Definition and History of Dry Needling, Trigger Points and Trigger Point Acupuncture

The Term Dry Needling–History

Dry Needling is a term first coined  by M.D. clinicians and researchers in England and the USA who treated myofascial pain, or  trigger point pain by injecting anesthetic like lidocaine into painful trigger points. At the same time some of these MDs, like Dr. Janet Travell, began to document the treatment of Trigger point pain by other methods. These included deactivation with external pressure, with spray and stretch, and by injection of the trigger point with saline.

 

As the same time pain specialist MDs were aware of that orthopedic style Classical Chinese acupuncture methods were also being used on acupuncture points located exactly where trigger points were located by Dr. Travell in her anatomy based research.

 

Because of the potential negative side effets of lidocaine injection (botox is much more toxic) some of these MDs in the 1970s and 80s did studies that compared injection of lidocaine into active trigger points with saline injection and with insertion of a hypodermic with no liquid. This third technique they called  “deactivation” of trigger points with a “dry needle”. And so the idea of dry needling as a term was born

 

Dry Needling Myofascial Pain with Acupuncture Needles vs. Hypodermics–MDs, Acupuncturists, Physical Therapists

Fast forward to the late 1990’s in USA, when Acupuncture gains traction as a physical medicine therapy for relieving pain.  At this point some of us acupuncturists with a special interest in orthopedics, sports medicine, and physical medicine, had been deactiving trigger points for a decade, myself included, both from our Chinese acupuncture backgrounds in martial arts, but also, in my case and a few others, from encountering the work and text books of Janet Travell and William Simon, M.D.s

 

Physical therapists, quite understandably, began to want to add Acupuncture to their work with body.  Unfortunately, the P.T. license historically did not allow them to penetrate the skin, as that was something left to M.D.s, nurses, and phlebotomists…And they were not allowed to do Acupuncture without going to acupuncture school, another 4 years of study. It was then that some physical therapists figured out that reviving the term Dry Needling, and limiting it to using acupuncture needles to do “dry needling” of trigger points, would enable them to get around the prohibition against penetrating the skin with a needle. Unlike MDs, they are not allowed to use an hypodermic, and they are not allowed to claim they are doing acupuncture.

 

So ultimately the term dry needling is used by physical therapists because there are states where it is illegal for anyone but M.D.s or  Licensed Acupuncturists to call what they do acupuncture.

 

Treating the Whole Person–Combining Dry Needling for Myfascial Pain with Channel Based Classical Acupuncture

 

But an acupuncturist trained in anatomy, surface anatomy, trigger point location. and the theory of trigger points, not to mention motor points, will do dry needling exactly the way that physical therapists do. We may even do it better, because we might also introduce Chinese medical theory that will support the release of trigger points by dry needling.

 

Classical Chinese acupuncture has always looked at the human body and mind as a continuous whole.

 

When I treat chronic and acute pain with or without trigger points (although its really rare to find any chronic or acute pain condition without trigger points, unless its purely neurological) in my San Diego acupuncture practice, unless there is a specific request to do very light acupuncture, or Japanese style acupuncture, which I also do, I myself do Dry Needling based on the Trigger Points and Motor Points, but I  also often combine Dry Needling, with Myofascial Acupuncture in which I may needle the origin and insertions of the muscles and tendons, or the fascial layer, or into the tendons.

I also pay attention to the Acupuncture Channels as described in Chinese Acupuncture theory, for example that supply the Qi and Blood to the painful area. For example if needling trigger points in the back for a herniated disc, I will usually needle the “opening and closing points” of the “Governing vessel” which has the effect of relaxing all the ligaments and small muscles that act on the spine. This gives an even faster and deeper result than needling the trigger points alone,

and its one of the reasons why Dry Needling plus Classical Chinese Acupuncture can be better than Dry Needling alone. Which is not to say that a P.T. might not offer other things I don’t, such as ultrasound….There are many different ways to treat. I like to add electrical stimulation, deep heat, and cupping to difficult cases to help the Dry Needles do their job.

 

Dry Needling as Myofasical Pain Acupuncture.

Lets talk a little more about pain relief with Dry Needling and “Trigger Point” or “Myo-fascial” acupuncture. I prefer the latter nomenclature, as the technique I have developed over the past twenty years in my San Diego acupuncture practice is not limited to the deactivation of trigger points, but includes stimulation of motor points, needling into fascia, tendons, ligaments, and even just below the skin or the skin itself. It also involves the use of Chinese style “cupping”, that I have modified with the use of a warm sliding technique using  Ayuredic herbal oils like Mahanarayan oil,  electrical stimulation, and application of counter-irritants (like Tiger Balm or Ben Gay, but what I use is Dr. Shih”s linement ), all of which combine to provide powerful relief from pain.

However, the practice of trigger point acupuncture requires a knowledge of western anatomy, as well as the precise location and referral pattern of the trigger points found in the various muscles, tendons, ligaments, joint capsules, periosteum, and even skin of the body. Trigger points occur often in the thick portion of muscle bellies, particularly in the region of the motor point, but are also found in their origin and insertion. Its the careful palpation of the skin, muscles, tendons and ligaments that enables the acupuncturist to identify their location and do very precise acupuncture needling.

Cause of Myofascial Pain–Trigger Points

Trigger points can form in weak, overused muscles, such as occurs in repetitive stress injuries in keyboard use. But they can also occur in very strong, but overused muscles, such as occurs in runners who rest inadequately, or other athletes. I recently deactivated the forearm and wrist trigger points in a patient that routinely does 1000 pushups at a stretch.

Trigger points may also occur in trauma from direct injury, such as a blow or sprain, as in the patient with sudden onset shoulder pain after being pulled suddenly and unexpectedly by her 110 pound dog Many of us are familiar with the “tension” lumps found in both the shoulders and low back, properly called “fibrositic nodules.” These nodules also contain trigger points.


Effect of Trigger Points

The problem of trigger points is not just that they are at the source of much myofascial pain; but that a muscle containing active trigger points undergoes shortening, and becomes weaker and less capable of the task at hand. This can then lead to a cascade of compensatory biomechanics, that further increase pain within the affected and allied muscles.

Diseases/Pain Conditions that Benefit from Dry Needling and Myo-fascial Acupuncture

Over the past 24 years doing Dry Needling and Trigger Point Acupuncture here in my San Diego acupuncture clinic, and even before, starting with my internship at Pacific College of Oriental Medicine, and continuing with my further advanced studies with Matt Callison, Greg Berkoff, D.C., and others, I have been amazed at the wide variety of conditions that benefit from Dry Needling and Trigger Point or Myofasical style  acupuncture. Here is a brief list

Tendonitis

Frozen Shoulder

Back Pain due to Herniated Disc, Sprain of Strain

Neck Pain

Athletic/Sports Injuries

Ligament Sprain

Carpal Tunnel

Should Pain from Throwing

Golfer’s Elbow, Tennis Elbow

Tension Headache, Migraine

Tight Shoulder from Stress and Overuse

Overuse Injuries

 

Role of Stress

I have observed a link between the presence of pervasive, active trigger points and the presence of shortened tight muscles, a bowstring pulse, and high levels of stress responses. We know, scientifically, that constant and poorly managed stress places us in the “fight or flight” response that elevates our stress hormones like cortisol. My informal theory is that this mechanism imitates an overuse syndrome in that our muscles are held as if ready to run or fight. This is work, and places our muscles into anaerobic sources of respiration and concomitant lactic acid burn. This creates various chemical cascades that may contribute to both inflammation and the formation of active trigger points.

Treatment of Trigger Points and Stress with Acupuncture

One of the great things about acupuncture of any kind is that is places you into the relaxation response, similar to what is achieved by meditation. Acupuncture reduces our body’s biochemical responses to stress, lowers blood pressure and reduces inflammation and pain.In terms of hormones and neurotransmitters it does this by increasing the secretion of our body’s natural opiates, endorphins; and by increasing secretion of natural cortisone-like anti-inflammation drugs in the adrenal glands.

Myofascial trigger point acupuncture goes one step further. In addition to being profoundly relaxing, as above, when you relieve trigger points, especially the ones in the muscle belly associated with motor points, the muscle responds by actually lengthening; this has a decompressing effect on joints, tendons, and tendon sheaths. It is not unusual after a myofascial acupuncture treatment for the affected joints to “release” as after a chiropractic adjustment, gently, naturally, and safely. This is generally followed by an immediate relief in pain. Nothing releases a tight muscle and trigger points like a carefully placed acupuncture needle. Generally the patient feels an immediate effect while still on the table.

It is also typical that after acupuncture treatment to feel extremely refreshed, as if after a deep sleep. One will often sleep profoundly well the night of a treatment, which has enormous restorative value.I have found myo-fascial acupuncture, along with herbal medicine, stretching, cupping, moxabustion therapy, therapeutic exercises such as Egoscue, massage, exercise, and progressive relaxation practices such as body scanning and mindfulness extremely effective in the treatment of even the most difficult cases of  myofascial pain, frozen shoulder, and migraine.

 

 

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