Trigger Point Dry Needling NYC

What is Dry Needling?

Dry needling, or myofascial trigger point therapy, is a filiform needling technique focused on muscles and myofascial chains with anatomical needling instead of a reliance on traditional acupuncture points. It is primarily based on myofascial trigger points and their referral patterns. It has recently increased in popularity due to it’s effectiveness for pain relief without the need for prescription drugs or surgical intervention. While initially practiced by physicians, acupuncturists, and physical therapists, it is now incorporated by other health professions like chiropractors, veterinarians, dentists, athletic trainers, osteopaths, and other health providers.

Dry needling applications initially only included treating and deactivating myofascial trigger points as presented by Dr. Janet Travell and Dr. David Simons.

It is called “dry” needling because acupuncture needles are solid and do not contain any fluid in them like hypodermic needles (“wet” needles). Dry needling involves a specific needling technique that seeks to identify and release areas of myofascial constriction to deactivate trigger points and release tight and taut bands of muscle.

Dry needling induces a neurophysiological response which means that it works both at a physical level to release myofascial trigger points, and at a deeper level to affect the nervous system.

Dry needling has been found to neuromodulate chemicals in the body related to pain and inflammation without the need for drugs or surgical intervention.

When dry needling is performed by an acupuncturist it may also be called trigger point acupuncture. Other terms used may include intramuscular stimulation or myofascial release. Only acupuncturists can use the term acupuncture when using acupuncture needles so when other professions use acupuncture needles they need to use those other terms.

What are myofascial trigger points?

Trigger points are hyperirritable taut bands of muscle that cause referred pain patterns locally or elsewhere in the body.

An active trigger point results in pain, while a latent trigger points elicits referred pain upon pressure or palpation. Either one can cause biomechanical changes that results in restricted range of motion and reduced muscle function.

Trigger points are sarcomere contractures - or tight bands of muscle. A trigger point starts out as a taut band of muscle, which then restricts blood flow and oxygen and reduces the pH of the surrounding area. The lower pH causes a downregulation of acetylcholinesterase which causes excessive acetylcholine, as well as a release of nociceptive biochemicals that create pain. The increase in pain chemicals in the body eventually results in changes to the nervous system like sensitization that can result in chronic pain and a lower pain threshold.

A 2005 Study looked at the biochemical makeup before, during, and after a local twitch response of a myofascial trigger point. The study found lower pH around active trigger points and increased levels of the following nociceptive chemicals:

• Calcitonin gene related peptide (CGRP)

• Inflammatory cytokines

• Substance P

• Bradykinin

• Serotonin and norepinephrine

• Prostaglandins

In particular – there were significantly elevated levels of Substance P and CGRP near active trigger points. After a local muscle twitch levels of these dropped significantly – which coincides with the general sensation of reduced pain after releasing a trigger point.

A follow-up study in 2008 confirmed that chemicals in the body associated with pain, inflammation, and increased pain signaling are higher near active trigger points.

A similar 2008 study found elevated levels of pain related chemicals in upper trapezius trigger points resulted in increased levels of those chemicals in other areas of the body that did not have trigger points (the gastrocnemius in the study), which suggests that myofascial trigger points may contributed to generalized pain and inflammation in other areas of the body.

The findings of these studies are consistent with the idea that muscle contracture leads to reduced blood flow and oxygen, which leads to the release of pain causing substances. Subsequently, dry needling can release myofascial trigger points with a local twitch response to restore blood flow and oxygen, and reduce pain.

How do trigger points form?

Generally, trigger points form from overuse or direct trauma to a muscle. There can also be other factors including stress and visceral problems that can also lead to the formation of trigger points.

Muscle overload that can result in trigger points can come from:

• Direct trauma to a muscle that causes a muscle to shorten

• Persistent low level muscle contractions like static posture or repetitive tasks

• Concentric muscle contractions that overload the muscle like from exercise and sports

How do you find trigger points?

Trigger points are found via patient history and a physical exam that includes palpation of affected areas and other possible areas that may refer pain. Using flat or pincer grip palpation allows the clinician to find active and latent myofascial trigger points. They will feel a taut band of muscle and be able to identify a contracture band along that band. The patient may feel their pain activated during the physical exam which confirms that there is an active or latent trigger point. Our acupuncturists are trained in trigger point dry needling and myofascial trigger point therapy will be able to find your trigger points based on the symptoms you are describing and by palpating for taut bands of muscle that elicit pain.

How do you release a trigger point?

Releasing a trigger point requires a mechanical intervention using a filiform acupuncture needle. The goal is to deactivate the trigger points by needling into the taut band and eliciting a local twitch response. The local twitch response is a spinal cord reflex and resembles a strong muscle ache or muscle spasm, and is an involuntary contraction of the muscle.

Brief History of Dry Needling

Originally, dry needling originated separately from traditional acupuncture and started with research on referral pain from various muscles by J.H. Kellgren in London in the 1930s. This research initially found that pain can occur in areas away from the actual site of pain (referred pain). This was found by injecting saline (an irritant) into muscles and observing the pain sensations that were felt as a result. Interestingly enough, the injections produced pain away from the injection site and in some cases the most pain was felt in other structures that were not the muscle.

After this realization, physicians began injecting trigger points with local anesthetics or other substances to relieve pain (wet needling). Physicians in the 1940s including Dr. Janet Travell further studied this type of pain and its clinical implications and eventually found that trigger points are the source of pain for numerous musculoskeletal pain issues. Research in 1949 showed that cardiac pain could have a somatic component that was caused by trigger points. By 1951, Dr. Travell and Dr. Seymour Rinzler had enough information about trigger points and referral patterns to provide illustrations for many causes of musculoskeletal pain.

Eventually, research by a Czech doctor in 1979 named Karel Lewit found that it was not necessary to inject any substances to relieve the pain caused by trigger points. Simply stimulating the muscle to release the trigger points was enough to alleviate the pain (dry needling). This was known as “the needle effect.”

In 1983, Dr. Travell and Dr. David Simons wrote the authoritative text on trigger points including their referral patterns, causes and treatment. According to Dr. Simons, “Dry Needling includes the use of sterile disposable acupuncture needles to improve circulation and blood flow to the affected muscle trigger point areas.”

Today, in its current form, dry needling uses filiform acupuncture needles instead of thicker and more painful hypodermic needles. Acupuncture needles are much thinner, generally don’t hurt when they are inserted, and have less side effects like bruising or bleeding that is often caused by hypodermic needles.

The history of traditional acupuncture and dry needling has some overlap since acupuncture has been used to treat pain for thousands of years whereas pain science that underlies myofascial trigger point theory is less than 200 years old.

How does dry needling relieve pain?

When muscles are tight they create pain, prohibit proper blood flow, and pull on the structures they attach to which may lead to a domino effect of pain that can spread throughout the body. Many common trigger points correspond with acupuncture points that have been around for many centuries. In the dry needling technique, we essential poke a muscle that is tight or shortened with the acupuncture needle which makes it contract involuntarily to restore function and lengthen the muscle closer to a more normal state. This allows more blood flow to return to the muscle and also relieves pulling at muscle attachment sites (bones and joints) that can cause pain and inflammation.

For more information about trigger points see our blog post Acupuncture for Trigger Points.

It is possible to experience soreness, muscle fatigue, and bruising at the needling site and that intensity of that often corresponds to the levels of muscle tightness prior to the treatment.

A 2019 review in the Journal of Pain Research highlights how dry needling can help relieve pain by releasing trigger points. To summarize:

• Trigger points have referred pain or referred sensation patterns that can be recreated upon stimulation of the trigger point area. For example, a trigger point in the trapezius muscle can create a referral pattern in the head that can create a headache.

• Releasing a trigger point usually involves obtaining a local twitch response at the muscle targeted. This is a brief and involuntary contraction of the muscle believed to be brought on by a spinal cord reflex. Some studies have shown that obtaining a local twitch response makes it more likely to relieve pain than just inserting the needle into a muscle without stimulation.

• Dry needling can result in post-needling soreness as a consequence of the neuromuscular stimulation that occurs during treatment. Most patients recover from the soreness within 48 to 72 hours and many patients describe it as similar to workout soreness.

• Studies have shown that dry needling is effective for managing musculoskeletal pain especially in the short to mid term (1 to 3 months). More studies need to be done to determine to longer term effects.

• Dry needling (acupuncture) also has an effect on the nervous system and parts of the brain which reduce the perception of pain by reducing peripheral nociception (the detection of painful stimuli).

Source: Fernández-de-Las-Peñas, C., & Nijs, J. (2019, June 18). Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31354339

Common conditions associated with dry needling

• Lower back pain

• Upper back pain

• Neck pain

• Shoulder & arm pain

• Hip pain

• Knee pain

• Ankle & foot pain

• Wrist & hand pain

Specific conditions associated with dry needling

(From head to toe)

• TMJ pain & dysfunction

• Torticollis

• Shoulder and hip impingement syndromes

• Golfers and tennis Elbow

• Carpal tunnel syndrome

• Trigger finger

• Spinal disc problems

• Sciatica

• Piriformis syndrome

• Iliotibial band syndrome (IT band)

• Patello-femoral syndrome

• Shin splints

• Achilles tendonitis

• Plantar fasciitis

Trigger point referral pattern examples:

The X’s in the images below refer to the common trigger point locations. The shaded areas correspond to areas where a referred sensation of pain is felt. Some muscles have multiple trigger points and I color-coded them so the appropriate trigger points correspond to the appropriate referral zones.

These patterns explain why releasing a trigger point in the trapezius muscle can relieve neck pain or headaches, or why releasing trigger points in upper back muscles like the teres major/minor and infraspinatus can relieve pain going down the back of the arm, even down to the hand.

We are licensed acupuncturists specializing in combining trigger point dry needling and traditional acupuncture

Not all acupuncturists are trained in dry needling or trigger point styles of acupuncture. A large number are only trained in the traditional Chinese medicine (TCM) form that has been standardized in China and is required for many state licensing exams in the US. There are many other styles of acupuncture in China, Japan, Korea, and other parts of the world and any style that uses acupuncture needles is considered acupuncture.

We were all trained in these styles of acupuncture as part of our core training in school and are considered experts when it comes to trigger point acupuncture, dry needling, and muscle release. Our treatments incorporate whatever is best for your condition and may include a combination of traditional acupuncture, dry needling, electroacupuncture, and other modalities within Chinese medicine that are appropriate.

Dry needling vs Acupuncture

Is Dry Needling Acupuncture?

That is a very common question when discussing acupuncture and dry needling since they appear to be similar. Since it is a specialized needling technique with its roots in biomedicine, it may or may not be considered acupuncture depending on who is performing it.

When performed by an acupuncturist, dry needling is a specialized acupuncture style. When performed by a physical therapist it is a mechanical physical therapy technique. When dry needling is performed by a pain management doctor it is a medical procedure.

It is a complicated question since dry needling and acupuncture originated from separate forms of medicine. Today they have been blended together since in it’s current form, dry needling uses filiform acupuncture needles. The beauty of medicine and science is that when we look at the human body from differing perspectives, we can blend techniques that provide more effective care from patients.

To complicate things further, dry needling is not standard training for any profession - whether it is acupuncturists, physical therapists, pain management doctors, veterinarians, or anyone else that may be able to practice dry needling within their scope of practice.

Acupuncture is not Dry Needling

While dry needling may be considered a style of acupuncture if being performed by an acupuncturist, acupuncture is not dry needling. You could argue that using a filiform acupuncture needle regardless of needling technique could be dry needling since there is no fluid in the needles, but the term was initially coined to describe the release of myofascial trigger points with hypodermic needles without fluid in them. It wasn’t until later that “the needle effect” was discovered which showed that needling into trigger points and obtaining a twitch response was effective for relieving pain.

The term is now used to refer to a specialized needling technique that addresses myofascial trigger points and their pain referral patterns. While there are many styles of acupuncture, it is usually thought of as the Traditional Chinese Medicine (TCM) style that uses Chinese medicine theory, acupuncture points, and meridians to determine treatment.

This doesn’t cover the whole picture, and there are in fact many styles of acupuncture that do not rely of meridians and acupoints like scalp acupuncture, auricular (ear) acupuncture, Master Tung style acupuncture, and many others.

Acupuncturists have been treating tight, hyperirritable bands of muscle for many centuries by using acupuncture techniques that penetrate muscle tissue and cause muscles to twitch involuntarily to loosen them and restore function - but they were never labeled as trigger points. Interestingly, many common trigger points correspond with traditional acupuncture points, which shouldn’t be a surprise because we are all looking at the same human body and pain patterns are the same whether you describe them in terms of trigger points or Chinese medicine metaphors.

Pain is the most common reason that people seek acupuncture treatments, and there are numerous needling and non-needling techniques to relieve pain that fall under the acupuncture umbrella including shallow needling, deep needling, electroacupuncture, cupping, and gua sha.

Research has shown that needling acupuncture points can reduce inflammation, promote blood circulation, and activate certain parts of the brain depending on the point used.

Many acupuncturists will argue that dry needling is acupuncture, but aren’t trained in how to do it. Most acupuncture schools do not teach dry needling in their curriculums, so not all acupuncturists are trained in dry needling and it is a specialized technique. Most acupuncturists receive training in the TCM style and learning other styles often requires additional training beyond what is required for state licensure.

Is Dry Needling legal in NY?

In New York, only licensed acupuncturists (acupuncturists with over 2500 hours of acupuncture specific training) and certified acupuncturists (medical doctors with 300 hours of specific acupuncture training) are allowed to use acupuncture needles and perform dry needling.

The practice of acupuncture is defined by the New York State Office of the Professions as:

"Profession of acupuncture" is the treating, by means of mechanical, thermal or electrical stimulation effected by the insertion of needles or by the application of heat, pressure or electrical stimulation at a point or combination of points on the surface of the body predetermined on the basis of the theory of the physiological interrelationship of body organs with an associated point or combination of points for diseases, disorders and dysfunctions of the body for the purpose of achieving a therapeutic or prophylactic effect.

Since dry needling involves the “insertion of needles” it is considered acupuncture in the state of New York.

If someone other than an acupuncturist performs acupuncture or dry needling in New York, it is considered unauthorized practice of a profession, which is a class E felony and punishable by up to 4 years in jail.

Other states and countries may allow dry needling by other professions depending on their scope of practice laws, most commonly physical therapists and physiotherapists.

A 2020 survey of physical therapists that perform dry needling found that only 10% of physical therapists that perform dry needling have over 100 hours of needle specific training before they see real patients. 66% of physical therapists had 60 hours or less of dry needling training. The same survey also found that only 21% of physical therapists that perform dry needling do more than 3 treatments per day and that the length of treatment was less than 15 minutes for 67% of PTs that responded.

In comparison, acupuncturists in New York state are required to completed an accredited acupuncture program consisting of 4,050 classroom hours and at least 650 hours of supervised clinical acupuncture experience. Dry needling treatments performed by acupuncturists are typically between 30-60 minutes and involve a more holistic understanding of how the body works.

AMA position on dry needling

In 2016, the American Medical Association adopted Resolution 223 which stated that Dry Needling is an Invasive Procedure.

This resolution asked the AMA to “recognize dry needling as an invasive procedure and maintain that dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.”

More information about dry needling

There are a number of textbooks dedicated to dry needling. Some of the most important are:

• Myofascial Pain and Dysfunction: The Trigger Point Manual by Janet Travell and David Simons

• Trigger Point Dry Needling: An Evidence and Clinical-Based Approach by Jan Dommerholt and Cesar Fernandez-de-las-Penas

• The Gunn Approach to the Treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin by C. Chan Gunn

• Acupuncture, Trigger Points and Musculoskeletal Pain by Peter Baldry

• An Introduction to Western Medical Acupuncture by

• A New American Acupuncture by Mark Seem

Sources:

Travell, J. G., & Simons, D. G. (1999). Travell & Simons' myofascial pain and dysfunction: The trigger point manual (2nd ed., Vol. 1, Upper Body). Baltimore, MD: Williams & Watkins.

Fernández-de-Las-Peñas, C., & Nijs, J. (2019, June 18). Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31354339

Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol (1985). 2005 Nov;99(5):1977-84. doi: 10.1152/japplphysiol.00419.2005. Epub 2005 Jul 21. PMID: 16037403. Retreived from https://pubmed.ncbi.nlm.nih.gov/16037403/

Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008 Oct;12(4):371-384. doi: 10.1016/j.jbmt.2008.06.006. Epub 2008 Aug 13. PMID: 19083696. Retreived from https://pubmed.ncbi.nlm.nih.gov/19083696/

Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008 Jan;89(1):16-23. doi: 10.1016/j.apmr.2007.10.018. PMID: 18164325. Retreived from https://pubmed.ncbi.nlm.nih.gov/18164325/

For more information or to schedule an appointment for dry needling acupuncture in NYC, please contact us below: