Trigger Point Dry Needling

WHAT ARE TRIGGER POINTS

Trigger points are localized areas of muscular constriction, commonly referred to as knots. They inhibit full range of muscular movement and produce pain which can radiate to other areas of the body.

WHAT IS DRY NEEDLING

Dry needling is the insertion and manipulation of solid, filiform needles into trigger points to cause their release. This results is reduction of pain and restoration of normal muscle movement.

WHAT IS TRIGGER POINT DRY NEEDLING

Trigger point dry needling is the use of solid needles (there is no medicine inside, thus they are dry) to treat and release trigger points. Trigger points can also be treated with manual therapies such as massage and physical therapy, as well as various other modalities.

IS DRY NEEDLING THE SAME AS ACUPUNCTURE

Dry needling is not the same as acupuncture. Acupuncture is part of the larger and more comprehensive system of Chinese medicine. Acupuncture is applied according to the diagnostic and therapeutic principle of Chinese medicine. It is used to treat a wide variety of pain and disease.

Acupuncture includes local treatment into the muscles along the tendino-muscluar channels using techniques such as sparrow-pecking. This part is very similar to dry needling, though there are still some differences in techinque. Acupuncture also includes systemic treatment at other points on the body; this is not part of dry needling.

Dry needling is a treatment modality, not a system of medicine. However, it is generally administered as part of a larger therapeutic system. It is commonly asserted that acupuncture utilizes ancient Chinese medical theories while dry needling relies on modern scientific theories. This is not really true. The scientific theories of how dry needling works have little to do with clinical application. The needle does not know if the hand holding it is attached to an acupuncturist or to another type of provider. Whatever biochemical and mechanical processes result from dry needling, this is true regardless of the knowledge of the practitioner. In my opinion, dry needling should be thought of as a treatment modality that is used to apply the system of the treating practitioner. The perspective may vary, but the ultimate aim is to reduce pain and improve function.

IS TRIGGER POINT ACUPUNCTURE THE SAME AS TRIGGER POINT DRY NEEDLING

Trigger point acupuncture is not the same as trigger point dry needling. There is no such thing as trigger pint acupuncture. Local treatment to relieve blockage has always been part of acupuncture. In modern times, particularly in the West, this approach has not generally been emphasized. Instead, the idea of acupuncture that is completely free of sensation has been promoted.

Mark Seem, founder of the Tri-State Institute of Traditional Chinese Acupuncture, was one of the first to teach this traditional approach in the West. He eventually coined the term Acupuncture Physical Medicine, and subsequently there arose terms such as trigger point acupuncture and orthopedic acupuncture. I trained at this college with Mark Seem, during which time I attended one teaching by Janet Travell. I also trained and received board certification in trigger point dry needling. They are not the same thing. The level of training for this trigger point acupuncture is very basic, and in my opinion greatly inferior to what is offered by at least one dry needling school. The issue is not that acupuncture is inferior; it is that the training for local myofascial needling is poor at this time in the West.

WHO CAN PERFORM DRY NEEDLING

Trigger point dry needling regulations vary from state to state. Any MD or DO can perform dry needling in any state. Generally this is done only by interventional pain management doctors. The same is true for acupuncturists, regardless of additional dry needling training. Chiropractors can perform dry needling in some states, though there are not many. The field with the biggest conflict has been physical therapy. Some states allow physical therapists to dry needle and some do not. Generally, the educational standards are increasing in states that do allow physical therapists to dry needle. In New Jersey, currently only medical doctors and acupuncturists are legally allowed to perform dry needling.

IS DRY NEEDLING SAFE

Needle Safety

Dry needle training includes safe handling of needles; for acupuncturists this issue is even more emphasized. The Clean Needle Technique (CNT) certification that is administered by the Council of Colleges of Acupuncture and Oriental Medicine (CCOM) is part of the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) national board certification requirements for all acupuncturists. Similar training and certification is not yet available for dry needling in other professions.

Technique Safety

Dry needle training includes detailed anatomical studies. Safety of needle insertion is directly related to knowledge of anatomy, as needles are sometimes inserted deeply into muscle tissue. There is no danger when properly administered by a trained practitioner.

ARE THERE ANY CONTRADICTIONS FOR DRY NEEDLING

Dry needling is typically not performed on children or in cases where tissue healing may be a problem. Elderly patients can be safely treated if they have good circulation and healing capacity. Extra caution is used if someone is taking blood thinners.

DOES DRY NEEDLING PRODUCE SIDE EFFECTS

Soreness is the most common residual effect from dry needling. For most people this resolves within 48 hours. Occasionally dry needling produces small bruises that will heal quickly.

WHAT IS DRY NEEDLING USED TO TREAT

Dry needling is used to treat pain and restricted movement anyplace in the body.

HOW FAST DOES DRY NEEDLING WORK

Dry needling typically produces immediate results. Chronic conditions still require time to fully address the condition, and time is needed after treatment for tissue to heal and soreness to resolve. Regaining strength and function also takes time and often requires stretching, strength training, etc. Release of trigger points and diminishment of acute pain occurs right away.

WHAT IS THE HISTORY OF TRIGGER POINT DRY NEEDLING

The concept of a local tender point that produces pain and can be treated with needles and massage has been part of Chinese medicine for over 2,000 years. This same recognition has existed in the West for hundreds of years. As a modern modality, the notion of trigger points and the development of techniques to treat them dates to the 20th century. Most notably it was Janet Travel, M.D., who developed and popularized the field of trigger point therapy. Trigger point dry needling is now a well-established field that is supported by ongoing research and technique refinement.