Kristina Carter, DPT
Pivot Physical Therapy
Formerly Tidewater Physical Therapy
May 20, 2017
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Understand the definition of a trigger point
Understand the benefits of dry needling and
who it may help
◦ Mini-case study
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Observe a dry needling treatment
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Invasive procedure
◦ Precautions/contraindications
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Solid filiform needle inserted directly into the
trigger point
◦ Vary in length and diameter
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Almost every muscle is “needle-able”
Goal is relief of pain through the release of
the trigger point
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1960’s researched myofascial pain syndrome
◦ Chronic pain caused by multiple TrPs
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Referred pain patterns
Recent advances in imaging have validated
her hypotheses
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Pain related to a discrete, irritable point in
skeletal muscle or fascia
The painful point can be felt as a nodule 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
The great “mimicker”
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Unaccustomed eccentric exercise
Poor posture
Repetitive activity in untrained muscles
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Muscle weakness
Inhibition
Increased motor irritability
Altered motor recruitment
◦ Restrictions in ankle ROM were corrected after
manual release of latent TrPs in the soleus (Grieve
et al. 2011)
Active Trigger Point
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Taut bands reproduce
their symptoms and is
recognized as familiar
pain
Pain is often referred
from the palpated
tissue and follows
referred pain patterns
Latent Trigger Point
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Taut bands are present
but they are not always
painful upon palpation
and do not refer pain
Contribute to
decreased ROM in
effected area
Can turn into active
TrPs
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Excessive acetycholine
Sustained depolarization
Impedes local blood flow
◦ As seen on MRE and US
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Heat
Cold
Ultrasound
Electrical stimulation
Correction of muscle imbalances
PNF
Myofascial release with external pressure
applied to the tissue
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Invasive procedure
Solid filiform needle inserted directly into the
trigger point
Goal is a local twitch response
◦ Involuntary spinal cord reflex
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Endogenous opoid activation
Restoration of normal tissue length
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Relief can be immediate
Very specific to muscle—can help in
confirming diagnosis
Can be active immediately after
Can be used in conjunction with other
traditional therapies
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College football player with history of MCL
tear 10 months prior to evaluation
Two recent episodes of medial hamstring
pain following sprinting in preseason practice
◦ No weakness with MMT
◦ Medial hamstring very reactive to palpation or quick
stretch
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TrPs found in pes anserine muscles—WHY?
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Residual valgus laxity from MCL tear caused
increased load on pes anserine muscles as
they cross the knee
Treated with dry needling and bracing/taping
to reduce instability
Able to participate with no time loss after
two dry needling sessions
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Thank you!