Don't Be Scared of Needles

Have you ever wondered how people managed their aches and pains thousands of years ago, without the use of modern day medications and fancy physio modalities we so often take for granted?  Surely those Chinese Warriors must have done something right to get themselves up for battle back in the day?


It turns out that traditional acupuncture, used widely to treat these warriors for their sore bits, is coming back into fashion in the physiotherapy world some 2000 years later, and for good reason too.


Now slightly reformed, and termed “dry needling”, the use of solid, filament needles are used predominately to be inserted into muscle and the thin wrapping around it to try and release its “myofascial trigger point”. In simple terms, a myofascial trigger point can be thought of as a small contraction knot in a muscle. So whenever you are feeling a bit sore at the back of your neck, and feel as though your muscles are all knotted up when you reach back there, there is a high chance you may have developed a myofascial trigger point.


But before we get to how these little (often 30-50mm in length depending on the area involved)  needles can help, I am sure you are all wondering how these annoying trigger points can develop in the first place (if not, I’m going to tell you anyway!)


Even though there is still much controversy around how exactly these trigger points form and their true prescence, we understand that they can occur in a muscle for a multitude of reasons, including an acute muscular strain, a fall, a sprain or fracture, or excessive or unusual exercise. However, trigger points can also develop over a less acute period, and are often the result of chronic overload of a muscle due to poor sitting/standing posture, sleeping habits and repetitive work tasks. Stress can also be closely linked to the prescence of trigger points due to the person holding increased tension through their muscles throughout their whole body.


A myofascial trigger point can present as a localised hyperirritable spot of a muscle. It can also cause referred pain to another area of the body, and there seem to be common referral areas for trigger points found in certain muscles around the body. Compression of a myofascial trigger point can also elicit a localised twitch of a muscle. 


Now lets get down to business and talk about how we can get rid of these annoying things.


Dry needling is thought to work in a number of different ways. The first mechanism, can be thought of as fighting pain with pain. By inserting a sharp object such as a needle in to the body, this causes the brain to focus on this pain (transmitted to the brain by slightly different pain fibres) and blocks onward pain transmission of another type of pain fibres responsible for the dull ache often associated with myofascial trigger points. Evidence has also shown that by stimulating a trigger point, a chemical called cortisol increases in the body, which is a chemical which eventually leads to an anti-inflammatory and pain numbing effect in the body (acknowledgment to Acupuncture, Muscles and Pain course- Glenn Ruscoe).  


Physiotherapists are well placed to practice dry needling, as we are competent in assessing for the presence of myofascial trigger points and assessing why these trigger points may be present.


Even though I’m sure you all cant wait to get some needles put into you to alleviate all your aches and pains after reading this, it is important you take some responsibility for your pain to get the most optimal effect from dry needling. As effective as dry needling is, supported by medical studies done in the past (Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: a randomized controlled trial., Pecos-Martin et. al is just one example), it is important the correction of posture, alleviation of stress and muscle stretching is all completed to ensure your pain does not come back!


So even though our understanding of pain and the way we treat it has come a long way since the days of ancient Chinese Medicine, it seems that some things don’t need to change.