I must admit that I am always looking for new ways or tools to enhance my practice and work as a sports physical therapist. I recently completed the necessary hours of training to perform dry needling in the state of North Carolina. I trained with Myopain Seminars and have nothing but great things to say about their courses.

For those unfamiliar with trigger point dry needling (TDN), it is a treatment gaining traction in the therapy world. Dry needling is a treatment that involves a very thin needle being pushed through the skin to stimulate a trigger point. Dry needling may release the tight muscle bands associated with trigger points and lead to decreased pain and improved function for those suffering from pain related to muscular dysfunction.

Trigger points may ultimately refer pain to other sites, and research indicates that TDN can reduce acidity in the muscle and clear out pain propagating chemicals. The picture below is an example of me performing trigger point dry needling to the upper trapezius of a 16 y/o female.


This particular client had been suffering from an inability to lift the arm above shoulder height and marked shoulder pain since September 2013.  She also mentioned having headaches at school.  Clinically, she was diagnosed with multi-directional instability and scapular dyskinesis by the referring MD. We began working on a scapular stabilizer and rotator cuff strengthening program in late November that was helping to diminish pain and increase function. However, she continued to c/o pain in school, stiffness and headaches.

In light of the chronic pain/headaches, I advocated dry needling to the patient and her mother about 3 months into our therapy. I focused on the upper trapezius and levator scapula muscles. After three sessions of TDN, she reported a complete resolution of shoulder pain and headaches.  This is one of several dramatic responses I have seen in the past month.

Other noteworthy cases:

1.A 46 y/o male patient  with a 1 year history of low back, hip, pelvic floor and abdominal wall pain reports feeling the best he has since before the pain began after a single session of TDN to his lumbar multifidi.  In fact, he reported complete relief that lasted about 2 weeks after one session.  He had been treated by a pelvic floor specialist with some success in the past, but noted a persistent abdominal pain pattern that limited his workouts.  See the image below for the referral pattern of the muscle as it explains why I focused in on the multifidi based on his symptoms.


2. A 37 y/o female runner has been battling chronic heel pain for 11 months, and medical treatment and home remedies have failed.  She also suffered an ACL tear and was rehabbing at another facility.  She was referred to me for a higher level functional progression at 12 weeks post-op.  Unfortunately, her heel pain was preventing her from moving forward.  She had received 6 injections in her foot/heel from a podiatrist in the past year with no relief. Upon assessing her, she had positive trigger points in her medial soleus and I suspected this may be a big part of her pain.

I talked with her about dry needling and she wanted to try it.  After one session, she reported a 50% reduction in pain.  She was 75% better after the second session and virtually pain free after the third session.  She felt so good, she decided to run a mile. While she had no pain during this, she was sore afterward.  So, she is not completely over the issue, but readily acknowledged she felt great for the first time in 11 months after the three needling sessions.  The image below explains my rationale behind needling the soleus as it refers pain to the heel and bottom of the foot.


These are just a few examples of patients facing chronic pain who failed to resolve pain with traditional approaches.  While, I am not using TDN with all my patients, it is an excellent way to treat chronic myofascial pain and can help facilitate and/or accelerate healing.  We must keep in mind how the fascial system works and not overlook the possibility of referred pain related to trigger points.

Below are two references about the effectiveness of needling with respect to treating adhesive capsulitis and chronic hamstring tendinopathy.

Click here to read the adhesive capsulitis abstract

Click here to read the proximal hamstring tendinopathy abstract

Clearly, we need more research to help identify the best applications for dry needling, but the early impact in my practice has been astounding.  I look forward to seeing how it changes my practice moving forward!