Picture of a trigger point in the muscle as well as trigger point acupuncture with text bubble saying how dry needling works for pain

Dry needling is a method to help alleviate trigger points. Dry needling is often referred to as trigger point acupuncture. Trigger points are hypersensitive points within a muscle which create pain, limit range of motion, cause weakness and other symptoms. To learn more about trigger points, click here.

Dry needling is a technique used to release trigger points, using an acupuncture needle. For more information about the use of trigger point release using dry needling, click here.

Picture of trigger point in muscle, which is a hyperirritable or tense spot in a band of tissue
Picture showing a trigger point in the muscle and how dry needling involves inserting an acupuncture needle into the trigger point

How Does Trigger Point Release Actually Work?

There are some aspects of dry needling not fully understood. We believe there are both mechanical and neurophysiological mechanisms going on [1].

Mechanical Mechanisms

Dry needling disrupts the dysfunctional end plates, to increase sarcomere length and reduce overlapping actin and myosin filaments [1]. Needling insertion reduces spontaneous electrical activity which is associated with a brief, uncomfortable muscle contraction referred to as a ‘local twitch response’. The localized twitch produces a decrease in acetylcholine levels [1]. Other Naturopathic interventions could work along side dry needling to help reduce acetylcholine biosynthesis by other means.

Finally, blood flow and increased oxygenation after the dry needling treatment helps induce repair and promote healing [1].

Neurophysiological Mechanisms

Dry needling can affect different levels of the nervous system [1]:

  1. Effects on the Peripheral Nervous System
  • Reduction of peripheral nociception
    • Nociception is our nervous system's response to any noxious (harmful or potentially harmful) stimuli. Any chemical, mechanical or thermal sensations travel along special nerve fibers to the brain (called Aδ and C fibers) [1]. These pathways become dysfunctional in chronic pain
  • Dry needling produces an immediate alteration in the peripheral concentrations of various neurotransmitters and chemokines
    • Reduction of: calcitonin gene related peptide, substance P, inflammatory cytokines, inflammatory interleukins within the extracellular fluid of the trigger point [2], [3]. It’s these inflammatory chemicals which enables the painful sensations travelling to the brain.
    • Increase of: B-endorphin and TNA-a and decrease in substance P [2], [3]
  • Dry needling affects sensitization pathways by removing a source of peripheral nociception, modulating spinal dorsal horn activity and activating central inhibitory pain pathways [1].
  1. Decrease in spinal dorsal horn neuron activity [1]
  • The reduction in peripheral nociception would lead to this
  • Evidenced by the fact inserting a muscle into a trigger point will have remote effects in muscles anatomically located in the referral pain area.
  • This finding is bi-directional – needling a proximial muscle leads to a remote effect on a distal related muscle [4], and needling a distal muscle leads to a remote effect on a proximal related muscle [5]
  • Remote effect of trigger point dry needling involves reduction of substance P levels in spinal superficial laminae of the dorsal horn
  1. Brainstem [1]
  • This is also due to the reduction in activity in the spinal dorsal horn neuron activity
  • Needling activates cortical brain areas involved in sensorimotor processing, including insula, thalamus, anterior cingulate cortex or somatosensory cortex
  • Also deactivates the brain regions involved in the limbic-paralimbic neocortical network such as the medial prefrontal cortex, caudate, amygdala, and posterior cingulate cortex
  • Insertion of the needle PLUS electrical stimulation, is mediated through the periaqueductal gray substance in the brainstem. Stimulation of the nociceptive fibers may activate enkephalinergic inhibitory dorsal horn interneurons
Step by step process of how trigger point acupuncture works. First the needle is inserted into the muscle to get a local twitch response which influences the peripheral nervous system, spinal cord, and brain stem to help manage pain

Summary

Trigger point acupuncture is widely used for myofascial pain syndrome. Dry needling, or trigger point acupuncture, has been extensively researched and found to be helpful for a wide range of conditions.

How trigger point acupuncture works is interesting, as it works locally in the muscle, within the peripheral nervous system, the spinal cord and the brain stem. These effects lead to long term pain reduction. Alongside other therapies, our team at Absolute Health and Wellness can help you manage your pain.

References

Interested in learning more?

Read on in our series of articles on Pain Management!

About the Author - Sonia Gashgarian

sonia gashgarian physiotherapist

Sonia Gashgarian is a registered physiotherapist who graduated with a Master of Science in Physical Therapy from the University of Toronto. Prior to this she completed her Bachelor of Science in Kinesiology with Honours from the University of Waterloo. Sonia has completed courses in sports taping and basic kinesio-taping, as well as the McKenzie Method of Mechanical Diagnosis and Therapy and Mulligan Concept. She also has her APTEI Acupuncture and Dry Needling Certification.

Sonia uses a variety of treatment techniques to help clients feel better and return to their regular activities as soon as possible. Her individualized treatments may include the following: education, joint mobilizations, exercise prescription, soft tissue release, trigger point release, taping, acupuncture and dry needling, cupping, and Gua Sha.

Too book in please call us at (519) 442-2206 or click here.

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