The Needle Effect
In 1978, a Czech doctor, Karel Lewit, published a landmark study in the Journal Pain.
His study looked at therapeutic injection techniques for myofascial pain. In his analysis of 241 patients, he concluded that “it appeared that it was the puncture of the needle that was the common denominator, not the substance that was injected.”
He went on to say that “the effectiveness of the treatment was related to the intensity of pain produced at the trigger zone and to the precision with which the site of maximal tenderness was located and stimulated by the needle”.
The significance of this study is two-fold:
Firstly, while it is true that many trigger points have been shown to correspond to classical acupuncture points, these points should only serve as a starting point in the assessment used to identify optimum needle placement.
Ultimately, observing functional movements and range of motion, along with provocation and palpation, will be the key to determining optimal needle placement in order to achieve the needle effect and subsequent pain relief.
Secondly, since the therapeutic effect is mechanical, minimally invasive needling techniques, such as dry needling, can be used, as these have less risks and potential for adverse reactions.
Dry needling is also more cost effective and is easy to perform with the appropriate training.
A closer look at common needling techniques
Lidocaine or Procaine are commonly used in the management of myofascial pain. These medications anesthetize the area, however, beyond that, offer little if any additional benefits.
A study by Eroglu showed that treatments with dry needling, lidocaine injection and oral flurbiprofen, along with home exercises, were all effective in the management of myofascial pain syndromes.
In addition, Ga demonstrated that there was no significant difference between acupuncture needling and 0.5% lidocaine injection of trigger points for treating myofascial pain syndromes in elderly patients.
(Eroglu, 2013) (Ga, 2007)
Prolotherapy, also known as proliferation therapy or regenerative injection therapy, involves injecting an irritant solution, such a dextrose, into the body, generally in the region of tendons or ligaments, for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain.
Prolotherapy is thought to work by stimulating a local inflammatory reaction that initiates the healing process.
Because tendons and ligaments have a lower blood supply, the healing process of these tissues is often compromised or delayed.
Prolotherapy has been theorized to augment the healing process in these tissues.
The current trend is to use platelet injections for conditions such as tendonosis, as a form prolotherapy.
A study by stenhouse et al compared dry needling as a stand-alone procedure versus dry needling and autologous conditioned plasma (PRP) and found no significant difference between PRP and dry needling. This further supports the contention that the needle effect may be at play as the mechanism behind tissue healing.
Another study by James et al concluded that dry needling and autologous blood injection under ultrasound guidance showed promise as a treatment for patients with patellar tendinosis.
(Stenhouse, 2013) (James, 2007)
Dry needling (AKA, Intramuscular Stimulation- IMS), has been shown to have three primary effects:
- A stretch receptor (muscle spindle) in the muscle is stimulated, producing a reflex relaxation (lengthening).
- The needle causes a small injury that draws blood (Platelet derived growth factor) to the area, initiating the natural healing process.
- The treatment creates an electrical potential in the muscle that restores nerve function.
(Gunn, 1996 ) (Hsieh, 2012)
Functional, Kinetic and Fascial Dry Needling- A new development
Last summer I took a course called FAKTR. FAKTR is the acronym for Function and Kinetic Treatment with Rehabilitation and Provocation.
The theory behind this approach is that injuries and pain are not always static.
Many times there are specific movements, positions or activities that provoke the pain.
Given that this is the case, it would make more sense to treat the pain during the specific movements, positions or activities that illicit it.
FAKTR use Instrument Assisted Soft Tissue Mobilisation (IASTM).
I have started using superficial dry needling while having my patients move or reproduce positions that provoke their pain.
Because the needles are inserted superficially (into the fascia), there is minimal discomfort. In fact, in many cases the needle is barely inserted into the tissue.
By combining FAKTR and superficial dry needling, the trigger point release and subsequent pain relief is often instantaneous.
While the needle effect can often provide instantaneous and lasting relief, a problem can recur if the perpetuating factors aren’t addressed.
Perpetuating factors can include:
- Ongoing postural strain due to ergonomics, poor mechanics or kinetic chain imbalances that have led to faulty movement patterns
- Nutrition or dietary inadequacies/imbalances
- Thyroid or other metabolic problems
- An underlying disease process, e.g. arthritis, inflammatory bowel disease etc
- Ongoing stress
If you have pain, you should experience the “needle effect”.
Eroglu, PK, Yilmaz, O, Bodur, H, Ates, C: 2013. A Comparison of the Efficacy of Dry Needling, Lidocane Injection and Oral Flurbiprofen Treatments in Patients with Myofascial Pain Syndrome: A Double- Blind (For Injection, Groups Only) Randomized Clinical Trial, Turk J Rheumatol, 2013;28(1): 38-46.
Ga, H, Choi, JH, Park, CH, Yoon, HJ. (2007). Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients- a randomized trial. Acupuncture in Medicine 2007;25(4):130-136.
Gunn, C. (1996). The Gunn Approach to the Treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin, Churchill Livingstone; 2 edition (August 6, 1996)
James, S, Ali, K, Pocock, C, Robertson, C, Walter, J, Bell, J, Connell, D: 2007. Ultrasound guided dry needling and autollogous blood injection for patellar tendinosis, Br J Sports Med, 2007; 41:518-522.
Hsieh, Yueh-Ling, Yang, Shun-An, Yang, Chen-Chia, Chou, Li-Wei. Dry Needling at Myofascial Trigger Spots of Rabbit Skeletal Muscles Modulates the Biochemicals Associated with Pain, Inflammation, and Hypoxia. Evidence-based Complementary & Alternative Medicine. 2012, p1-12.
Stenhouse, G, Sookur, P, Watson, M. (2013). Do blood growth factors offer additional benefit in refractory lateral epicondylitis? A prospective, randomized pilot trial of dry needling as a stand-alone procedure versus dry needling and autologous conditioned plasma. Skeletal Radiol (2013) 42:1515-1520.