Written by Dr. Sarah Cash Crawford from Beyond Exercise, LLC. for the Fall issue of our Trail Times newsletter.
Dry needling is a technique used mostly by physical therapists and occasionally by chiropractors, medical doctors and dare I say…acupuncturists. You may be asking: is it not the same as acupuncture? That is a very short answer: No.
Acupuncture is based on Traditional Chinese Medicine where the belief is that our bodies are fed by a variety of energy channels which have grand central stations of flow (“chi”) and a needle is inserted into those central stations to increase the amount of energy to a given system (for example, low back).
Trigger point dry needling came about in the United States as a practice for physical therapists in the early 1980s as a result of studies performed by Dr. Janet Travell, a cardiologist at Beth Israel Hospital in New York and the first female physician to President Kennedy. Dr. Travell observed a trend in her patients presenting with cardiac symptoms, however upon testing, those symptoms were not found to be coming from the heart. Further examination found that when she pressed on a spot between the 5th and 6th rib on the right side of the body of these patients she could reproduce their cardiac symptoms. Ah ha! Already a believer in referred pain; this was the evidence she needed to develop her hypotheses.
Dr. Travell then partnered with Dr. David Simmons, an aerospace physician who studied the physiologic response of stress to weightlessness, and wrote The Trigger Point Manual. This manual has become the primary teaching tool for medical professionals on the diagnosis and treatment of myofascial pain. What does this have to do with Dry Needling? With this knowledge and the impact of myofascial trigger points, Dr. Travell convinced some unbelieving physician friends of hers to begin treating trigger points with pain medication.
Initially the treatment of choice was procaine, an injectable analgesic but eventually tried less invasive options like topical spray analgesics and found both provided only temporary relief of symptoms.
Wanting to know more, further studies found that inflammatory chemicals inside the taut band of muscle (trigger point) were the contributing factors to on-going dysfunction of the muscular fiber and subsequently pain. This new information led investigators to the use of steroids (anti-inflammatories) as a treatment option.
When research ensued, comparison studies were performed to find the better outcome, analgesic (pain medication) versus steroids (anti-inflammatories). Such studies required the use of a control group (saline solution) that would also be injected into the trigger point of certain subjects. Upon follow up at six and 12 months, the subjects who were injected with saline had the better outcomes. WHAT? WHY? The answer is easy: the needle.
We have known for hundreds of years that muscles respond to mechanical pressure, which is why for that same period of time people have sought out massage therapy for relief of muscular pain. It’s also why for years physical therapists have dug their elbows into your buttocks to get rid of the nagging gluteal pain. It’s why Cross-fitters lay over lacrosse balls and why others use foam rollers and any other device to cause ourselves physical discomfort for the sake of relief. A needle is a noxious stimulus that causes a local twitch response (also known as the “twitch” for those of you who have had dry needling done) and subsequently causes a dump of the inflammatory agents that accumulate in your muscles thus impeding the brains ability to tell the muscle what to do and when to do it. Instead of using the hypodermic needles that were required with injections, research leaned toward the idea of using thin, mono-filiform needle that would not cause any tissue shearing or damage (à la, the well-known acupuncture needle).
So, how then is Dry Needling really any different from Acupuncture? Dry Needling is a technique in which a well-trained practitioner (preferably one who has been through the entirety of training and testing) completes a thorough examination and determines that the etiology of symptoms arises from or is contributed by the presence of myofascial trigger points.
The dry needle (because there is no medication) is inserted into the taut bands of muscle. Trained professionals such as Certified Myofascial Trigger Point Therapists (CMTPT), determine the most appropriate points to treat based on knowledge gained through research, training and clinical experience.
It is also the job of the practitioner to determine whether Dry Needling is the best option for a patient, because it is not for everyone. Believe it or not, there are other ways to treat trigger points. Dry Needling just happens to be one tool in the toolbox of medical practitioners, especially physical therapists, who have a vast knowledge of the musculoskeletal and neuromuscular systems. Ultimately, Trigger Point Dry Needling proves to be highly successful in the treatment of a variety of common conditions including headache, low back pain, plantar fasciitis, carpal tunnel, frozen shoulder, IT Band syndrome, and more.
Dr. Sarah Cash Crawford, PT, DPT, COMT, CMTPT, is a physical therapist and certified myofasical trigger point therapist through Myopain Seminars® and has been performing Dry Needling in the Cincinnati area for over three years Dr. Crawford can be contacted at Beyond Exercise, LLC, www.gobeyondexercise.com.
