What is a trigger point (TP)? “A hyperirritable spot within a taught band of skeletal muscle that is painful on compression, stretch, overload or contraction of the tissue, which usually responds with a referred pain that is perceived distant from the spot” (Symonds DG, Travell, 1999)
One can also argue that TPs are basically a construction in muscle fibre.
Causes of trigger points:
Trigger points can develop with or without damage, mechanical and metabolic. Mechanical stress: Postural, Repetitive activity or sustained overuse. Acute injury or trauma, Chronic injury/pain or Psychological and emotional stress (Menses & Simons, 2001)
Referred sensation: The heightened sensitisation or irritability of the central nervous system also correlates with higher intensities of pain (in different levels, that’s why the term sensation would be more accurate) and larger referral zones. Referred sensation is reproduced by applied pressure.
Symptoms:
Aching, Heaviness/tiredness, Feeling of fatigue, Muscle stiffness, Local and Radiating pain, Deep non-specific muscle weakness, reduced ROM and Tender to pressure.
Both active (producing pain) and latent (pain-free) trigger points can have negative effects on muscle function, such as weakness, inhibition, increased motor irritability, spasm, and altered motor recruitment.
Neuromuscular technique refers to the manual application of specialised (usually) digital pressure and strokes, most commonly applied by finger or thumb contact by friction, if the origin/ insertion of a muscle is held for a certain number of times, followed by “flushing” the belly.
Chronic pain is the presence of areas of soft tissue dysfunction that promote pain and distress in distant structures. These are known as myofascial trigger points.
NMT (neuromuscular therapy) aims to produce modifications in dysfunctional tissue, encouraging a restoration of functional normality, with a particular focus on deactivating focal points of reflexogenic activity, such as myofascial trigger points.
Myofascia: myo – muscle, fascia – connective tissue. The Myofascial system is the fabric that stabilises and connects the body, influences movement and acts as a sensory organ – relating and influencing emotions.
A trigger point sits in the muscle tissue; however, the muscle tissue is wrapped by connective tissue and, as a result, is also influenced by the biochemical changes that occur as a result of this neuromuscular change, leading to many physical and emotional influences.
Us clinicians need to understand that referred pain happens in the dorsal horn (a region in the spinal cord) and is reflected in the muscle, which is why our main focus is the nervous system and treating a patient in a holistic approach, considering their whole wellbeing and not just looking at one muscle or one aspect of their health.
Dry Needling is a form of more invasive physical therapy to help treat trigger points and reduce their occurrence by inserting a fine acupuncture needle into the muscle fibre to promote a local twitch response.
“The advantages of dry needling are increasingly documented and include an immediate reduction in local, referred, and widespread pain, restoration of range of motion and muscle activation patterns, and a normalisation of the immediate chemical environment of active myofascial trigger points. Dry needling can reduce peripheral and central sensitisation.” (Dommerholt, 2011).
Contraindications (a condition that indicates a treatment is not recommended) for dry needling (DN):
Fear of needles, beliefs, communication, cognitive, and age-related factors.
Medical emergency or acute medical condition.
Local infection
Over an area or limb with lymphedema, as this may increase the risk of infection/cellulitis and the difficulty of fighting the infection if one should occur.
Inappropriate for any other reason.
Some adverse reactions to DN may be:
Minor reactions might be bleeding, bruising, pain during treatment, or short-term pain after treatment.
Major reactions may be shortness of breath, severe, sharp pain, signs of infection or unusual discomfort. It is important to seek medical treatment urgently. Some people may also feel faint or lightheaded, dizzy, or even vomit in severe cases (research shows that around 0.1% of clients would experience major adverse effects from dry needling).
Research shows that ideal Dry Needling results can be long-lasting and require anywhere between 5 to 12 sessions due to the heavy chemical composition released from tissues during application of this technique; therefore, the therapist should not work more than 6 to 12 trigger points in a session, depending on the client.
Dry needling is also used for SCAR TISSUE release and CONNECTIVE TISSUE CHANGES ..
References:
1). Advanced clinic education: advancedclinicaled.com
2) Jan Dommerholt (2011) Dry needling – peripheral and central considerations, Journal of Manual & Manipulative Therapy, 19:4, 223-227, DOI:10.1179/106698111X13129729552065
link to this article: http://dx.doi.org/10.1179/106698111X13129729552065
3).Physiopedia/ https://www.physio-pedia.com/Dry_Needling
“The possible explanations found in the literature for the decrease in pain include the effects of dry needling at the local level (producing an interruption of spontaneous electrical activity on the taut band or local vasodilation), activation of the peripheral segmental pain inhibition (explained through Gate Control Theory), or activation of the descending pathways of pain inhibition at the central nervous system level (serotonergic and noradrenergic endogenous opioid release and conditioned modulation of pain)”.
1)https://pmc.ncbi.nlm.nih.gov/articles/PMC8199958/#:~:text=The%20possible%20explanations%20found%20in,of%20pain)%20%5B8%5D.