According to the British Medical Acupuncture Society, myofascial pain syndrome results from the development of myofascial trigger points. A myofascial trigger point is a hyperirritable locus within a taut band of skeletal muscle or its associated fascia. It is painful on compression and can evoke a characteristic referral pattern of pain or autonomic dysfunction.
Various therapeutic techniques have been proposed to treat trigger points and associated myofascial pain syndrome. Nonpharmacological approaches, such as dry needling, are now more widely used and generally preferred over pharmacological ones as they are generally better tolerated and have safer adverse event profiles.
Dry needling is a minimally invasive procedure consisting of a fine, solid filiform needle repetitively inserted into the fascia and muscle, typically using a fan-like technique. Here at Mount Merrion Physiotherapy & Health, we generally prefer to use more gentle needling techniques, including low-level electrical stimulation, which our clients find less uncomfortable and result in the same if not better treatment outcomes.
Dry needling has been shown to bring about musculoskeletal pain relief and improved mobility, which may be related to triggering a local twitch response, subsequently leading to a temporary attenuation or deactivation of the trigger points. It is unclear whether local twitch responses are necessary; however, clinical evidence suggests quicker results are usually achieved if a twitch response is evoked when needling to deactivate trigger points.
The dry needling of trigger points can reduce peripheral nociceptive (potentially painful) signals from the muscles. The reduction in nociceptive input converging on the central nervous system may result in desensitisation of various parts of the central nervous system and activate multiple central pain regulatory pathways, restoring more normal muscle function.
Dry needling also reduces the irritability of neuromuscular junctions (thought to be central to the formation of trigger points), effectively reducing the overlap of the contractile proteins and relaxing the sarcomeres, resulting in a reduction of localised muscle tension. For example, the treatment of the trigger points within tense and sore neck muscles can reduce the heightened pain sensitivity associated with migraine and whiplash injury.
By Simon Coghlan MSc, BSc Physio, DipMedAc
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