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Trigger Point Dry Needling (TDN) is a physical therapy treatment technique that utilizes filament needles to make changes in myofascial trigger points.
Trigger point dry needling is a form of physical therapy that uses a thin filiform needle to penetrate the skin and stimulate underlying neuromuscular trigger points. This treatment aims to release the tension within the trigger point that may be causing pain, abnormal movement patterns, or chronic tightness.
Dry needling physical therapy should not be confused with acupuncture as it is based on Western medicine principles and targets trigger points found by a physical therapist during an examination. These trigger points could be caused by poor posture, athletic overuse, chronic pain, or trauma-related conditions.
To understand dry needling for trigger point relief, it is first important to understand what a trigger point is. A trigger point is a hyperirritable spot within a taut band of skeletal muscle or fascia that is associated with pain when compressed and may cause referred pain, motor dysfunction, or localized tenderness.1
These spots often feel like a small knot or bump under the skin and can be a result from overuse, injury, poor posture or stress. Trigger points are often associated with limited range of motion (ROM), muscle weakness, and chronic pain. Trigger point dry needling, in conjunction with skilled physical therapy, is one of the most effective modalities used to treat the pain and dysfunction associated with trigger points. Trigger point dry needling is a specialized technique used by clinicians, including physical therapists, to treat muscle pain and dysfunction by targeting myofascial trigger points.2 The technique involves the insertion of a sterile filament needle directly into the trigger point to elicit a local twitch response.3
This causes an involuntary contraction of the muscle which aids in reducing tension, improving blood flow, as well as a disruption in the pain cycle. Unlike medication based treatments, trigger point release works internally to reset the muscle and patients often experience immediate relief. As previously stated, trigger point dry needling plays a valuable role in physical therapy as a targeted intervention used to address muscle related pain, motor dysfunction, and weakness. When used as a component of a personalized care plan, trigger point dry needling improves ROM while reducing muscle tightness and inflammation. This reduction in trigger point related symptoms allows the patient to engage more fully in therapeutic exercise and functional activities that contribute to achieving their long term goals.
As with any modality, dry needling and acupuncture have similarities and differences.3 Both treatments utilize thin sterile needles that are inserted at various depths into the trigger point to treat symptoms. Neither treatment involves medication, and both have a similar goal, to relieve pain and improve function. They often overlap in the treatment of musculoskeletal conditions as they both promote increased blood flow, relaxation and stimulate the body’s natural healing process. Despite these similarities, the underlying philosophies and clinical goals differ. Acupuncture has been practiced for over 3,000 years as part of traditional Chinese medicine and is based on the concept of balancing energy, or “chi” through specific points along energy pathways, or meridians, in your body.3
Licensed acupuncturists use multiple needles to help restore this energy balance to promote overall healing and wellness. Acupuncture is used to treat a wide range of conditions including, pain, anxiety, infertility, and insomnia and its effectiveness has been extensively researched. Dry needling is rooted in Western medicine and is a modern technique that has evolved over the last few decades.3
The primary focus of this technique is relieving musculoskeletal and neuromuscular pain by targeting specific trigger points. Unlike Acupuncture, which focuses on energy restoration, dry needling directly addresses muscle dysfunction. Typically, dry needling uses less needles than acupuncture and is often done in conjunction with electrical stimulation, which aids in gently contracting and relaxing the muscle, promoting a deeper muscle release and thus pain relief.
Trigger points, commonly known as “knots,” often develop when a muscle is under constant strain or tension. These tight bands of muscle fibers can form as a result of poor movement patterns, muscle overuse, injury, or poor posture. The most common causes include; 1
Certain lifestyle habits and health conditions can increase the likelihood of developing trigger points. These factors often predispose an individual to increased muscle tension, reduced circulation and thus impaired movement. The most common risk factors are as follows;1
Trigger points are often associated with and contribute to or worsen various pain conditions.1 They can cause localized discomfort or refer pain elsewhere in the body. These include but are not limited to;
As previously mentioned, dry needling is a highly effective treatment commonly used to treat a variety of musculoskeletal symptoms by targeting myofascial trigger points and areas of muscle dysfunction. Dry needling is commonly used to relieve local muscle pain and restore limited range of motion, which often stems from chronic tension or stiffness within a muscle or muscle group. Dry needling can also be used to address referred pain patterns, which is when pain is felt in a different area than the actual source of pain. Additionally, dry needling can assist in restoring ROM by releasing taut bands within the muscle while also promoting more efficient muscle activation. It is also beneficial for reducing muscle spasms or cramping, managing chronic pain conditions, and enhancing athletic recovery and performance. Many patients experience noticeable relief shortly after treatment, making it a valuable tool in both rehabilitation and performance settings.
Trigger point dry needling works by targeting specific trigger points within a muscle that cause pain, restrict movement, and impair muscle function.4 When a needle is inserted into a trigger point, it stimulates a local twitch response, which is a brief involuntary contraction of the muscle. This response is thought to disrupt the pain cycle by releasing tension within the muscle and reducing the excitability of the central nervous system. In turn, this increases blood flow and normalizes the biochemical imbalances that were generating the muscle irritation and tension.
Physiologically, deactivating trigger points reduces the excessive electrical activity in the muscle, restores normal length and tone, and alleviates nerve and blood vessel compression. This process helps reset the neuromuscular system, allowing the muscle to function more efficiently and reduce pain and tension. In turn, dry needling promotes healing by increasing oxygen and nutrient delivery to the affected muscles, flushing out inflammatory toxins, and allowing the body’s natural pain-relief mechanisms to function properly. The result of this process is decreased pain, improved mobility, and a faster return to the individual’s prior level of function.
Dry needling is often considered when traditional soft tissue techniques aren’t providing sufficient relief. This is especially true in cases of persistent muscle tightness, limited ROM, or referred pain. As previously stated, dry needling is not a stand alone treatment especially when the root cause is related to postural abnormalities, chronic illness, or muscle imbalances. Dry needling is most beneficial when done in conjunction with traditional physical therapy. As with the diagnosis of any functional impairment, a physical therapist first begins with a comprehensive evaluation to determine if dry needling is an appropriate part of the patient’s plan of care.
This includes a thorough review of the patient’s past medical history, symptoms, and functional limitations. A physical assessment is also conducted which consists of strength and ROM testing as well as a postural assessment to identify muscle imbalances or abnormal movement patterns. Trigger points are typically identified by a skilled physical therapist through palpation. Palpation is the act of applying pressure to taut bands within the muscle to see whether or not they reproduce the patient’s reported pain. Movement assessments, strength testing, and special orthopedic tests are also utilized to further isolate the source of pain or restricted ROM.
If dry needling for trigger point relief is identified as an appropriate treatment during the initial evaluation, the physical therapist will first start by cleansing the area to be treated with 70% isopropyl alcohol. The provider will also cleanse their hands and wear gloves to ensure proper hygiene standards are withheld. The patient will be comfortably positioned to facilitate the clinician’s assessment for adverse reactions of discomfort (such as grimacing). A thin, sterile, needle will then be directly inserted into the trigger point, approximately 10 mm. You may feel a brief muscle twitch response, followed by a deep ache or cramping sensation- this is normal and indicates an effective release of the trigger point. Once the needle is inserted there are various mechanisms used to elicit the release of the trigger point.5
The physical therapist might use a static method- where they simply place the needle and leave it stationary or they might use a dynamic method in which they rotate it or slowly move it in and out of the trigger point. On average the needle will remain in the trigger point for 30-60 seconds. For those with a weak response the treatment time might be closer to 2-3 minutes.
Once the needle is removed, the physical therapist will cleanse the area with alcohol to reduce risk of infection. The application site should then be compressed for 30-60 seconds to minimize bleeding and ensure hemostasis. If bleeding is noted, a bandage will be applied. The therapists will then sanitize their hands again following the procedure.
Dry needling doesn’t just help the muscle, it also helps “reset” the way your brain and muscles communicate. When a trigger point is released, it can interrupt faulty patterns in how the muscle fires, which allows your body to relearn more efficient and coordinated movement. This helps improve muscle control, reduce pain, and restore proper function over time.
Following a dry needling treatment it is common to experience some muscular soreness for a day or two that is often described as post-exercise soreness and resolves within 24-48 hours. Some individuals might experience minor bruising and swelling at the needle insertion site. Minor bleeding might also occur at the insertion site. Less commonly, individuals might experience fatigue, nausea, dizziness, or headache which is associated with release of tension and toxins in the muscle. These side effects are typically resolved quickly and can be managed with rest, hydration, ice, and gentle stretching. Dry needling can be a highly effective intervention when used appropriately however, it is not for everyone. Before incorporating it into care, it’s important to understand the key contraindications and precautions to ensure safe and effective application.2
Preventing trigger points and associated muscle pain starts with incorporating smart ergonomic and lifestyle habits into your daily routine in order to support optimal posture and movement patterns. Ergonomics plays a crucial role in preventing trigger points by minimizing unnecessary strain on the muscles during daily activities. Poor posture, repetitive movements, and awkward positioning can lead to muscle imbalances and the development of trigger points. A few ways to improve your ergonomic setup might include adjusting your chair or getting a stand up desk. Whether you have a desk job or one that requires heavy lifting, it is important to maintain proper alignment and posture in order to minimize muscle overload and strain. It is also important to vary your position and move regularly. A good rule of thumb is getting up every hour and moving for a minute or two in order to avoid prolonged static postures that often contribute to muscle tightness and the development of trigger points. In addition to ergonomics, a well rounded physical routine that includes stretching, mobility work, and strength training is key to maintaining balanced muscle function. Gentle stretching and mobility work allow you to improve circulation and flexibility and thus reduce tension in your muscles. Targeted strength training reinforces proper muscle activation and reduces the risk of overuse or compensatory patterns. It is also important to vary the muscles you are working in any given session to allow for a well rounded strength training program that reduces the risk for muscle imbalances. Managing stress levels and allowing for adequate rest is equally as important, as chronic tension can contribute to muscle tension and pain. In addition, staying hydrated helps support muscle elasticity and recovery, which aids in flushing out metabolic waste and allows for optimal tissue function.
At Confluent Health, dry needling is integrated into a personalized care plan as part of a comprehensive, evidence-based physical therapy approach. It is used in conjunction with manual therapy, corrective exercises, and functional movement training to promote lifestyle modifications that aid in long-term recovery and trigger point prevention. A key component to the approach of the physical therapists at Confluent Health is a commitment to patient education and informed care. Therapists explain the science behind dry needling- including how it helps release taut muscle bands, improve blood flow, and reduce pain- to ensure patients feel empowered and confident in their treatment plan. Each session is guided by clinical evidence and is tailored to each patient’s goals and needs. Before scheduling a dry needling session, it is important to verify your state’s regulations, as not all states permit physical therapists to perform dry needling. Scope of practice laws vary from state to state, so be sure to confirm this treatment is authorized and safely administered by licensed professionals in your area.
If you are suffering from muscle pain, tightness, or limited mobility, dry needling may be an effective solution. Our skilled physical therapists at Confluent Health clinics are trained to safely and effectively incorporate dry needling into your personalized care plan. Schedule a dry needling consultation today- find your nearest clinic and contact us here. Your path to pain relief and improved mobility starts here.
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Dry needling involves using a small monofilament needle to treat pain and muscle stiffness. It is called dry needling because nothing is injected.
Acupuncture is based on the concept of the body’s flow of energy (Qi). Dry needling is a modern practice that focuses on the neuromuscular system by targeting specific muscles and nerves to reduce pain and stiffness. Typically, acupuncture tends to insert needles superficially, whereas dry needling can reach deeper muscles. The same needles are used, but methodology differs.
Yes, dry needling is safe when performed by a licensed professional.
Dry needling can cause some slight discomfort during insertion and a deeper ache or cramping sensation when the needle hits a trigger point. Some might experience a brief muscle twitch and some soreness after the treatment. Overall, it’s usually well tolerated and often described as manageable.
The number of sessions needed varies. Most people see improvement within 3-6 sessions. Treatment frequency often depends on the severity of symptoms, response to treatment, and root cause.
Most insurance providers including private/commercial as well as medicare consider dry needling as experimental or not medically necessary. It is best to check with your insurer and therapist ahead of time as coverage varies.