Myofascial pain syndrome is a chronic pain disorder. In this condition, pressure on sensitive points in your muscles (known as trigger points) causes pain in the muscle and sometimes in seemingly unrelated parts of your body. This is called referred pain. This syndrome typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension. While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens.
According to the British Medical Acupuncture Society, a 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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