How dry puncture works to relieve pain from trigger points
On other occasions we have talked about the physiotherapy technique called puncture dry, which can be used to relieve muscle pain originated in the trigger points (also known as myofascial pain syndrome).
But we do not want to get too technical, because the purpose of this entry is to give an explanation for patients about the use of dry needling : when it is indicated and what problems and discomforts can help to solve.
The dry needling is a technique invasive physical therapy consisting of the introduction of needles through the skin , without injecting or withdrawing a substance (hence “dry”), as the therapeutic effect is achieved by the mechanical action of the needle. To apply it, the physiotherapist must properly assess the patient.
The dry needling can be applied in many muscles. The main indication of dry needling, as we have said in the first paragraph, is to treat the pain produced by the trigger points, which we have already named and defined.
The physiotherapist palpates the trigger points, and will assess, also asking the patient, if those points are painful and if pressing them reproduces pains or discomfort that the patient relates to their habitual pain (the pain that has motivated the consultation).
The trigger point frequently give referred pain, i.e. that “reflect” in body regions far the trigger point. This should also be assessed in the examination, when the physiotherapist presses and explores the trigger points. Those areas are very sensitive and painful, and this is where the puncture is applied, as you can see:
One of the characteristics associated with puncture is the appearance of “muscular spasms”. In the previous video they are seen quite well (for example, from minute 1:06). They are fast and abrupt muscular contractions. They are not movements that the person makes voluntarily, nor are they due to pain. They are a response to the puncture.
Indications of dry needling
Although it is still necessary to establish solid evidence in certain treatments, dry needling has been shown to be effective in:
- Shoulder: muscle problems, hemiparesis, subacromial syndrome and adherent capsulitis.
- Lumbar pain (will have to assess, it depends on the causes of pain).
- Radiculopathies and cervical pain, pain due to whiplash,
- Plantar fasciitis
- Some headaches and migraines
- Joint pains in knee and other joints
There are more indications, but I have highlighted some of those that affect frequent injuries.
As always when we talk about a technique in isolation, it must be said that diagnosis and assessment are fundamental, as each case is particular and will require techniques and treatment guidelines that will vary from one person to another.
In the case of muscular and joint problems, in which dry needling can help, it is always necessary to add guidelines such as specific exercises and learn guidelines and corrections that prevent the pain from reappearing, avoiding postures, gestures or efforts that cause the reappearance of pain, in addition to applying physiotherapy techniques and medical or other treatments that are relevant.
Mechanisms of action of dry needling
If we ask what the dry needling does to alleviate the pain, the question is complex, and there is still a lot of research going on to explain how and why the results of the dry needling are produced.
By way of summary (and making inaccuracies, for short), we can say that the mechanical effect of the needle influences the stimulation of nerve fibers, produces an indirect action that causes the release of substances that inhibit pain ( endorphins and the like), there is also a decrease in substances accumulated in the area of the trigger point and that influence the sensitivity and increase of pain, effects on blood flow, anti-inflammatory effect and others.
Contraindications and precautions of dry needling
We already mentioned in another entry the contraindications of dry needling. It is essential that the physiotherapist explore and assess the contraindications, and explain them to the patient. You should also explain that it is a technique that can bother you at the moment (remember, it is a needle) and that there may even be discomfort on the day or days following the application.
All doubts must be clarified and it is necessary that the information be verbally and also in writing; that is, informed consent is necessary , something very important in physiotherapy.
In conclusion, we can say that dry needling is a technique that can be useful in certain muscle problems (myofascial) and that it gives a lot of yes, because there are variants such as electropuncture (combining dry needling with application of analgesic currents through the own needle), different puncture techniques to achieve different effects and also, conservative method (puncture and treatment of trigger points using the hands), for cases in which the use of needles is not indicated.