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    dry needling, trigger points

    Enough is enough. You have had a nagging injury for as long as you can remember. But why? Most of the stories I hear sound something like this:


    “My orthopedic doctor said my rotator cuff has a tear.”


    “The knee is arthritic, not much they can do about it.”


    “I have fibromyalgia, not sure what that means, and my doctor couldn’t explain why either”


    MRI, Michael Infantino

    And so on, and so on. Sadly, these diagnoses are tossed around loosely. Many people have arthritic joints, rotator cuff tears, and bulging discs without pain. This is not common knowledge because most people don’t causally hop in MRI’s when they are pain free. These diagnoses may be valid, but they don’t necessarily explain your pain.

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    Clinical experience and research continues to point to the fact that Dry Needling helps with pain and function. Our muscles and fascia are responsible for more dysfunction than you’d think. It has a name – myofascial pain syndrome. Most people are on board and partly understand this diagnosis. This is why you see a million different types of soft tissue tools, like canes, balls, and roller sticks. The possibilities are limitless. When these tools aren’t getting the job done, then what? This is where Dry Needling can be effective to help with trigger points.


    Myofascial pain syndromeMyofascial pain syndrome (MPS) refers to pain and presumed inflammation in the body’s soft tissues or muscles. Myofascial pain is a chronic, painful condition that affects the fascia (connective tissue that covers the muscles). In some cases, the area where a person experiences the pain might not be where the myofascial pain generator is located. Experts believe that the actual site of the injury or the strain prompts the development of a trigger point that, in turn, causes pain in other areas. This situation is known as referred pain. –Cleveland Clinic


    First things first, what is a trigger point?


    Trigger points are hyper-irritable nodules in firm muscle fibers that are filled with a lot of angry and pissed off pain generating chemicals that wreak havoc. Trigger points in your muscles are real. We can see them with doppler ultrasound imaging. You can no longer group them with the Loch Ness Monster and Big Foot.


    The lack of oxygen and decreased PH (elevated acid levels) at the trigger point are comparable to pouring lemon juice on a cut; sometimes producing local pain and referred pain. This could be the cause for your “sciatica” or even numbness into your hands.


    The longer trigger points are around the more irritable your central nervous system gets. Your spinal cord is continuously receiving these awful messages from your muscles. It is like receiving spam mail every day until you can no longer access your inbox. When your brain gets used to this spam it starts to get hyper-sensitized to even the smallest messages. Sometimes you even mistake normal input, like the touch of a towel, as bad. This light touch may start to feel like numbness (allodynia). Getting tapped on the arm by your 4-year-old daughter might feel like the hulk just threw you a punch (hyperalgesia).


    So how does Dry Needling work?

    dry needling, trigger points


    It gets rid of this painful input by eliminating trigger points. When the spam is no longer filling your inbox, you are able to move freer and your brain starts to calm down.


    It produces an immediate pain relieving response that can sometimes last for months and even years (Lewit, 1979). Dry Needling of trigger points has also demonstrated a reduction in pain generating chemicals and an increase in our body’s own self-made opioids (the good kind, you won’t have the police banging down your door).


    Working with a chronic pain population allows me to reach for a dry needle more than I have in the past. For the most part, people with acute injuries do just fine with joint manipulation, stretching, taping, etc. Chronic pain patients have tried it all… and I mean everything. Regularly seeing remarkable improvements in my chronic pain patients with Dry Needling who thought they needed to settle for bike riding or aquatic therapy is amazing.


    How is it different from Acupuncture?

    acupuncture, dry needling, trigger points

    It is the philosophy behind Acupuncture and Dry Needling that varies. Have no fear, the needle is the same! Traditional Chinese Medicine relies on meridian lines and ah-shi points that are not based on scientific literature (this is not to say that it can’t be an effective treatment technique).


    Western Medical Acupuncture is similar to Dry Needling in its use of anatomy, physiology and pathology, and principles of evidence based medicine. This form of acupuncture still uses traditional ah-shi points, but the points chosen are based on stimulation of the nervous system, in most cases.


    Western Medical Acupuncture is more common in the United States today, compared to Traditional Chinese Medicine techniques that include meridian lines and the flow of qi.


    Trigger Point Dry Needling is based solely on the treatment of trigger points to help reduce local and referred pain. Interest in trigger point needling among Western Medical Acupuncturists began following the investigation of trigger points and myofascial pain by Dr. Travell and Simons (Seem 2007). Physical Therapists who worked with Dr. Travell during this time took an interest in treating trigger points with a needle.  


    Will it work for me?


    One of the first studies that looked at needling for myofascial pain found immediate pain relief in 86.8% of cases (241 patients, 312 pain sites, Lewit 1978). This doesn’t mean you won’t be the other 13.2%. But I like the odds. Being skilled in this technique and providing the correct dosage can make all the difference. Properly diagnosing your condition is also important in determining your appropriateness for this technique. Something a skilled clinician can do for you!


    Studies have shown improvements for both muscular and joint pain in the upper body, lower body, and the spine.


    More notable studies have specifically identified effectiveness in Dry Needling with:


    Neck and Upper Back Pain

    • Trigger points have been shown to develop as quickly as one hour following repetitive typing in (regardless of the posture). We have made this point before. It is not necessarily “bad posture” that is to blame. It is sustained postures that get us into trouble. Get up and change positions often!
    • Dry Needling was found to be effective for reducing pain at the upper back and neck, and improving general health reports (Tekin et. Al, 2012).

    Levator Scapula, trigger point, referral, pain

    (Levator Scapula)


    • Trigger points continue to be associated with headaches, both tension and migraines. It is not clear if this is a “chicken or the egg” situation, but studies by Giamberardino, Calandre and Fernández-de-las-Peñas have been able to reproduce headaches with palpation of trigger points.
    • Referral of headaches can be reproduced with palpation of the neck, head, and facial muscles. Referred pain areas from the neck trigger points were more common than the face or head (Fernández-de-las-Peñas, 2010). The takeaway from this study is to take care of your neck first. Then feel free to explore other areas when managing headaches.

    Check out this link to learn self treatment techniques. 

    sternocleidomastoid, pain, referral, trigger point


    Knee Pain Post Knee Replacement

    • Significant reductions in knee pain were seen in the first month post knee replacement surgery in patients treated with dry needling before hand (Mayoral, 2013).


    Chronic Low Back Pain

    • Dry Needling was shown to be an effective therapy for chronic low back pain in a Meta-Review (Furlan, 2005).


    Pelvic Pain

    • Myofascial pain was identified to be a primary source of chronic pelvic pain (Montenegro, 2009). In 15% of patients, symptoms were reproduced by abdominal myofascial pain. The takeaway here is to consider taking care of the trigger points in your abdominals when experiencing pelvic pain. Dry needling or self-soft tissue mobilization can be effective.
    • Treatment of trigger points in the abdominal region (manually) showed significant improvements in male pelvic pain, urinary symptoms, libido, ejaculatory pain, and erectile and ejaculatory dysfunction (Anderson, 2006).


    Myofascial Pain Post Lumpectomy and Mastectomy

    • Development of myofascial pain syndrome post lumpectomy or mastectomy is also well documented. Muscles such as the latissimus dorsi and serratus anterior are commonly affected following these procedures. Palpation of trigger points in the upper trunk and shoulders were able to reproduce symptoms experienced by people who had received both lumpectomy and mastectomy.(Lacomba, 2010 & Fernandez-Lao, 2011).


    Shoulder Pain

    • In our last post we discussed the impact of trigger points on shoulder pain. Trigger points in the infraspinatus, supraspinatus, upper trapezius and subscapularis commonly contribute to pain, as well as altered muscle function (timing and strength). Treating these trigger points with Dry Needling has shown to be effective in reducing pain and improving performance (Bron, 2011 & Osborne, 2010).

    infraspinatus, trigger point, referral


    Carpal Tunnel

    • In patients suspected to have Carpal Tunnel Syndrome, reproduction of symptoms was possible with palpation of the infraspinatus muscle in 50% of those found not to have a true Carpal Tunnel Syndrome (normal nerve conduction velocity testing). This means that forearm and wrist pain and abnormal sensations in the arm and hand could be related to trigger point development! Instead of reaching for the wrist splint and gearing up for surgery, treat that infraspinatus! (Querma, 2009)


    Hemiparetic Limbs Post Stroke

    • Treatment of hemiparetic shoulders post stroke during the early phase of rehabilitation has been shown to reduce pain, reduce pain medication, restore normal sleep, and improve compliance with rehabilitation programs (Di Lorenzo, 2004).



    • In fibromyalgia patients, treatment of trigger points resulted in improvement in local and widespread symptoms (Ge, 2009).


    Where Can I find a GOOD Dry Needle Certified medical provider?

    Dry Needling is performed by a variety of medical providers. This includes physical therapists, chiropractors, physicians, dentists; the list goes on and on. I received my certification through Myopain Seminars. Their focus on safety, and their familiarity with Anatomy and Physiology allow me to faithfully endorse their providers. I have some familiarity with Kinetacore, which is why I recommend their providers as well. You can locate people on each of their websites.


    Find a Clinician




    The Quick and Dirty Summary!

    Myofascial pain syndrome is the source, or at least a contributor in many instances to pain. Dry needles are not always the first tool I reach for. Nonetheless, it has been one of the most effective that I have seen. Both medical providers and those that have experienced Dry Needling will most often agree. It has changed the way I practice. It has made me question much of what we learned in school in terms of exercise programming. Seeing a respected physical therapist change someone’s gluteal strength in a matter of minutes, while I have spent 4 weeks trying to accomplish the same feat was eye opening, to say the least. Understanding how trigger points can impact pain and muscle performance could be a game changer for you as well. If foam rolling, stretching, improved sleep habits, and elimination diets have not allowed you to meet the goals you desire, consider Dry Needling.

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    Dr. Michael Infantino, DPT, CMTPT, TPI


    Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2011;15(1):61-69

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    Fernández-de-las-Peñas C, Galan-Del-Rio F, Alonso-Blanco C, Jimenez-Garcia R, Arendt-Nielsen L, Svensson P. Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disorders. J Pain 2010;11(12):1295-1304

    Fernandez-Lao C, Cantarero-Villanueva I, Fernandez-de-las-Penas C, Del-Moral- Avila R, Menjon-Beltran S, Arroyo-Morales M. Development of active myofascial trigger points in neck and shoulder musculature is similar after lumpectomy or mastectomy surgery for breast cancer. J Bodyw Mov Ther. 2011;in press

    Furlan A, Tulder M, Cherkin D, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev. 2005(1):CD001351

    Ge HY, Nie H, Madeleine P, Danneskiold-Samsoe B, Graven-Nielsen T, Arendt- Nielsen L. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009;147(1-3):233-240

    Giamberardino MA, Tafuri E, Savini A, et al. Contribution of myofascial trigger points to migraine symptoms. J Pain. 2007;8(11):869-878

    Hidalgo-Lozano A, Fernández-de-las-Peñas C, Alonso-Blanco C, Ge H-Y, Arendt- Nielsen L, Arroyo-Morales M. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study. Exp Brain Res. 2010;202(4):915-925 197

    Lewit K. The needle effect in the relief of myofascial pain. Pain. 1979;6:83-90

    Montenegro ML, Gomide LB, Mateus-Vasconcelos EL, et al. Abdominal myofascial pain syndrome must be considered in the differential diagnosis of chronic pelvic pain. Eur J Obstet Gynecol Reprod Biol. 2009;147(1):21-24

    Osborne NJ, Gatt IT. Management of shoulder injuries using dry needling in elite volleyball players. Acupunct Med. 2010;28(1):42-45

    Tekin L, Akarsu S, Durmus O, Cakar E, Dincer U, Kiralp MZ: The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double- blinded placebo-controlled trial. Clin. Rheumatol., 2012.

    Torres Lacomba M, Mayoral del Moral O, Coperias Zazo JL, Gerwin RD, Goni AZ. Incidence of myofascial pain syndrome in breast cancer surgery: a prospective study. Clin J Pain. 2010;26(4):320-325

    Qerama E, Kasch H, Fuglsang-Frederiksen A. Occurrence of myofascial pain in patients with possible carpal tunnel syndrome – a single-blinded study. Eur J Pain. 2009;13(6):588-591


    1. Great article. Also finishing my DN certification through Myopain Seminars and sheen seeing great results. Thanks for an eye opener article about DN.

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