What is Myofascial Pain / Pain from Myofascial Trigger Point?
Like the joints and nerves of our body, muscles and their coverings can also be source of pain that is scientifically termed as ‘Myofascial Pain’.Myofascial trigger points (MTrPs) in our body are described as knotted/taut band of muscles that can give characteristic referred pain on pressure. These points can be source of acute/ chronic pain and also lead to many other dysfunctions. Many pioneer researchers (Travell & Simons) in this field have mapped out the referral patterns of many trigger points of human body. There are several reasons why MTrPs develop in muscles. The most common are overuse, over stretch, over loading, and trauma to muscles etc. Pain is produced from these MTrPs through complex physiological processes. In lay terms: Muscle spasm is a protective mechanism and affected muscles should return back to their normal state after sometime. However, some of the muscle fibers develop stubborn spasm and don’t return to their normal state and tangled fibers also do not allow normal muscle function.By doing so, they choke their own circulation and starve. Due to starvation they produce bad chemicals which get accumulated at the site and can’t be flushed due to poor local circulation. These bad chemicals irritate surrounding nerve fibers and hence give pain. This pain becomes more pronounced as increased activity put more demand on already starving muscles. This leads to more muscles spasm and the cycle develops. That’s why deep massage to the area helps to some extent by temporarily improving circulation.
What is Dry Needling?
It is a form of therapeutic approach in which fine solid filament needles are inserted into specific points on the body to relieve pain and improve function. As nothing is injected into body except the needle, the procedure is called ‘Dry Needling’. These needles are the same as acupuncture needles.
Is it a form of Acupuncture? / What is the difference between Acupuncture and Dry Needling?
‘Dry Needling’ (mainly understood as myofascial trigger point needling) is not at all the same as acupuncture. ‘Dry Needling’ is based on theory and assessment principles of Western Medicine technique. Although, some of the physiological effects of needling are common in both, the principles of assessment and treatment techniques are quite different. Acupuncture as part of Traditional Chinese Medicine has different theory and assessment technique and treatment involves specific points / meridians.
How does it help?
Dry Needling helps in many ways; mechanical, electrical and chemical changes at the site of needling helps in reducing pain and initiate healing process. With pin prick body initiates its own analgesic mechanism and also jams abnormal sensation going to brain and thus helps in controlling pain. With twitch reactions the fibers untangle and restore normal function of muscle. Our body perceives needling as another injury and blood rushes to the site which flushes out the pain producing chemicals and also helps in healing process.
Is it a new technique?
Neither needling nor myofascial pain concept is new; However, the practice of trigger point needling is relatively new and being practised for many decades in several countries and recently gaining popularity due to excellent results in majority cases.
Is it the only treatment option? / What next if this doesn’t help?
‘Dry Needling’ technique is another tool in the hands of your therapist. Like many other treatment approaches it also gives excellent result in appropriate cases if performed correctly. It is not a miracle cure and only part of your overall therapeutic regimen. Your therapist will explore other treatment options or refer to other medical professional if you fail to recover.
I don’t like needles what should I do?
You must report to your therapist if you have extreme ‘Needle Phobia’ and can’t tolerate the procedure at all. We all have some degrees of needle phobia!!!
What should I tell to my therapist before the procedure?
Your therapist will run through few check lists prior to the procedure. However it is in your best interest to report any existing or past medical condition(s) you have; for example, history of epilepsy / faint / collapse, high dosage of anticoagulants (warfarin / aspirin etc), any heart conditions, pregnancy, diabetes, blood clotting disorder, and prone to infection / immunotherapy etc.
Are the needles very long? / What will I feel? / Is it very painful?
It is a common belief that longer needles hurt more. This is not true. Your therapist has been specifically trained in various dry needling techniques and will choose needle(s) of appropriate length and thickness depending on your condition, target tissue and your body size. Upon insertion you will feel pinprick and depending on the technique employed, you may also feel deep muscle ache and/or muscle twitches. Research shows that these twitches are desirable and help in untangling muscles fibers. These sensations are transient. You must report to your therapist if the procedure is extremely painful and you can’t tolerate. He/she will adjust the needle or stop the treatment.
What are the side effects? / Is dry needling safe? / What can I expect after treatment?
Dry needling is generally very safe. Although many side effects are reported in literature, serious side effects are very rare. The risks are minimal if the technique is performed properly by a trained physiotherapist. Most commonly people experience soreness at the needling site which may last between few hours to few days. Also you may notice a little bruise near the needled site which will fade away in few days.
There is no fixed pattern of effects after needling. Some report initial increase in symptoms followed by great relief, while others report immediate or gradual relief from pain over few days. On rare occasions, people may feel very happy, tearful, sweaty or cold for some time. Drowsiness is also reported in few cases and you should not to drive long distances immediately after the treatment (especially after first treatment as it not possible to predict the effects and how one would react). Fainting may occur in a very small minority of people. There are no lasting ill effects of these side effects.
Treatment in chest, shoulder and base of neck area carries an additional risk that involves the lung. A condition called ‘Pneumothorax’ (air in the space around the lung) may develop if the lung is punctured. The symptoms of this event include shortness of breath (even at rest) which gets worse, sudden sharp pain in chest with breathing, a bluish discoloration of lips, and an inability to “catch your breath”. You must go to hospital emergency department without delay. Do not panic if it happens. This is a rare but serious problem and treatment is very successful.
Are the needles safe?
Yes.The best practice is to use sterile, individually packaged, disposable needles so as to eliminate the possibility of causing infection or transmitting a disease by a contaminated needle. Good quality Needles come with CE mark/ UK Kitemark.
What should I do while receiving dry needling therapy?
Stay relaxed. Do not move suddenly or change your position as the needle may enter unintended tissue. Rarely some patients experience increased pain, dizziness, nausea, cold sweat, shortness of breath, or faintness during treatment. This often occurs if you are nervous. If you are uncomfortable and can’t tolerate the treatment, then alert your therapist.
Do I have to sign a consent form?
Keeping best practices in view your therapist may ask you to sign a consent form prior to the procedure. It is in your best interest to discuss if you have any query. Your therapist will be happy to answer your queries.