At a glance:
- Myofascial trigger points (muscle knots) are tight bunches of muscle fibre that reduce the ability of a muscle to expand and contract, potentially causing pain and limiting movement and function
- They are formed when the “guarding” response causes muscle fibres to contract around sites of trauma or injury to protect that area from further injury
- A number of things can cause this guarding response, including stress, poor posture, injury, infection, poor nutrition, sudden or unexpected movements, muscle strain and more
- Dry needling is a treatment that uses filiform (narrow) needles inserted into myofascial trigger points to release the knot or to help manage pain in people suffering myofascial pain syndrome
- This is achieved by triggering a Local Twitch Response (LTR)
- Although dry needling and acupuncture both utilise thin needles in treatment they are not related
- Dry needling practitioners insert needles directly into trigger points, whereas acupuncture practitioners place needles around the body during treatment to help the flow of Chi
What is Dry Needling?
Muscle knots, known in medical parlance as myofascial trigger points, are areas within a muscle in which the muscle fibres or bands of tissue known as fascia have bunched and tightened. These trigger points may be classified as either latent or active, with active trigger points being painful without the need for contact, and latent trigger points requiring physical contact to cause pain.
Myofascial trigger points can form anywhere on the body, but the most common muscle in which they are regularly found is the trapezius muscle. This large, triangular muscle connects to the neck, shoulder and middle of the back and is prone to forming knots due to stress and poor posture.
In addition to being painful, myofascial trigger points may reduce range of motion or restrict a person’s ability to perform normally. As such, it’s recommended that muscle knots be treated early before they cause lasting damage or discomfort. Dry needling is a technique used by physiotherapists to release myofascial trigger points. Long, sterile, single use, fine filament needles (acupuncture needles) are inserted into the trigger point, allowing the tight ball of muscle and fascia fibres to relax, relieving pain and restoring function to the muscle.
What Causes Myofascial Trigger Points?
Trigger points often form as a protective response to injury or trauma. This response, known as “guarding”, causes tissue to bunch up and tighten around the area of an injury to help protect it from further injury. It is an appropriate initial adaptive strategy of the body, but left unchecked, can cause ongoing issues. Causes of myofascial trigger points include:
- Damage/Injury – the most direct form of guarding response. Muscles tense up around injury to protect it from further injury. This is generally experienced as muscle spasm
- Overuse - overworking a muscle can cause it to tense and bunch
- Unexpected movement - stepping off an unseen step or gutter, losing footing/slipping, sudden acceleration or stopping, etc
- Sudden movements - turning your head suddenly, moving to avoid collision, et
- Change in frequency, intensity or muscle load of regular activity - playing sport more often than you are used to, sudden ramp up of workout intensity, starting a new sport or physical activity
- Poor or sustained posture - prolonged sitting, slouching, poor ergonomics in the workplace
- Nerve impingement (pinched nerve) – much like the case of muscle damage, nerve impingement may cause the guarding response to bunch the muscle around the impinged nerve to protect it from further damage
- Stress - muscle tension is a common reaction to stress. Stress causes muscles to tense and bunch
- Bacterial or viral infection
- Nutritional deficiencies - a number of vitamin or mineral deficiencies may lead to muscle tension and knots, including Vitamins C, B1, B12 and B6, as well as Folic Acid, Malic Acid and Magnesium
- Metabolic and endocrine conditions - a number of conditions affecting the metabolic system (metabolic myopathies) as well as endocrine conditions such as adrenal insufficiency and hyperthyroidism can lead to the formation of muscle knots
The fastest and easiest way to search for and book an appointment with a physiotherapist for dry needling is to do it online with MyHealth1st.
How Does Dry Needling Work?
There are two overall styles of dry needling - deep tissue and superficial. Both utilise the insertion of a filiform (extremely thin, around 0.3mm) needle, but the depth to which the needle is inserted determines both the style and mechanics of the needling.Deep dry needling sees the needles inserted deep into muscles to penetrate myofascial trigger points. Depending on who is performing the procedure the needle may be inserted and left in the muscle or may be “pistoned” in an up and down motion. No matter the technique, the desired result is what is referred to as a Local Twitch Response (LTR). The LTR causes the muscle fibres around the needle to contract and relax rapidly.
This may lead to increased discomfort in the short term but a release in muscle tension in the long term. New studies also suggest that the local twitch response may prompt the release of endogenous opioids, causing a local analgesic (numbing) response, and also reducing pain in line with gateway theory of pain management, in much the same manner as TENS machines.
Recently, some practitioners have been utilising superficial (shallow) dry needling for the treatment of pain in muscle fascia, scar tissue, connective tissue and tendons.
What is the Difference Between Dry Needling and Acupuncture?
While both dry needling and acupuncture utilise the same style of needle, the approach between the two disciplines is very different. Dry needling takes a very direct approach to how the needles are used - the needles are inserted directly into the affected area to achieve the desired effect.
Depending on the training and background, acupuncture practitioners may claim that acupuncture helps guide the flow of Chi, or that it works by targeting sympathetic connections between parts of the body. Rather than inserting a needle into a trigger point, a typical acupuncture session will see a patient having between five and 20 or so acupuncture needles inserted in various parts of the body and then left in for a period of time.Where the needles are placed is determined by “sympathetic connections” and diagnosis - so someone getting acupuncture for shoulder pain may have needles placed in their feet and knees, for example, rather than the actual site of the pain. Dry needling is only used for pain relief and to increase mobility. Acupuncture in Traditional Chinese Medicine (TCM) is considered an appropriate treatment for all manner of conditions, from pain to addiction.Both dry needling and acupuncture are typically delivered as part of a care plan with a number of other complementary therapies.
If you have stiff, sore muscles, or have muscles and joints that are restricted in the way they can move and function, you might benefit from trying dry needling.