Several studies demonstrate a high prevalence of pain due to myofascial trigger points. One researcher suggests that prevalence of pain originating from myofascial trigger points in a general pain practice can reach the level of 85 percent. The recognition of the myofascial pain phenomenon by the medical community as one of the key pain generators has led to the development and expansion of a variety of myofascial therapy interventions.
Two instrument-assisted means of treating chronic pain conditions are acupuncture and trigger-point dry needling. Unfortunately, many therapists confuse the terms acupuncture and dry needling, or use the terms interchangeably. However, a clear and definitive distinction exists between the two modalities, and a distinction must be made to avoid confusion.
Trigger-point dry needling is one of many treatment methods for myofascial trigger points and it is not proprietary to one specific profession. Trigger-point dry needling is practiced around the world by physicians, physical therapists, acupuncturists, chiropractors, osteopaths, dentists, nurses and many other properly trained healthcare providers who specialize in the treatment of myofascial trigger points.
Dry needling is the insertion and repetitive manipulation of a fine, flexible, filamentous needle within a myofascial trigger-point area that produces repetitive local twitch responses and leads to inactivation of the trigger point or a decrease of the trigger-point activity. Preliminary research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.
It's unfortunate that a number of acupuncture practitioners and some of their associations try to equate dry needling with acupuncture, and to make dry needling proprietary to acupuncturists. Some do this by using a modified definition of acupuncture points, which defines an acupuncture point the same as a myofascial trigger point. This creates confusion regarding appropriateness of treatment, which may have negative consequences on consumers deciding on the most appropriate provider for their condition.
Belgrade supports that "tender points are acupuncture points and can be often chosen for therapy."1-3 Belgrade uses one of the major criteria used to define a trigger point to also define an acupuncture point. Issues become even more confusing when one considers that trigger-point dry needling,4-6 one of the major treatments for myofascial trigger points, is performed with an acupuncture needle.
Acupuncture is a traditional system of Chinese medicine that has been practiced for more than 2000 years.7 The Florida State Code defines acupuncture as follows: "Acupuncture" means a form of primary health care, based on traditional Chinese medical concepts and modern oriental medical techniques, that employs acupuncture diagnosis and treatment, as well as adjunctive therapies and diagnostic techniques, for the promotion, maintenance and restoration of health and the prevention of disease. Acupuncture shall include, but not be limited to, the insertion of acupuncture needles and the application of moxibustion to specific areas of the human body and the use of electroacupuncture, Qi gong, Oriental massage, herbal therapy, dietary guidelines and other adjunctive therapies as defined by board rule.
In some manner, the ancient Chinese became aware of certain sensitive skin areas (sensitive points) when a body organ, muscle or function was impaired. They also observed that these sensitive skin areas were the same or similar in all people who suffered from the same impairment. Moreover, the sensitive areas varied consistently according to the organ or muscle function deviating from the norm. It was at this point that some of the relationships among various internal organs or muscles and their functions were observed and established.7-9
Acupuncture was introduced to the West in the 17th century by Jesuit missionaries sent to Peking. In the 1940s, French sinologist and diplomat Soulie de Morant published his voluminous writings on acupuncture.8
Acupuncture was first introduced in the United States in the late 1960s. Since then, Western licensed acupuncturists use acupuncture primarily for the treatment of various conditions such as gastrointestinal problems,
gynecological conditions, infertility, musculoskeletal problems, immunological conditions, smoking cessation and many others.
Melzack et al found a 71-percent correlation between trigger points and acupuncture points for the treatment of pain.10 Melzack's contention was that trigger points and acupuncture points may have the same neural mechanism. However, new discoveries clearly demonstrate that the trigger-point phenomena originate in the vicinity of dysfunctional endplates,11-12 and this puts an end to the previous claim by Melzack. In a subsequent article, Melzack defines acupuncture and trigger-point dry needling as two distinctively different approaches.13
Recognizing the Distinction
Despite some similarities in terms of location between acupuncture points and trigger points, the objective clinician and researcher must recognize the distinct differences. These differences define acupuncture points and trigger points as two completely different clinical entities with possible overlaps.5-14
There are foundational and pathophysiological differences between trigger points and acupuncture points. Classical acupuncture points are identified as precise points along meridians defined by ancient Chinese documents.9 An exception to that are extrameridian and "achi" points. Conversely, myofascial trigger points may be found anywhere within a muscle belly, and there is evidence that their pathophysiological mechanism resides in dysfunctional endplates.12,15
Trigger-point dry needling is a very effective clinical intervention for the treatment of myofascial pain syndrome. While this intervention uses a thin filamentous stainless steel needle, the same as an acupuncture needle, it is distinctly different from acupuncture both in the rationale and its means of application.5-14
It is important to understand that these two approaches are very different and require different training for their clinical application.
Trigger-point dry needling is not proprietary to one specific profession, but can be practiced by properly trained healthcare providers. Scientific merit requires that we are clear in our distinction between these two separate treatment approaches.
References are available at www.advanceweb.com/pt under the Resources tab.
Dimitrios Kostopoulos graduated from the New York College of Traditional Chinese Medicine and UHSA School of Medicine. He can be reached at firstname.lastname@example.org. Konstantine Rizopoulos is a graduate of Evidence in Motion's DPT program. He can be reached at email@example.com They are founders of Hands-On Seminars (www.handsonseminars.com) and Hands-On Care Physical Therapy in New York.
Therapist, Heal Thyself
The concept for a soft-tissue therapy device evolved over the past 25 years treating
patients with every condition from carpal tunnel syndrome to low-back
pain to plantar fasciitis and more.
About seven years ago, I found myself in the middle of battling
carpel tunnel syndrome and osteoarthritis in both of my hands, wrists
and forearms from the years of practicing soft-tissue therapy without
using any professional quality instruments.
I searched for a tool that could facilitate my manual therapy
techniques and that would ultimately help me get better results for my
patients. Finding none, I knew I had to create something myself that
would help me continue practicing all of those soft-tissue therapy
techniques while simultaneously protecting and rehabilitating myself.
The bene?ts of the soft-tissue therapy tool are numerous for both the
patient and the therapist. Every millimeter is designed to be in
contact with the human body either as a treatment surface, handle/grip
The device is very capable at implementing a wide variety of
orthopedic and manual soft-tissue therapy treatments, techniques and
conditions. These include but are not limited to IT band syndrome,
rotator cuff injuries, nerve entrapment, osteoarthritis, psoas release,
TMJ, tennis elbow and carpel tunnel syndrome. Clinicians can implement
almost any soft-tissue therapy technique regardless of whether it is
traditionally applied with a tool or with just the hands. The
soft-tissue therapy tool enables clinicians to seamlessly integrate a
wide variety of both hand and instrument therapies and techniques with
stellar results and ease of use.
Self treatment is another designed strength of the soft-tissue
therapy tool. A user can easily and effectively treat more than 90
percent of their own body, from the trapezius and teres muscles to the
glutes, piriformis, calves, feet, hands, elbows, hips and knees. I was
able to treat my carpel tunnel condition successfully with the
prototypes I had created of the device.
For therapists with limited treatment time, the tool can make a
signi?cant impact in as little as a minute or two. It is especially good
for isolated pressure points, cross-friction ?ber and myofascial
This tool is extremely efficient because of the increased leverage
and mass that add a tremendous value to the practitioner. They will only
need a fraction of the force that they would normally apply to
implement the treatment. It is much easier to guide the weight than it
is to create the force.
The ability to "feel" the tissues is greatly enhanced when utilizing
this instrument, much like a needle on a record player as it picks up
the vibrations of the music. Treatment with the device is a very stable,
comfortable and balanced experience for the therapist. One of the
central design elements was to free up the therapist's ?ngers during the
treatments so they could be used in conjunction with the instrument to
stay in full patient contact.
Now, clinicians have twice as much feedback since both the instrument
and their ?ngers are actively involved in the treatment. The key thing
here is that the instrument by design absorbs all of the treatment force
through the palm of the hand and not the ?ngers. Therapists should see
the soft-tissue therapy tool do the treatment and let it work for them.
Michael Conchard is an exercise physiologist and the president of Soft Tissue Therapy Tools in Indianapolis.