Deep dry needling (DDN) is an invasive procedure in which an acupuncture needle is inserted into the skin and muscle.
DDN is directed at myofascial trigger points (MTrPs), which are defined as “hyper-irritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band”. MTrPs may consist of multiple contraction knots, which are thought to be due to an excessive release of acetylcholine (ACh) from select motor endplates, and can be divided into active and latent MTrPs.
Active MTrPs can spontaneously trigger local pain in the vicinity of the MTrP, or they can refer pain or paraesthesiae to more distant locations. They cause muscle weakness, a range of motion restrictions, and several autonomic phenomena.
Latent MTrPs do not trigger local or referred pain without being stimulated, but they may alter muscle activation patterns and contribute to limited range of motion.
Diagnostically, DDN can assist in differentiating between pain that originates from a joint, an entrapped nerve, or a muscle.
Mechanical stimulation or deformation of a sensitized MTrP can reproduce the patient’s pain and may assist in the differential diagnostic process.
One of the unique features of MTrPs is the local twitch response (LTR), which is an involuntary spinal cord reflex contraction of the muscle fibers in a taut band following palpation or needling of the band or MtrP.
Despite a growing body of literature exploring the etiology and pathophysiology of MTrPs, the exact mechanisms of DDN remain elusive. Possible explanations of its efficacy include normalisation of the chemical environment of the active MTrP or lengthening of the cytoskeletal structures secondary to induced stretch reflexes.
DDN falls within the scope of physiotherapy in many countries and here at West Limerick Physiotherapy Clinic, it is one of our most popular and successful procedures.