What is Dry Needling? Physiotheraphy Near Me – Synapse

Mechanism of dry needling 

The efficacy of dry needling in musculoskeletal conditions is evident through its immediate impact on pressure pain threshold, range of motion (ROM), muscle tone reduction, and pain alleviation. The proposed mechanisms of action encompass several intriguing aspects that contribute to its therapeutic effects.

One notable mechanism is the induction of a ‘local twitch response,’ an involuntary spinal reflex triggering localised muscle contractions within the needled area. This response not only influences the length and tension of muscle fibers but also stimulates mechanoreceptors like A Beta fibers, showcasing its multifaceted impact.

Furthermore, the impact on blood flow is a compelling facet. The sustained contraction of taut muscle bands in trigger points can induce local ischemia and hypoxia. Dry needling, in turn, prompts vasodilation in small blood vessels, enhancing muscle blood flow and oxygenation.

The neurophysiological effects of dry needling are equally intriguing, with documented local and central nervous responses. This prompts homeostasis at trigger points, resulting in decreased central and peripheral sensitisation to pain.

Lastly, the placebo effect should not be overlooked. The role of expectations in influencing pain perception is a critical aspect to consider when assessing the overall impact of dry needling.

Trigger point 

Trigger points, arising from an excessive release of acetylcholine at specific motor endplates, can be classified as Active or Latent myofascial trigger points. Active points may spontaneously cause local or referred pain, muscle weakness, restricted range of motion (ROM), and autonomic phenomena. In contrast, latent points remain asymptomatic unless stimulated, yet they can influence muscle activation patterns and contribute to limited ROM.

Both types induce allodynia at the trigger point site and hyperalgesia away from it when pressure is applied. The formation of trigger points involves the development of a taut band within the muscle, triggered by excessive acetylcholine release from the motor endplate. This process is coupled with the inhibition of acetylcholinesterase and an upregulation of nicotinic acetylcholine receptors.

Taut bands, initially a normal protective response to actual or potential muscle damage, often occur due to unaccustomed eccentric or concentric loading, sustained postures, and repetitive low-load stress. When sustained, these bands contribute to persistent pain.

Pain from trigger points is attributed to hypoxia and reduced blood flow, leading to decreased pH activating muscle nociceptors. This activation aims to restore homeostasis but ultimately causes peripheral sensitisation. Trigger points also play a role in central sensitisation, perpetuating nociceptive input into the dorsal horn, although the exact mechanism remains unclear. Understanding these mechanisms is crucial for the effective management and treatment of pain associated with trigger points.

Protocol

Executing Trigger Point Dry Needling (TDN) demands a meticulous and decisive protocol to ensure optimal efficiency and patient safety. Initiate the procedure with a thorough examination to pinpoint neuromuscular impairments, using a targeted approach. Prioritise patient safety by confirming the absence of contraindications before proceeding.

Obtain informed consent, providing a detailed disclosure of potential adverse effects linked to TDN. Uphold stringent adherence to clean needle technique and universal precautions, incorporating essential measures like wearing gloves, skin cleaning, and using single-use filiform needles to minimise infection risks.

Accurately identify the trigger point before engaging in direct needling, employing techniques such as piston motion at the practitioner’s discretion to elicit a twitch response. Swiftly and efficiently remove the needle, ensure proper disposal, and promptly assess the patient for any adverse effects.

Post-needling, reassess the patient’s neuromuscular impairments to gauge the immediate effects of the intervention. Conclude the procedure by introducing additional therapeutic interventions tailored to further diminish impairments and enhance overall function. This protocol underscores precision, clarity, and a commitment to achieving definitive outcomes in the TDN process. Strive for efficiency, maintaining a resolute stance throughout each step for the benefit of both practitioner and patient.

Indication

Dry needling is a therapeutic technique with diverse applications, particularly in addressing musculoskeletal conditions and pain syndromes. One key indication for the use of dry needling is in the management of Myofascial Pain Syndrome (MPS). This technique proves effective in targeting myofascial trigger points, which are hyperirritable spots in skeletal muscle associated with localised pain and dysfunction. By inserting thin monofilament needles precisely into these trigger points, dry needling aims to alleviate pain and improve muscle function.

Another significant indication for dry needling is in the treatment of muscle strains, both acute and chronic. The targeted insertion of needles helps promote muscle relaxation, enhance blood circulation to the affected area, and reduce muscle tone. This proves beneficial in facilitating the healing process and restoring optimal muscle function, making dry needling a valuable modality for individuals dealing with injuries resulting from overuse, trauma, or repetitive stress.

Precautions and contraindications 

Absolute contraindications to Trigger Point Dry Needling (TDN) necessitate a balanced approach, combining innovation and practicality for the safety of individuals seeking this therapeutic intervention. Patient consent denial stands as a fundamental contraindication, underscoring the importance of respecting autonomy. Practitioner incompetence due to inadequate knowledge or training is a significant obstacle, emphasising the need for proper education and training. State-of-the-art equipment is imperative for a safe and effective TDN procedure.

Specific scenarios, such as the first trimester of pregnancy, delicate areas like the scalp in infants, and sensitive regions like nipples, umbilicus, and external genitalia, are absolute contraindications due to their vulnerability. Uncontrolled anticoagulant usage and the presence of local infection, skin lesions, or active tumors require careful assessment. The occipital region with Arnold-Chiari malformation, cardiac pacemaker areas, and over surgical implants or in areas of laminectomy also necessitate cautious consideration.

Precautions include needle phobia, cognitive impairment, communication barriers, a history of pneumothorax, hyperalgesia, allodynia, compromised immune systems, metal allergies, abnormal bleeding tendencies, and vascular diseases.