trigger points and dry needling

1. TRIGGER POINT – DRY NEEDLING
Dr. Ramesh Kumar. PhD PT.
Professor & Head,
Department of Physiotherapy,
SDUAHER, KOLAR

2. Definition
• “Trigger Point (TrP) is a hyperirritable spot in a
taut band of a skeletal muscle that is painful
on compression, stretch, overload or
contraction of the tissue which usually
responds with a referred pain that is perceived
distant from the spot”.
Simons et al. 1999

3. trigger point

5. • International Association for the Study of Pain
(IASP) has included myofascial pain syndrome
in inter professional pain curriculum outline

6. Etiology for Trigger Point
 Postural deviations
 Prolonged muscle contractions
 Nerve compression
 Direct trauma

7. Classification of trigger point
• Active trigger point
– Spontaneous pain
– Referral pattern of pain- not at the site of origin
• Latent trigger point
– Pain only in response to compression

8. Cardinal signs
 Presence of a taut band in the target muscle
 A nodular point of tenderness
 A jump sign: patient reacts to the application of digital
pressure to the taut band or nodular point
 Referral of pain on the application of pressure to the
taut band or nodule

11. Arch Phys Med Rehabil Vol 90, November 2009

12. Colour doppler Images
Ballyns et al J Ultrasound Med 2011; 30:1331–1340

13. Common areas –
upper back , lower back

14. Common areas – gluteal muscles

15. Thigh and calf muscles

16. Different Models of Dry Needling
 Superficial dry needling (Baldry 2001 )
 Deep dry needling (Travell 1968)

17. Physiological & Therapeutic Effects of
intramuscular Dry Needling
• Chemical Effect: elicitation of local twitch
response lead to reduction in various
chemicals such as substance P, Calcitonin
Gene Related Peptide (CGRP),Bradykinin etc
reduction in pain & local tenderness

18. Effects of Dry Needling
• Mechanical Effect: disruption of trigger point
contraction knot and restore normal ROM and
Muscle Activation Pattern (MAP)
• Neural effect: Stimulates A delta sensory fiber- may
activate enkephalinergic, serotonergic and
noradrenergic inhibitory systems: opiod mediated
pain suppression

19.  Dry needling when indicated produces-
 IMMEDIATE EFFECT
Effects of Dry Needling

20.  Evidence

21. Evidence
• Cochrane database: Supported use of dry
needling as an adjunct in the management of
chronic low back pain (Tudler et al 2005)
• Four systematic reviews
• Randomised controlled trials: neck pain, back
pain, shoulder pain, lateral epicondylitis, Head
aches, temperomanibular disorder, heel pain,
piriformis syndrome

22.  Case report
Video