As many of you have heard, I recently became certified in Functional Dry Needling (FDN). And understandably, the first question I get is, “What does it do exactly?”. This is generally followed up by, “Is it like acupuncture?” and finally “Does it work well with the chiropractic adjustment?”. All of these are fantastic questions and hopefully this blog will help to answer those and maybe a few more questions that come from this new service we will be offering at BMC!
Functional Dry Needling shares similar needles with acupuncture and that is about where the similarities end. Each treatment uses very thin needles called monofilament needles. These are much smaller than needles (hypodermic needles) used when we see our medical providers for any type of injection or blood draw. In fact, these monofilament needles are so small they can fit inside the opening of the needles that are used in medical offices. Because of this size, the insertion creates little, if any, discomfort for the patient. Dry needling gets its name from the fact that there is no liquid to inject, as we come to think of with all the different types of shots/injections.
Where the needle is placed is the first big difference between these two treatments. Acupuncture uses the philosophy of Traditional Chinese Medicine (TCM) and most insertion points are located along meridian points that are associated with body organs. According to TCM, acupuncture works by balancing the flow of energy, or qi (pronounced chee), throughout the body. When qi is blocked or stagnant, it can lead to pain, illness, and other health problems. By stimulating specific acupuncture points, practitioners can release blockages and restore the flow of qi, promoting healing and well-being.
FDN uses the same needles, but instead of using the meridians of TCM/acupuncture, the needles are inserted directly into muscles that have tight and taut bands, also known as trigger points. These tight muscles or trigger points are responsible for pain and dysfunction that occurs within these particular muscles. By inserting the needles directly into the areas of dysfunction, we are able to increase blood flow to that muscle, decrease the sensitization of the muscle (the amount of pain that is felt) and restore normal function within the muscle.
Let’s take a moment and talk about trigger points (TrPs). Everybody has TrPs but not everyone has experienced just how painful they can be. Trigger points form within the myofascia of the muscle, generally close to the muscle belly where motor end plates enter the muscle. These motor end plates receive the electrical signal from the nerves and allow for a contraction of the muscle. These TrPs are palpable nodules located throughout the body within skeletal muscle. The presence of a Trp does not guarantee pain.
Within the world of trigger points, there are two subcategories of TrPs: Active vs. Latent trigger points. Active trigger points (ATrPs) usually produce referred pain and tenderness. In contrast, latent trigger points (LTrPs) are foci of hyperirritability in a taut band of muscle, which are clinically associated with a local twitch response, tenderness and/or referred pain upon manual examination[1].
Many of us have felt these in our own bodies. Have you ever felt a “knot” in your shoulder and thought, what in the world is that? That would be a trigger point. Has that knot ever sent pain down lower into your shoulder or even into your arm? That would be an active trigger point. Have you ever been surprised that someone “found” a random knot that actually hurt when pressed on? That would be a latent trigger point.
The next question to address with this is why do these trigger points form in the first place? And probably more importantly, how can we get rid of these painful knots in our muscles? There are many causes of TrPs but the most common we see are from either acute injury or a chronic stressing of the muscle tissue. Even the chronic stressing of the tissue can be broken down into subcategories of physical stress and emotional stress. A trigger point caused by acute injury should be the easiest to understand. A very specific injury occurs to the muscle tissue. In response to the injury, the muscle tissue adapts and causes it to have dysfunction, which leads to pain. Chronic stresses work much slower. Our most commonly seen chronic stress is from poor postural positions. For example, we commonly see in our office trigger point stress in the trapezius and the shoulders. Most of these are directly connected to improper posture. For people who have forward head posture, it creates excessive tension in the neck muscles, moving down into the trapezius muscles. For the shoulders, we see people with shoulders rolled forward. This position excessively stresses the muscles supporting the shoulder blades, creating those taut and tender nodules that make up TrPs.
The emotional stress cause is probably the one most people don’t ever stop to consider. Think about how much emotional stress each of us carries with us every day. Whether it be work related, family related or all of the other reasons we have had to deal with over the past few years, we are all inundated with stressors. Unfortunately, when we are under this much stress, it does have physical ramifications. When we are chronically stressed, our muscles tend to move toward a flexed state, which increases the tension within them and overtime those TrPs can form. When we are chronically stressed, our body also releases excessive amounts of cortisol, our long-term stress hormone, which has a sensitization effect on our muscles. This sensitization can cause those muscles to become much more painful than normal.
Don’t get me wrong, there are many other causes of TrPs but I only wanted to discuss the common causes that we see in our office. Hopefully you can understand how easily these TrPs can form and more importantly, how easily they can affect our lives. Pain and dysfunction isn’t normal, but too many people continue their lives without stopping to think about how it does affect their life and their function. We have been trained that pain is “normal” and as long as we can type on a computer that we are moving “just fine”. There is more to life than that and we want to help you achieve that!
Now that we understand what we are dry needling, let us focus on the actual process of dry needling. Again, dry needling involves taking a small acupuncture needle and inserting it directly into a TrP. We do this to cause three main effects: 1. Decrease muscle tightness; 2. Increase blood flow to the area; and 3. Reduce overall pain levels.
With TrPs present, the muscle remains in a tight or contracted state. With the insertion of the needle, the muscle will sometimes have what is called a Local Twitch Response (LTR). LTRs allow the muscle to “reset” and cause receptors to exit the contracted/tight state by decreasing the tension that is present. Even without the LTR, dry needling can help release the tightness found within the muscle and help return it to its normal state of ease.
When a muscle is tight for extended periods of time, one of the physiological changes that we see is a state of decreased blood flow or ischemia, which also leads to less oxygen within the muscle. The ischemia is part of what leads to an increase in discomfort and overall sensitization of the muscle. Dry needling allows for vasodilation, or the opening up of blood vessels, which brings blood flow to the muscle, thereby increasing oxygen within the muscle. The increased blood flow also brings all of the healing nutrients found in blood and helps to eliminate/remove any waste that accumulated within the muscle.
Naturally, releasing tension and increasing blood flow is going to help decrease the sensitization within the muscle, allowing an overall decrease in pain and discomfort. Secondary effects to this also include improved range of motion and increased performance/function, which makes sense when you think about it. If your muscles are incredibly tight and it hurts when you move, most people aren’t going to move very much. Unfortunately that creates a wind-up phenomenon, which creates even more pain and tightness. If you can reduce the tension and decrease the pain in the muscle, you can return to your normal movement. The more you move, the more likely you are to continue to move.
One of the final questions commonly asked in reference to FDN is ,”does it hurt?”. In general terms, no. There is little discomfort when the needle is initially inserted. As the needle moves through the muscle, many people describe it as a muscle “crampy” feeling. Occasionally you might feel a different sensation but the crampy ache will largely but the most common. It is always “interesting” to have the first Local Twitch Response though. It is completely involuntary and can be startling, but rarely do you feel anything else with them. I have had many people comment about how little they felt as we finished the treatment.
To be clear, dry needling is not chiropractic by any stretch of the imagination. Instead, dry needling is a tool that a chiropractor can use to bring relief, help you reach your health goals and get you functioning as quickly as possible. Chiropractic itself, is the art of removing subluxations and/or nervous interference from the spine. When used together, our office has found FDN to be a great help in supporting the care that I provide to my patients through the adjustments. FDN is not a stand alone treatment. Even if it is the only treatment provided, exercises are recommended to help ensure that the changes within the muscle are more than just a temporary event. Isometric exercises are very helpful following a FDN treatment, as are gentle mobility exercises that help the muscle adapt to a more full range of motion.
Hopefully the above information has helped you understand a little more about functional dry needling. If you have any particular questions, please don’t hesitate to reach out to us. Our goal is to help you live the life that you want to live and now we have more tools in our toolbox to help you achieve that goal. If you would like to learn more about any of our treatments and how we approach them, give us a call at 303-284-7724 or shoot us an email at drchris@bmcfamilychiropractic.com and we would be happy to discuss this with you.
[1] Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 2013 Aug;17(8):353. doi: 10.1007/s11916-013-0353-8. PMID: 23801006.
