What is Dry Needling

Trigger point dry needling is a treatment technique, which uses small filament type needles to release tight muscles with the goal of permanently reducing muscle pain and dysfunction. Manual Therapists around the world are now using this technique to effectively treat acute and chronic orthopedic and musculoskeletal conditions. TDN can help you more efficiently treat your patients, improve your outcomes and save your aching wrists and thumbs!

How Dry Needling Works

Dry needling is the use of a solid needle for deactivation and desensitization of a myofascial trigger point which should stimulate a healing response in that tissue and reduce the biomechanical stress of the muscle treated.

What is Myofascial Pain?

Myofascial pain syndrome is a disease of the muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and by sensory abnormalities (tenderness and referred pain). It is classified as a musculoskeletal pain syndrome that can be acute or chronic, regional or generalized. It can be a primary disorder causing local or regional pain syndromes, or a secondary disorder that occurs as a consequence of some other condition. When it becomes chronic, it tends to generalize, but it does not change to fibromyalgia. It is a treatable condition that can respond well to manual and injection techniques, but requires attention to postural, ergonomic, and structural factors, and toxic or metabolic factors that impair muscle function.

Gerwin, Robert D. “Classification, epidemiology, and natural history of myofascial pain syndrome.(Author abstract)(Report).” Current Pain and Headache Reports 5.5 (Oct 2001): 412(9). Academic OneFile. Gale. BCR Regis University. 27 Oct. 2008

What is a Trigger Point?

CLASSIC DEFINITION

The term “trigger point” was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:

  • Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
  • The painful point can be felt as a tumor or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
  • Palpation of the trigger point reproduces the patient’s complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.
  • The pain cannot be explained by findings on neurological examination.

Twitch Response – to twitch, or not to twitch

Frequently Asked Questions

For Clinicians

Dry Needling involves multiple advances of a fine filament needle into the muscle in the region of a “Trigger Point’. The aim of Dry Needling is to achieve a local twitch response to release muscle tension and pain. Dry needling is an effective treatment for chronic pain of neuropathic origin with very few side effects. This technique is unequalled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.

The needle used is very thin and most subjects do not even feel it penetrate the skin. A healthy muscle feels very little discomfort with insertion of this needle. However if the muscle is sensitive and shortened or has active trigger points within it, the subject will feel a sensation like a muscle cramp -‘the twitch response’. The patient may also feel a reproduction of “their” pain which is a helpful diagnostic indicator for the practitioner attempting to diagnose the cause of the patient’s symptoms.

Patients soon learn to recognise and even welcome this sensation as it results in deactivating the trigger point, reducing pain and restoring normal length function to the involved muscle.

 

These courses are ideally suited to therapists with a strong manual background in their learning and treatment approach. The Level One, Two and Three courses are recommended for graduates of: Physiotherapy, Osteopathy, Chiropractors and Physicians who specialise in manual therapy. We also conduct courses specifically for Podiatrists, Occupational Therapists, Remedial Massage Therapists and Myotherapists.

GEMt Courses are fully Accredited for the following associations:

  • Osteopathy Australia
  • Massage and Myotherapy Australia
  • Myotherapy Association of Australia
  • Note: The APA no longer offers Accreditation for courses

Physiotherapists: The following hours can be claimed per course:
Level 1 Course: 20.5 hours total
Level 2 Course: 14.75 hours total
Level 3 Course: 13.5 hours total
Currently Physiotherapists need to maintain a minimum of 20 hours of CPD per annum.
For further information, please see the link: http://www.physiotherapyboard.gov.au/Registration-Standards.aspx

Osteopaths: The Level 1, 2 and 3 GEMt courses are an Osteopathy Australia Endorsed Course.
The following hours can be claimed per course:
Level 1 Course: 20.5 hours total
Level 2 Course: 14.75 hours total
Level 3 Course: 13.5 hours total
Currently Osteopaths need to maintain a minimum of 25 hours of CPD per annum.
​For further information, please see the link: http://www.osteopathyboard.gov.au/Registration-Standards.aspx

Chiropractors: All GEMt courses have been assessed by the Chiropractors’ Association of Australia (National) Ltd, a body recognized by the Chiropractic Board of Australia, and allocated the following Formal Learning Activity Hours per course:
Level 1 Course: 20.5 hours total
Level 2 Course: 13 hours total
Level 3 Course: 12.5 hours total
Currently Chiropractors need to maintain a minimum of 25 hours of CPD per annum.
For further information, please see the link: http://www.chiropracticboard.gov.au/Registration-standards.aspx

Remedial Massage Therapists:
​The GEMt Remedial Massage course is endorsed by Massage & Myotherapy and is worth 20 CPE points

During the GEMt course we expect participants to practice the technique on each other. If you are pregnant we don’t allow you to be needled on the course. Hence if you wish to participate on the course you will need to bring in someone who is willing and able to be needled during the course (to take your place).

Successful completion of the Introductory course will provide you with skills and knowledge to begin utilizing the treatment immediately. Theoretical and practical testing will be administered during the final day of all courses and participants will be expected to display an appropriate level of competency prior to receiving their course certificate. If you plan to take the Advanced course we strongly recommend that you are utilising dry needling clinically for a minimum of 3 months. There are no other time line restrictions for registering for the Advanced course.

The focus of the Introductory course is treatment for pain management and sport related injuries. Participants successfully completing the Introductory and Advanced courses will be able to treat pain and dysfunction originating from myofascial active trigger points that can lead to conditions such as; tendonopathies, movement impairments and other orthopaedic and sporting conditions of the following areas:

INTRO/INTERMEDIATE:

  • Hip
  • Lumbar Spine
  • Thigh
  • Cervical Spine
  • Shoulder
  • Upper & Lower Extremity

ADVANCED:

  • Advanced Hip
  • Advanced Lumbar Spine
  • TMJ/Face
  • Advanced Cervical Spine
  • Thoracic Spine
  • Advanced Upper & Lower Extremity
  • Hand/Thumb
  • Foot

The most common cause of nerve irritation and neuropathic pain is underlying spinal degeneration (i.e. spondylosis of the spine), which can be a result of trauma and/or normal wear and tear. Spondylosis irritates the nerve root and leads to neuropathy which can result in muscle shortening. This process leads to pain and dysfunction in many common acute and chronic conditions that practitioners see in every day practice. The introduction of a dry needle into the active trigger sites of these muscles can provide enormous relief of symptoms.

Dry Needling may also be used for acute and chronic sporting injuries such as:

  • Muscular haematomas
  • Muscle tears
  • Compartment syndrome
  • Medial tibial stress syndrome (shin splints)
  • Rotator cuff injuries
  • Tennis/golfers elbow

The application of Dry Needling techniques for the above conditions will be demonstrated during these courses. In the Advanced courses, participants will be instructed in advanced techniques that require prior knowledge of the skills and concepts taught in our GEMt Introductory course.

Dry Needling can also be used for spinal conditions where the underlying pathology may have triggered a movement disorder. This can result in the presence of reduced ROM or pain due to abnormal muscle tone or spasms. Such conditions may include:

  • Piriformis syndrome
  • Cervico-genic headaches
  • Sciatica
  • Hamstring issues

Common lower extremity conditions treated with Dry Needling include:

  • Patello Femoral Syndrome
  • Patellar tendonitis
  • Hamstring Strain
  • Groin Strain
  • Shin-splints; Compartment Syndrome
  • Achilles tendonopathies

Common upper extremity conditions treated with Dry Needling include:

  • Thoracic Outlet Syndrome
  • Carpal Tunnel Syndrome
  • Lateral Epicondylitis (tennis elbow)
  • Medial Epicondylitis (golfers elbow)
  • Impingement syndromes
You have the choice to start with just the Introductory Course and decide later if you wish to take the Level Two or Level Three Advanced Courses. You can do the Level Two or Level Three course in any order. The Course Summary section of the GEMt website summarises the muscles covered in each course. You do not have to register for both courses at the same time.

All course participants will be provided with an extensive illustrated course manual describing and depicting all the theory and course material covered during the 2 or 3 day workshops. All participants will also take away a starter pack (Introductory) inclusive of quality GEMt needles allowing you to effectively administer Dry Needling in your practice immediately following the completion of the course.

Advanced participants will receive a comprehensive manual for advanced techniques.

You will also be provided with pre-reading material to prepare you for the course.

Supplies used for TDN and therapy treatment will also be available for purchase at the end of the course and through our website.

GEMt courses boast having the best cuisine available for its course participants. Healthy food for a healthy mind!

The main product you will need to perform TDN is filament needles. GEMt has designed and developed our own TGA approved ‘dry needling specific’ needles that are used on all courses. You will receive a starter pack of needles when you attend the course. At the completion of the course there will be the opportunity to purchase more needles or you can visit our website under ‘Supplies’, members of GEMt will access discounts on supplies from our site. There are some other optional products that can aide in the technique which will also be available for purchase.

Participants in all courses work in pairs allowing the instructors to work with and supervise no more than four groups each. A minimum of 12-14 participants are required for venues to proceed; numbers usually vary between 20 to 30 for our Introductory courses and 15‐20 for Advanced.

Should a course not reach its minimum quota (which may vary per venue) then GEMt will refund all course fees in full. Note for International courses, all course fees shall be paid to GEMt in Australian Dollars (AUD). In the unfortunate event of a course being cancelled GEMt is obliged to refund the course fees in AUD, GEMt cannot be held responsible for fluctuations in exchange rates. GEMt will be responsible for bank transfer fees applied at this end of the transfer.

For Patients

Dry Needling involves multiple advances of an acupuncture-type needle into the ‘trigger point’ of the muscle. The aim is to achieve a local twitch response to release muscle tension and pain.

The needles used are very thin, and you may or may not feel the needle enter your skin. If the target muscle is shortened and supersensitive you will feel a cramping or twitch sensation. This is very short-lasting, and patients soon learn to recognise this sensation as therapeutic as it is followed by a feeling of pain relief and muscle relaxation.

The most common side effect is temporary muscle soreness after the treatment. This typically lasts for a day or two, and your clinician will instruct you on how to minimise this. There are other less common side effects such as bruising. If you have any questions about side effects, please discuss this with your clinician.

Neuropathic pain is pain that occurs when nerves malfunction following minor irritation. The nerves become supersensitive and normal signals become exaggerated and misperceived as painful ones. The result is pain, even when medical tests show there is ‘nothing wrong’.

An important contributing factor in neuropathic pain is muscle shortening or spasm. This produces pain by pulling on tendons, creating tension on the joints they attach into, and thus contributing to degenerative changes such as tendonitis and osteoarthritis.

Dry Needling helps to reduce pressure on the nerve by releasing muscle shortening. It is now well researched that the ‘twitch’ response in the muscle during dry needling is associated with the muscle relaxing and stopping the pull on adjacent areas.

Treatments are typically once a week, to allow enough recovery time between treatment sessions. However, this can vary. The number of treatments you will require will depend on many things, such as:

  • How long you have had your problem
  • The extent of your problem
  • How long it takes to address the contributing factors
  • How quickly your body can heal

Prior to treatment please inform your clinician if you are pregnant, or have any of the following​:

  • Metal allergies
  • Implants
  • Axillary or inguinal node dissection
  • Joint replacements
  • Needle phobia

We will never dry needle someone during their first trimester of pregnancy. There are some situations in which we will consider dry needling someone after this time, however there are certain points we will avoid as an extra safety measure. If you are unsure or have any questions feel free to discuss this with your practitioner.

Feel free to contact one of our Clinicians at Sandringham Sports Physio on +61 03 9131 0711 to answer your questions. Or email us for an appointment on: courses@gemtinfo.com.au

Scientific View

Spontaneous Electrical Activity (SEA)

“Results: All subjects demonstrated objective signs of spontaneous electrical activity, spike activity and local twitch responses at the myofascial trigger point sites within taut bands. The frequency of these signs was significantly greater at myofascial trigger points than at control sites (P<0.05). “

Hong C-Z, Torigoe Y. Electrophysiological characteristics of localized twitch responses in responsive taut bands of rabbit skeletal muscle fibers. J Musculoskel Pain 1994;2(2): 17-43.

Biochemical Milieu

“We have confirmed that biochemicals associated with pain, inflammation, and intercellular signaling are elevated in the vicinity of active MTrP’s. Furthermore, subjects with active MTrP’s in the upper trapezius have elevated levels of these biochemicals in a remote, unaffected muscle, suggesting that these conditions are not limited to localized areas of active MTrP’s.”

Biochemicals Associated With Pain and Inflammation are Elevated in Sites Near to and Remote From Active Myofascial Trigger Points.(Author abstract)(Report).Jay P. Shah, Jerome V. Danoff, Mehul J. Desai, Sagar Parikh, Lynn Y. Nakamura, Terry M. Phillips and Lynn H. Gerber. Archives of Physical Medicine and Rehabilitation 89.1 (Jan 2008): p16(8). Reading Level (Lexile): N/A.

GEMt’s View

Trigger point dry needling is a treatment that addresses dysfunction of the neuromuscular system.

Trigger points develop in the muscle secondary to various stresses, i.e. postural, repetitive motion, psychological, emotional etc and are more likely to develop in tissue that has neurological dysfunction likely caused by compression, disc dysfunction, facet joint dysfunction, vascular compression, metabolic stress, biomechanical stress, postural stress etc.

When muscles develop trigger points, they neurologically remain tight causing local compression of vascular, neurological and joint/biomechanical structures hampering the normal function of that tissue.

All tissues distal to the involved nerve will likely be involved. If you adequately release the muscle, the tissues then are allowed to assume normal function with improved neurological conduction and vascularity.

To the Patient

TDN is a treatment that uses fine filament (acupuncture) needles, but that is where the similarity to acupuncture stops. Acupuncture tends to be a more superficial treatment that focuses on restoring energy or “Qi” to the body. It is thought there are blockages that can be restored by properly placing needles along energy channels called meridians.

Wheras, TDN directly treats the neuromuscular system affecting muscle tightness, joint mobility, and symptoms of pain and irritation. Testing active trigger points with an EMG needle has shown that there is increased spontaneous electrical activity (SEA) at this active trigger point. It is kind of like buzzing or uncontrolled electricity causing the nerve muscle connection to trigger the muscle to be tight. This tightness can cause limited range of joint motion resulting in a reduction of normal functional activities of the whole body.

Recent research has reported that there are numerous inflammatory and pain producing chemicals at an active trigger point causing pain and dysfunction of the muscle, consequently affecting the local nerves and joints. The dry needle has been shown, when causing a local twitch response (LTR) in the active trigger point and muscle fiber, to decrease or completely reduce that spontaneous electrical activity and reduce or completely eliminate the irritating chemicals in that active trigger point. This release can immediately improve range of motion, decrease pain and improve function. Patients often feel a significant cramping sensation from the twitch response but then feel an immediate improvement of their symptoms.

Utilizing trigger point dry needing in manual therapy practice allows the patient and the therapist a hastened return to strengthening and exercise that results in a faster return to function and improved maintenance of that dysfunction.

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