Treating Myofascial Pain

By Tamer S. Issa, PT

Myofascial pain is a common muscle pain condition that is often overlooked in medical and clinical practice settings. It can be acute or chronic, and is characterized by the presence of myofascial trigger points, which are hyperirritable contraction knots found in tight bands of muscles. Trigger points can cause localized pain or can refer pain to other areas. A muscle that is burdened with trigger points could lose its flexibility, strength and coordination, which may contribute to the formation of other musculoskeletal problems.
Dry needling is an effective and efficient therapy method for the treatment of myofascial trigger points. The approach is based on Western anatomical and physiological principles. The technique utilizes fine solid acupuncture needles to release trigger points in muscle, but in all other aspects it is different than traditional acupuncture. Other terminology used to describe similar techniques to dry needling includes intramuscular stimulation and twitch-obtaining intramuscular stimulation.
Injections are performed by injecting trigger points primarily with saline or analgesics. Through the years it has been shown that it is not the substance that is being injected that is providing the therapeutic benefit, but rather the mechanical stimulus of the needle hitting the trigger point. When a needle tip hits a trigger point, a characteristic “local twitch” is noted by the therapist and the client. This local twitch is involuntary. It has been shown that the elicitation of local twitch responses is the most important aspect in obtaining a successful therapeutic outcome for trigger point deactivation.
There are a number of hypotheses as to the reasons why dry needling works. Dry needling and the subsequent local twitch responses may mechanically disrupt the contracted nature of the trigger point. Dry needling stimulates certain sensors in the body which modulate pain signals. Dry needling and the subsequent local twitch responses can cause local biochemical changes and result in an increase of blood flow in the trigger point area.
The benefits of trigger point release through dry needling include a decrease in the tightness and the pain associated with a particular muscle. Often times an immediate improvement is noted. Dry needling is tolerable for most, but not all people. A limited amount of muscle soreness is to be expected for 1-2 days, after which the soreness resolves. Dry needling is never used as an isolated treatment; it is followed by myofascial release and soft tissue work to minimize soreness and to maximize connective tissue flexibility. Other important aspects of musculoskeletal improvement of pain and function requires addressing possible contributing factors which includes the presence of joint or spinal dysfunction, postural imbalances, poor coordination of movement and poor posture and body mechanics with activities of daily living.
Trigger point dry needling requires highly specialized training. One must be adept at finding trigger points before they attempt to treat them. If you have suffered pain or tightness of muscular origin, consider the possibility of trigger point dry needling as a treatment option.