Dry Needling

Question 1

Describe the muscle trigger point crisis theory

Answer 1

• Injury to the muscle fibers results in unregulated CA++ ions to be related
• Results in continual contraction & ischemia of the muscle fiber & further lack of O2 & increased metabolic demands result in the “Energy Crisis”
• This presents clinically as a tight band

Question 2

Describe the different mechanisms of trigger point dry needling (TDN)

Answer 2

• Myofascial trigger point (MTrP): “hyper-irrritable” spot Taut Band or denser area within a muscle
• Active TrP: site of spontaneous pain or pain with movement
• Latent TrP: site with pain responding to compression
• Local Twitch Response: brief contraction of the tense muscle fibers in response to palpation & particularly strumming/snapping the taut band

Question 3

Describe the relationship between trigger points & central sensitization

Answer 3

• Same process of acute to chronic pain also occurs in myofascial trigger points
• Neuromatrix Theory: consider TPs as input but also output
• Contribution to central nocioplastic changes

Question 4

Define a mediator

Answer 4

• Process variable that influences the outcome

Question 5

Define a moderator

Answer 5

• Variable prior to treatment that interacts & influences outcome

Question 6

Contraindications for dry needling

Answer 6

• Medications that prevent clotting
• Metal allergies
• Cosmetic implants
• Phobia to needles (Trypanophobia)
• Local or Systemic infection
• Blood borne pathogens
• Vascular or Lymphatic disease or skin conditions at the DN site
• Pregnancy

Question 7

Describe flat palpation

Answer 7

• Non-dominant hand transverse to the muscle fiber direction isolate the trigger point between finger tips

Question 8

Describe pincer palpation

Answer 8

• Use to guide needle direction AWAY from adverse anatomical structures
• Non-dominant hand grasps the tissue & palpated the trigger point
• Thumb on bottom serves as target for needle insertion