Technique
In the treatment of trigger points for persons with myofascial pain syndrome, dry needling is an invasive procedure in which a filiform needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle. Deep dry needling for treating trigger points was first introduced by Czech physician Karel Lewit in 1979. Lewit had noticed that the success of injections into trigger points in relieving pain was apparently unconnected to the analgesic used.
Proper dry needling of a myofascial trigger point will elicit a local twitch response (LTR), which is an involuntary spinal cord reflex in which the muscle fibers in the taut band of muscle contract. The LTR indicates the proper placement of the needle in a trigger point. Dry needling that elicits LTRs improves treatment outcomes, and may work by activating endogenous opioids. Inserting the needle can itself cause considerable pain, although when done by well-trained practitioners that is not a common occurrence. No study to date has reported the reliability of trigger point diagnosis and physical diagnosis cannot be recommended as a reliable test for the diagnosis of trigger points.
Chan Gunn introduced a type of dry needling called intramuscular stimulation in the 1980s that moved away from using trigger points. Gunn believed that the peripheral muscle spasm was not the origin of pain, but instead a tight multifidi was causing spinal nerve compression, radiculopathy, and nerve damage running peripherally. This spinal nerve damage eventually reached the associated muscle, causing spasm and transformation to a trigger point. Therefore, Gunn recommended a needle be placed in the paraspinal muscles in addition to the distally affected muscle. Peter Baldry developed a version called superficial dry needling in 2005, in which the needle is inserted about 5–10 mm into the tissue above the trigger point. Baldry practiced deep dry needling until he had a patient in the early 1980s with a trigger point in his anterior scalene muscle. Baldry decided to only penetrate the skin for fear of puncturing a lung. Baldry has such success with this technique that he applied it throughout the body by simply puncturing the skin superficially over a trigger point without actually reaching it.
Read more about this topic: Dry Needling
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