History of Trigger Point Dry Needling (TDN)
Trigger Point Dry Needling (TDN) is an effective treatment for chronic pain of neuropathic origin. IMS was developed by Dr. Chan Gunn while he was a clinic physician at the Workers’ Compensation Board of British Columbia. Dr. Gunn, recently elected an Honorary Fellow of Peterhouse Cambridge University, is currently a clinical professor and teaches IMS at the University of Washington’s Multidisciplinary Pain Center in Seattle and the University of British Columbia’s Medical School. IMS is also taught and utilized at many other pain centers around the world.
What is TDN?
TDN is effective and has few side-effects; the technique is also unequaled for finding and diagnosing muscle shortening in deep muscles.
Although TDN uses implements adapted from traditional acupuncture, it is based on scientific, neurophysiological principles. The needle used is very thin (much thinner than the hollow needle used to inject medicine or take blood samples). You may not even feel it penetrating the skin, and if your muscle is normal, the needle is painless. However, if your muscle is supersensitive and shortened, you’ll feel a peculiar sensation—like a muscle cramp or Charlie Horse. This is a distinctive type of discomfort caused by the muscle grasping the needle. Patients soon learn to recognize and welcome this sensation. They call it a “good” or positive pain because it soon disappears and is followed by a wonderful feeling of relief and relaxation. The needle may still be in you, but because the muscle is no longer tight, you no longer feel it. What has happened is that the needling has caused your abnormal muscle shortening to intensify and then release. It is important that you experience this sensation in order to gain lasting relief.
What is TDN used for?
Common things we treat with FDN are as follows:
- Neck and Back Pain
- Shoulder Pain
- Jaw Pain
- Chronic Pain
- Tennis/Golfer’s Elbow
- Hip and Gluteal Pain
- Knee Pain
- Achilles Tendonitis/Tendonosis
- Plantar Fasciitis
- Muscular Strains/Ligament Sprains
- Neuropathic Pain (read below)
Doctors usually have no difficulty in treating pain caused by injury (a fracture, for example) or inflammation (such as rheumatoid arthritis). But they are perplexed by pain that shows no sign of tissue damage or inflammation — headaches, “whiplash”, backache, tennis elbow or frozen shoulder.
This type of pain, known as neuropathic pain, typically occurs when nerves malfunction following minor irritation. Nerves and nerve-endings become extremely sensitive and cause innocent, harmless signals to be exaggerated and misperceived as painful ones. (This characteristic is known medically as supersensitivity). The result is pain, even when extensive medical tests show there is “nothing wrong”. Until recently, supersensitivity has received little attention in medical circles. To read more on supersensitivty, click here.
The Dry Needling Treatment Process
Dry Needling therapy treatments takes from 5-30 minutes to perform and when a shortened muscle or trigger point is deactivated, one can experience a cramping or “charlie horse” sensation. The muscle is “grasping” the tiny non-hollow needle. The effects can sometimes be immediate or may take a few days. The treatment sessions can average from 6-12, all dependent on chronicity and age/health of patient. If you are suffering from chronic pain and have decided to seek treatment using Functional Dry Needling (FDN), please make certain your practitioner is a certified practitioner.
Is It Like Acupuncture?
Similar thin monofilament needles are used with FDN as they are with acupuncture, but the similarities in treatment approach end there. FDN uses a neuroanatomical approach to treat trigger points based on Western medical research, whereas acupuncture is based on Traditional Chinese Medicine. Click here to watch a short video on Dry Needling in Physical Therapy from the APTA’s Move Forward campaign.
How Many Treatments Are Needed?
Treatments are usually once or twice a week and can vary significantly depending on your diagnosis or tolerance to treatment. The number of treatments you require will depend on several factors such as the duration and extent of your condition, how much scar tissue there is (usually increased after previous surgery) and how quickly your body can heal. The rate of healing depends on the condition of your nerves (young people usually heal more quickly, although older is not necessarily slower). If the pain is of recent origin, one treatment may be all that is necessary. In published studies of patients with low back pain, the average number of IMS treatments required was 8.2. IMS has been featured in newspapers, such as the Globe & Mail, the Vancouver Sun and the Province; on radio programs such as CKNW, CBC’s “Morning Show”; also on television, in CBC’s “Marketplace”, the “Health Show”, as well as CTV, BCTV & Rogers Cablevision.
Are There Side Effects?
The most common side effects are soreness and bruising. Many patients feel soreness in the general area that was treated and can feel it along the path where the pain was referring to as well. The soreness can last anywhere from a few hours to a few days. Our patients usually have improved motion and decreased pain after treatments and therefore tolerate the soreness from the treatment very well. There is also a chance of bruising at times in the local area of needling treatment. The amount of bruising can be affected by medications our patients are on as well. The bruising is usually minimal and should also fade in a few days.
Depending on the area being needled, there are precautions that need to be taken to avoid more serious side effects. This is why it is important to know the level of education and experience your therapist has in dry needling. It is ok to ask them what courses they have taken, as only those who have had the proper education should be needling. This may be why your therapist refers you to a different provider in the practice, to ensure you get the safest and most beneficial treatment for your condition.
What Do I Do After My Treatment?
Sometimes we see improvements immediately such as increased motion and decreased symptoms. To maintain these gains and also help with the commonly felt soreness, your therapist will tell you the right combination of what you can do to facilitate healing. Most commonly we ask that our patients stay hydrated, gently stretch with what they have been prescribed by their provider, and use ice or heat depending on the symptoms.