What Is a Trigger Point and How Does Dry Needling Help?
In today’s blog we will be answering the question, “what is a trigger point? and how does dry needling help?”
To understand what a trigger point is, we need to take a closer look at our muscles!
Muscles are a type of soft tissue made up of cells containing protein filaments of myosin and actin that will slide past one another.
The movement of these filaments creates a contraction that will either lengthen or shorten the muscle. There are 3 types of muscles in the human body:
1. Smooth Muscle à The muscles in our organs
2. Cardiac Muscle à The muscles in our heart
3. Skeletal Muscle à The muscles that move our bones or skeletal system.
Muscles can be further categorized, according to their action, into:
1. Voluntary muscles – those muscles that we can voluntarily control, such as the biceps being activated to lift a cup.
2. Involuntary muscles – those muscles that we have no voluntary control over, such as our heart beating.
A trigger point is defined as a taut band of hyper-irritable muscle fibres within a muscle. They develop in skeletal muscles and can be both superficial (close to the surface) or lie in the deeper fibres of the muscle.
Trigger points form as a result of muscular over contraction, injuries, strains, and trauma. When muscle fibres and the surrounding fascia become weakened, overstretched, or inflamed, tiny tears in the associated soft tissue can occur. As the tissue heals it contracts or shortens to protect itself from further injury, becoming twisted and knotted.
These knotted fibres restrict the fresh blood supply needed by the muscle cells and the result is a tight muscle with trigger points or adhesions in the taut band.
Trigger points can affect movement by keeping the muscle in a shortened and tightened state, reducing range of motion and the muscles ability to generate power. They prevent muscles from relaxing, causing them to fatigue quickly, recover slowly from exertion, and contract excessively when they work.
Trigger points generally exist in one of two states:
1. Active Trigger Point à Is where the trigger point is painful, in a resting or active position, without any pressure being applied.
2. Latent Trigger Point à The trigger point does not have any pain, unless pressure is applied, but it will contribute to the dysfunction of the muscle, i.e. reduced range of movement and strength.
Trigger points tend to accumulate at the motor point of a muscle, which is where the nerve innervates the muscle to create a muscular contraction. At this point the nerve is constantly irritated resulting in over contraction and a constant increase in tension of the muscle fibres, resulting in a trigger point. Because of the close relationship between the nervous innervation and the trigger point, pain can be felt locally around the trigger point or in a specific referral pattern associated with the aggravated nerve – this is known as referred pain.
In order to reduce or rid a muscle of trigger points, we need to apply some form of external stimulation to ‘deactivate’ the taut band. This is commonly achieved through soft tissue therapy, massage, trigger point therapy or dry needling, commonly referred to as acupuncture (but there is a difference).
In our experience, one of the most effective ways to treat trigger points is through the application of dry needling.
Dry needling is the insertion of a, single use, needle directly into the trigger point. In our practice the aim is to elicit a twitch response in the muscle fibres. This causes them to relax, resulting in a reduction in pain and improvement in range of motion and strength – this effect can be immediate.
In practical terms the needle is inserted under the skin via a guide tube, it is then gently pushed into the taut band of muscle fibres (trigger point). The muscle responds with a ‘twitch’ reaction that is thought to subsequently break the cycle of over stimulation of the muscle fibres involved in the trigger point.
Research also suggests that dry needling can have an analgesic or pain reliving effect. As the needles are inserted into the area, a chemical reaction occurs (in the spinal cord) in response to the sharp pain caused by the needle. It is suggested that stimulation of the nerve fibres that convey the sharp pain releases opioids in the spinal cord resulting in a dampening of the pain experienced within that dermatome (area of the body given sensation from that nerve). This affect does appear to be short-lived though.
A Common question asked with dry needling is, “Does it hurt?”. The simplest answer is, “Possibly!” Whether it hurts or not is entirely up to the individual being treated and the area being treated. For some individuals the discomfort is quite bearable for others it can be uncomfortable. In areas with a high concentration of nerve endings (hands and feet) the sensation is much more noticeable whereas broader and larger areas, such as the gluteals and lower back the sensation can be much less.
One thing to always consider is an individual’s general dislike to needles. If they have a needle phobia or become anxious with needles this will invoke a protective contraction and dry needling shouldn’t be used as the muscle needs to be as relaxed as possible for the best outcome.
Another common question asked is “How big are the needles?”. The needles themselves are the same as the needles used in acupuncture. They can, and do, range in length and thickness, so we can treat trigger points at different depths throughout the body. For example a trigger point in the forearm will require a much shorter needle than one deep in the gluteal muscles.
The needles are always termed by their thickness and length. The size of the needles we use include:
· 0.22mm thick x 13mm long à used for superficial areas around the head, neck and face
· 0.25mm thick x 30mm long à general use throughout the body in smaller, superficial, muscles around the shoulder, arm, forearm, hand, leg and foot
· 0.25mm thick x 40mm long à general use throughout the body, in smaller, superficial muscles around the shoulder, arm, forearm, hand, leg and foot in larger people
· 0.30mm thick x 50mm long à general use throughout the body in larger deeper muscles around the lumbar spine, gluteals and thighs.
· 0.30mm thick x 75mm long à general use throughout the body in larger deeper muscles around the lumbar spine, gluteals and thighs in larger people
· 0.30mm thick x 100mm long à Specialist use for very deep trigger points through the hip and lumbar regions.
The most common size we use in the clinic, is a 0.25mm thick x 30mm long, however the size of the needle used will always depend on the size of the client and depth of the trigger point we are trying to hit.
Dry needling, when performed correctly, is a very safe and effective way to treat trigger points. With any treatment technique there are always side effects that can arise and in the case of dry needling it is not uncommon to experience muscular soreness and/or fatigue after treatment. This is generally transient but can last for up to 48 hours.
As always make sure your practitioner is qualified in dry needling practice and explains the pros and cons of needling and the improvements they expect to see before engaging in it.
So that’s an overview of what trigger points are, how they occur, and how dry needling can help. If you have any questions or comments, please email us at firstname.lastname@example.org and we will be happy to answer them for you.
If you suffer with persistent muscular tightness or pain throughout your muscles, feel free to call us on (08) 9486 8653 and our therapists will be happy to chat with you about the best management plan.