCA uses the theory that the human body is controlled by the force or energy of "Qi" (pronounced "chee"). This Qi is accessed through acupoints in the body on the skin or deeper tissues. If an acupuncturist detects an abnormal flow of Qi, they use the corresponding acupoints to  attain/maintain homeostasis. TCA is used to treat musculoskeletal dysfunction, infertility, smoking cessation, allergies, depression, and other conditions. Treatment sessions can include needling of 4-10 acupoints and needles being left in up to 30 mins. Acupuncturists can add other therapies like massage, cupping, moxibustion, herbal preparations, and electrical current to the treatment session.

Trigger point Dry Needling is the most frequently used of the dry needling models. this model targets Myofascial Trigger Points (MTrPs) in hopes of relieving motor, sensory, and autonomic abnormalities that can occur. The goal is to get a local twitch response in order to relax and alleviate pain/dysfunction caused by these trigger points. MTrPs are hyperirritable spots on muscles described as taught bands or nodules that you can feel under the skin. Typically they are painful with pressure. MTrPs are believed to be caused by excessive buildup of acetylcholine which is used to activate contractions in the muscle. They can also have decreased blood flow and oxygen that contributes to a shortening of the local surrounding tissues.

To be a candidate for dry needling you should have a PT diagnosis that will improve with dry needling, ability to comprehend the procedure, communicate effectively your response to the treatment, lie still, and ability to provide informed consent. You may not be able to have dry needling if you have an abnormal reaction to needles, unwilling participant, needle phobia, on anticoagulant therapy, thrombocytopenia, into an area with lymphodemia, abnormal bleeding, auto immune diseases, vascular disease, cancer, Diabetes, frailty, epilepsy, allergy to metals or latex, and people on blood thinning medications. It is not suggested to perform DN on morbidly obese participants due to the risk of the inflammatory factor that dry needling causes.

During the dry needling procedure the PT identifies the MTrP using their fingers. A sterile disposable solid filament needle is inserted into the skin using a guide tube. Once the needle is inserted different techniques can vary from PT to PT. Current research suggests that leaving the needle in for up to 30 mins with estim to be the most effective way to get a local twitch response. Although an adequate outcome can happen from precise palpation and pistoning with needles being left in up to 8 minutes. To further your understanding of dry needling and its risks/benefits associated with your particular diagnosis, please speak with a Physical Therapist trained in this procedure.

FYI: Currently, health insurance does not cover its application. Costs can vary from clinic to clinic and cash options are available.

Unverzagt, Berglund, Thomas. Dry Needling for Myofascial Trigger Point Pain:A Clinical Commentary. IJSPT. 2015; 10:402-418
James Dunning, Raymond Butts, Firas Mourad, Ian Young, Sean Flannagan & Thomas Perreault (2014) Dry needling: a literature review with implications for clinical practice guidelines, Physical Therapy Reviews, 19:4, 252-265, DOI: 10.1179/108331913X13844245102034