1. Dry Needling Theory and Application
Kristina Carter, DPT
Pivot Physical Therapy
Formerly Tidewater Physical Therapy
May 20, 2017

2. Objectives Understand the definition of a trigger point
Understand the benefits of dry needling and who it may help
Mini-case study
Observe a dry needling treatment

3. Dry Needling Invasive procedure
Precautions/contraindications
Solid filiform needle inserted directly into the trigger point
Vary in length and diameter
Almost every muscle is “needle-able”
Goal is relief of pain through the release of the trigger point

4. Janet Travell, MD 1960’s researched myofascial pain syndrome
Chronic pain caused by multiple TrPs
Referred pain patterns
Recent advances in imaging have validated her hypotheses

5. What is a trigger point?
Pain related to a discrete, irritable point in skeletal muscle or fascia
The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
Palpation of the trigger point reproduces the patient's complaint of pain
The great “mimicker”

6. How do Trigger Points develop?
Unaccustomed eccentric exercise
Poor posture
Repetitive activity in untrained muscles

7. Effects of Trigger Points
Muscle weakness
Inhibition
Increased motor irritability
Altered motor recruitment
Restrictions in ankle ROM were corrected after manual release of latent TrPs in the soleus (Grieve et al. 2011)

8. Active vs Latent Trigger Point
Active Trigger Point
Latent Trigger Point
Taut bands reproduce their symptoms and is recognized as familiar pain
Pain is often referred from the palpated tissue and follows referred pain patterns
Taut bands are present but they are not always painful upon palpation and do not refer pain
Contribute to decreased ROM in effected area
Can turn into active TrPs

9. Pathophysiology of a Trigger Point
Excessive acetycholine
Sustained depolarization
Impedes local blood flow
As seen on MRE and US .

10. Traditional TrP Treatments
Heat
Cold
Ultrasound
Electrical stimulation
Correction of muscle imbalances
PNF
Myofascial release with external pressure applied to the tissue

11. Dry Needling Invasive procedure
Solid filiform needle inserted directly into the trigger point
Goal is a local twitch response
Involuntary spinal cord reflex
Endogenous opoid activation
Restoration of normal tissue length

12. Benefits of Dry Needling
Relief can be immediate
Very specific to muscle—can help in confirming diagnosis
Can be active immediately after
Can be used in conjunction with other traditional therapies

13. Mini-Case Study
College football player with history of MCL tear 10 months prior to evaluation
Two recent episodes of medial hamstring pain following sprinting in preseason practice
No weakness with MMT
Medial hamstring very reactive to palpation or quick stretch
TrPs found in pes anserine muscles—WHY?

14. Mini-Case Study
Residual valgus laxity from MCL tear caused increased load on pes anserine muscles as they cross the knee
Treated with dry needling and bracing/taping to reduce instability
Able to participate with no time loss after two dry needling sessions

15. Questions?
Thank you!