Written by Milan Lassiter, DC, 1303 W. Main St, Richmond, VA and reached at (804) 254-5765.
People with muscle pain may seek out care with their MD, often ending up with one of 3 different types of medications: muscle relaxants, anti-inflammatories, or pain meds. Sometimes this will give a bit of relief of the symptoms, but they rarely resolve the actual cause of the problem.
Myofascial pain is the pain coming from muslce (myo) and fascia (the surrounding connective tissue around the muscle). One of the common findings with myofascial pain syndromes is something called a “trigger point.” A trigger point is a tight band of contracted muscle, often felt as a “knot,” and responsible for ongoing pain and dysfunction. A trigger point will often cause a pattern of referred pain, which is pain that is noted at a location away from the actual origination site of the problem.
A trigger point “knot” exists somewhere between 3 different states: Active, passive, and latent. Active trigger points are the ones that are obvious; the ones you know that you have. Conversely, a passive trigger point is not evident, but would elicit a response if I started palpating around the area. Even more insidious are the third type: the latent trigger point, which have not yet manifested, but can be detected by a qualified practitioner. Many therapists who do dry needling insist that, in order for the needling effect to be effective, it’s essential to elicit something called the latent twitch response (which feels like a grabbing or cramping around the needle). Although it is desirable to have an active trigger point elicit the latent twitch response, a latent trigger point very well may not elicit that response.
Trigger point dry needling is one of the most effective treatment options available to resolve a myofascial trigger point in any of these 3 states previously mentioned.
Here is a synopsis of how a trigger point is formed:
1) Something causes pain. If the insult occurs repeatedly or if the trauma is severe enough, the pain can form a feedback loop. Technically, the pain signal may return through a part of your nervous system called the sympathetic nervous system, activating pain receptors (called nociceptors) and feeding back to the spinal cord. This is called a Reflex Arc, which causes the pain to continue instead of fading away.
2) The nerve that goes out to a muscle (a motor neuron) can become stuck in the Reflex Arc loop, causing a muscle to contract and spasm, sometimes lasting for years or even decades.
3) Introducing a new stimulus (dry needling) directly into the trigger point causes a disruption of this feedback loop, impedes the Reflex Arc from continuing, and has the effect of relaxing the muscle.
A contracted, spasmed, “knotted” muscle becomes a damaged muscle. Spasm reduces blood flow in the muscle, which means less oxygen and nutrients to the muscle. Muscle fibres die off and build up adhesive, fibrous scar tissue. This in turn holds the muscle in a tightened, shortened position and prevents the muscle metabolism by-products from leaving the muscle, which continues the cycle. What you’re left with is a muscle “knot” or a tight band of muscle that won’t seem to go away, instead restricting your ability to move the area and causing pain. Putting a needle into a spasmed muscle or trigger point causes the muscle to relax, which can be seen with an EMG (electromyogram), has been corroborated by many randomized research studies, and has been researched extensively by Dr. Karel Lewit, MD.
So there you have it: with regard to a trigger point, it’s not the injection of cortizone or taking some pill that resolves the problem. It’s the actual needle, inserted into the correct spot, by someone who’s trained and certified to do so. I have been trained and certified to do this procedure and have found it to be an indispensable procedure for the physical rehabilitation of many problems that come to my office in Richmond, VA.