Dry Needling: Difference between revisions
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Trigger-point dry needling is an invasive procedure where an acupuncture needle is inserted into the skin and muscle. It is aimed at myofascial trigger points which are hyperirritable spots in skeletal muscle that are associated with a hypersensitive palpable nocule in a taut band.<ref name="Dommerholt et al">Dommerholt, J., Del Morel, O. and Grobli, C. (2006) 'Trigger point dry needling', The journal of manual and manipulative therapy, 14(4), 70-87</ref> Trigger point dry needling can be carried out a superficial or deep tissue level. | Trigger-point dry needling is an invasive procedure where an acupuncture needle is inserted into the skin and muscle. It is aimed at myofascial trigger points which are hyperirritable spots in skeletal muscle that are associated with a hypersensitive palpable nocule in a taut band.<ref name="Dommerholt et al">Dommerholt, J., Del Morel, O. and Grobli, C. (2006) 'Trigger point dry needling', The journal of manual and manipulative therapy, 14(4), 70-87</ref> Trigger point dry needling can be carried out a superficial or deep tissue level. | ||
Trigger point model [[Image: | Superficial dry-needling<ref name="Baldry">Baldry, P. (2002) 'Superficial versus deep dry-needling', Acupuncture in medicine, 20(2-3), 78-81</ref> | ||
This was developed by Peter Baldry. He recommended the insertion of needles to 5-10mm over a MTrP for 30 secs. Palpation of the MTrP then determined the level of response and whether needle stimulation was sufficient to alleviate MTrP pain. If not the need was re-inserted. | |||
Trigger point model [[Image:Trigger point pain.pdf]] | |||
The trigger point model is a dry needling technique that specificall targets myofascial trigger points. They are thought to be due to an excessive release of acetylcholine from select motor endplates. They can be divided into Active and Latent myofascial trigger points. | The trigger point model is a dry needling technique that specificall targets myofascial trigger points. They are thought to be due to an excessive release of acetylcholine from select motor endplates. They can be divided into Active and Latent myofascial trigger points. | ||
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Deep dry needling reproduces the patients pattern of pain | Deep dry needling reproduces the patients pattern of pain | ||
Identification of 'Jump' and 'Shout' sign on palpation on MTrP. | |||
Clinical presentation | Clinical presentation | ||
Procedure post treatment: | |||
Assess ROM for restriction and pain | |||
Give patient a stretching programme | |||
Identify activities that may reactivate MTrP | |||
Key evidence | Key evidence |
Revision as of 18:00, 16 February 2014
Description
Trigger-point dry needling is an invasive procedure where an acupuncture needle is inserted into the skin and muscle. It is aimed at myofascial trigger points which are hyperirritable spots in skeletal muscle that are associated with a hypersensitive palpable nocule in a taut band.[1] Trigger point dry needling can be carried out a superficial or deep tissue level.
Superficial dry-needling[2]
This was developed by Peter Baldry. He recommended the insertion of needles to 5-10mm over a MTrP for 30 secs. Palpation of the MTrP then determined the level of response and whether needle stimulation was sufficient to alleviate MTrP pain. If not the need was re-inserted.
Trigger point model File:Trigger point pain.pdf
The trigger point model is a dry needling technique that specificall targets myofascial trigger points. They are thought to be due to an excessive release of acetylcholine from select motor endplates. They can be divided into Active and Latent myofascial trigger points.
Active trigger points can spontaneously trigger local or referred pain.They cause muscle weakness, restricted ROM and autonomic phenomena.
Latent trigger points do not cause pain unless they are stimulated. They may alter muscle activation patterns and contribute to restricted ROM.
Therefore both active and latent trigger points cause allodynia at the trigger point site and hyperalgesia away from the trigger point following applied pressure.[3]
The formation of trigger points is caused by the creation of a taut band within the muscle. This band is caused by excessive acetylcholine release from the motor endplate combined with inhibition of acetylcholine esterase and upregulation of nicotinic acetylcholine receptors.
Initially taut bands are produced as a normal protective, physiological measure in the presence of actual or potential muscle damage. They are thought to occur in response to unaccustomed eccentric or concentric loading, sustained postures and repetitive low load stress. However when sustained they contribute to sustained pain.
Pain caused by trigger points is due to hypoxia and decreased bloodflow within the trigger point. This leads to a decreased pH which activates the muscle nociceptors to restore homeostasis. This causes peripheral sensitization.
Trigger points are also involved in central sensitization. The mechanism remains unclear but trigger points maintain nocioceptive input into the dorsal horn and therefore contribute to central sensitization.
Suggested mechanisms of effect:
Stimulation of a local twitch response
Dry-needling of these myofascial trigger points via mechanical stimulation causes an analgesic effect. This mechanical stimulation causes a local twitch response (LTR). An LTR is an involuntary spinal cord reflex contraction of the muscle fbers in a taut band. Triggering an LTR has been shown to reduce the concentration of nociceptive substances in the chemical environment near myofascial trigger points.
Muscle regeneration
The needle may cause a small focal lesion which triggers satellite cell migration to the area which repair or replace damaged myofibers. This occurs 7-10 days after dry needling. It is unclear whether continued dry needling within this period may disrupt this process.
A localised stretch to the cytoskeletal structures
This stretch may allow sacomeres to resume their resting length.
Electrical polarization of muscle and connective tissue
The mechanical pressure causes collagen fibers to intrinsically electrically polarize which triggers tissue remodelling.
Indication
Identification of myofascial trigger points in the muscle through palpation
Deep dry needling reproduces the patients pattern of pain
Identification of 'Jump' and 'Shout' sign on palpation on MTrP.
Clinical presentation
Procedure post treatment:
Assess ROM for restriction and pain
Give patient a stretching programme
Identify activities that may reactivate MTrP
Key evidence
The effectiveness of this treatment depends greatly on the skill of the therapist to accurately palpate mysofascial trigger points as well as kinaesthetic awareness of the anatomical structures.
It is difficult to carry out large scale RCTs due to the invasive nature of this treatment and diffulty designing a placebo treatment.
A cochrane review (2005) of RCTs concluded that trigger point dry needling may be beneficial for low back pain when used in combination with other treatments. However further higher quality studies are needed to confirm this.
It is suggested that dry-needling reduces/removes nociceptive input from trigger points, normalize synaptic efficacy and reduce peripheral and central sensitization.
Dry-needling can restore muscle activation and strength as well as ROM.
Dry-needling decreases pain in patients with CLBP and in patients with hemiparetic upper limb post CVA.
Resources
Case studies
Recent related research (from PubMed)
References[edit | edit source]
- ↑ Dommerholt, J., Del Morel, O. and Grobli, C. (2006) 'Trigger point dry needling', The journal of manual and manipulative therapy, 14(4), 70-87
- ↑ Baldry, P. (2002) 'Superficial versus deep dry-needling', Acupuncture in medicine, 20(2-3), 78-81
- ↑ Dommerholt, J.(2011) 'dry-needling-peripheral and central considerations', Journal of manual and manipulative therapy, 19(4), 223-238