SPRING 2013

Trigger Point Dry Needling

Jessica Stepien, P.T., D.P.T.

T rigger point dry needling, also known as intra-

muscular stimulation, is a technique using a
solid filament needle to treat hyperirritable spots of
known as myofascial trigger points. Dr. Janet Travell
is recognized for bringing attention to myofascial trig-
ger points in the mid 1900’s. Dr. Travell started her
the skeletal muscle. These hyperirritable spots are medical career in cardiology and later shifted to mus-
called trigger points and are typically associated with culoskeletal conditions due to her interest in muscle
palpable nodules in taut bands of tissue. (Figure 1) pain and the impact of referred pain on patient’s dys-
Physical therapists insert a dry needle, without medi- function. Myofascial origin of pain was discovered
cation or injection, in trigger points to treat myofas- through an injection of hypertonic saline into trigger
cial pain.1 points which produced referred pain patterns. Initially,
As far back as the 16th century, myofascial pain injection of an analgesic medication into the trigger
syndromes have been recognized by medical practitio- points produced a decrease in a patient’s symptoms,
ners as causing sensory, motor, and autonomic symp- pain, and the sensitivity to touch of the trigger points.2
toms and dysfunctions. Myofascial pain syndromes After further research, it was discovered that the ac-
are associated with the palpable nodules or taut bands tual insertion and stimulation of the muscle with a dry
needle produced pain relief without the need for medi-
cation. Thus, the development of trigger point dry nee-
dling began. (Figure 2)

Figure 1.  Trigger point complex. Image courtesy of Medscape.com,

2011, available at http://emedicine.com/article/89095-overview. Figure 2.  Trigger point needling.

SPRING 2013 VOL. 8  No. 1 Journal of The Spinal Research Foundation  38

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J. Stepien/Journal of the Spinal Research Foundation  8 (2013) 38–40

The perpetuating factors of myofascial pain syn- twitch of the muscle is the desired response; how-
dromes are low level musculature contraction, unac- ever, benefits can occur even without a twitch of the
customed eccentric contraction, muscle overloads, and muscle. The simple insertion of the needle into the
muscle fatigue. These factors can be caused by, but not taut bands can interrupt the pathogenic process and
limited to, mechanical dysfunctions such as forward produce mechanical changes in the tissue. (Figure 3)
head postures, joint hypermobilities, ergonomic stres- The insertion of a needle into the trigger point can
sors, poor body mechanics, and scoliosis. produce a deep ache or cramping pressure that lasts
Dry needling techniques are developed on various only briefly. Reproduction of pain and referral of
models, which are implemented in physical therapy symptoms may also occur, and soreness may last up
practices on a daily basis. Dr. Chan Gunn contributed to 24–48 hours. Improvements in functional range of
to the development of dry needling and introduced the motion, decrease in complaints of pain, and ease of
term intramuscular stimulation (IMS), in which he de- mobility may be seen after treatment.
scribed that myofascial pain syndromes are a result of Dry needling allows access to deep musculature
radiculopathy or peripheral neuropathy, causing a dis- that may never have been reached without the use
ordered function of the peripheral nerve. This concept of a needle. By releasing the myofascial restrictions
is referred to as the radiculopathy model and is based through trigger point dry needling, a physical therapist
on the Cannon and Rosenblueth’s law of denervation, is able to further enhance a patients care and return
which states that free flow of nerve impulses maintains to function. Trigger point dry needling can disrupt the
innervated function and integrity of structures. When
any neural flow is disrupted, all the structures that
are innervated by that nerve, such as skeletal muscle,
smooth muscle, spinal neurons, sympathetic ganglia,
and sweat glands, are affected and can become atro-
phic, highly irritable, and hypersensitive. The trigger
point model describes myofascial trigger points con-
sisting of taut musculature bands due to the excessive
release of acetylcholine. Myofascial trigger points are
classified as active or latent. Active myofascial trig-
ger points can cause local and referred pain, or other
parasthesias, whereas latent myofascial trigger points
may not produce pain without being stimulated. Ac-
tive myofascial trigger points typically refer pain to
a particular site, and these sites are not restricted to
a single segmental or peripheral nerve distribution.
Clinically, myofascial trigger points can cause motor
dysfunction or muscle weakness as a result of motor
inhibition, restricted motion, and muscular stiffness.
Furthermore, sensory dysfunctions may be noted
through localized tenderness, referral of pain to spe-
cific areas, hyperalgesia (extreme pain reaction to a
painful stimulus), and/or allodynia (pain reaction to a
non-painful stimulus).
The goal of the insertion of a fine filament needle
Figure 3.  Identification of trigger by low-twitch response to palpa-
into a trigger point is to produce a twitch response tion. Image courtesy of Medscape.com, 2011, available at http://
(short contraction) of the muscle being needled. The emedicine.com/article/89095-overview.

39  Journal of The Spinal Research Foundation SPRING 2013 VOL. 8  No. 1
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New Horizons in Spine Treatment

neurological feedback loop eliciting pain in the mus- References

culoskeletal system.
1. Dommerholt J, Mayoral del Moral O, Grobil C. Trigger Point
Myofascial trigger point dry needling has no simi- Dry Needling. J. Man. Manip. Ther. 2006;14(4):E70–E87.
larities with traditional acupuncture except for the tool 2. Dommerholt J, Bron C, and Franssen J. Myofascial Trigger
being used during the process.3 Traditionally, acu- Points: An Evidence-Informed Review. J. Man. Manip. Ther.
2006;14(4):203–221.
puncture is based upon Chinese medicine that seeks 3. Itoh K, Katsumi Y, Kitakoji H. Trigger Point Acupuncture Treat-
to regulate flow and stability of energy through sub- ment of Chronic Low Back Pain in Elderly Patients—a blinded
cutaneous placements of needles. Acupuncture points RCT. Acupunct. Med. 2004;22(4):170–177.
are points mainly along the paths of energy flow (or 4. American Physical Therapy Association. Physical Therapist &
the Performance of Dry Needling—An Educational Resource
meridians). In contrast, trigger point dry needles are Paper. 2012;2–5.
inserted into specific musculature, targeting tight mus-
cles, and based on neuromuscular and biomechanical
principles. Jessica Stepien, P.T., D.P.T.
Trigger point dry needling is a novel technique in Dr. Stepien is a physical therapist at The
physical therapy.4 Internationally, Australia, Belgium, Virginia Therapy and Fitness Center.
Canada, Chile, Denmark, Ireland, The Netherlands, Her certifications and training includes:
New Zealand, Norway, South Africa, Spain, Sweden, North American Institute of Orthopae-
and Switzerland have recognized trigger point dry dic Manual Training, Level I & II; Thera-
band Academy, Beyond Ball, Institute of
needling to be within the scope of practice for a physi- Advanced Musculoskeletal Treatments,
cal therapist. In the United States, each state licensure Trigger Point Dry Needling. Jessica’s commitment to quality in
board determines the appropriateness of dry needling patient care returns her patients back to physical excellence
within the state’s scope of practice for physical ther- while achieving their goals and maximizing their quality of life.
apy. In 1984, Maryland was the first state to approve During her graduate studies, Jessica was awarded the K. Mad-
dry needling as a technique within the scope of physi- ison Smith Award for Clinical Excellence as voted on by her
clinical internship instructors, the 2012 Outstanding Graduate
cal therapy practice. The acceptance of dry needling is Award as voted on by her Shenandoah University professors,
rapidly spreading. As of 2012, approximately 30 states and received the Best Performance on Physical Therapy Com-
have approved dry needling as a procedure within the prehensive Exam for her graduation class.
scope of the physical therapy practice.

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