.. DRY NEEDLING N°1 Trigger Point-BMN

.. DRY NEEDLING N°1 Trigger Point-BMN                  

Dolor osteomuscular crónico -N°1- síndrome de dolor miofascial. PUNCIÓN SECA y la BMN.

Trigger point Dry Needling (or Intramuscular Manual Therapy. Trigger point needling Functional dry needling. Intramuscular stimulation). 

Abbreviations
TP, TPs: Trigger Point, Trigger Points.
DN: Dry Needling
WN: Wet Needling
AP, APs: Acupuncture Point, Acupuncture Points.
Ac: Acupuncture.

The Trigger point_ TP, TRAVELL and SIMONS, is defined as a tender nodule, a knot inserted in a palpable taut band of a skeletal muscle. 

DN involves palpating the taut band within the affected muscle, isolating the tender nodule, and inserting an acupuncture needle directly into the TP to cause a muscle twitch, a reflexive relaxation and lengthening of the muscle.

This set of manipulations, deactivates the TP responsible for the musculoskeletal pain and impaired movement caused by trauma or disease but ignores the root cause as it is not a holistic treatment but this approach is evolving …

TPs, Acupuncture Points and Ashi Points 
Many TPs are confused with APs.
Dorsher & al., determined that of the 255 TPs, listed by Travell and Simons, 234 (92 percent) had anatomic correspondence with classical, miscellaneous, or new APs listed in Deadman & al.

·                     For Acupuncture
Outside the listed APs there are APs commonly termed ‘Ashi point’ that do not necessarily correspond with traditional point locations. 
Ashi points are specific tender spots, palpated in a pain area and painful when pressed, without name, randomly located and only selected in accordance with the syndromes or diseases.

Ashi points are often not technically APs or on specific meridians but have a clinical effect nonetheless.

They are treated and needled in Acupuncture according to a classically and globally approach.

·                     For Dry Needling 
In front of the same components, for the Therapist using TPs, this falls within his jurisdiction with exquisitely tender and hyperirritable spots, included in a taut band of a skeletal muscle, painful on deep palpation and originated of a referred pain and motor dysfunction in deep palpation. Inserting an acupuncture needle into the area, in concordance with the TPs treatment or DN, pain or sufferings are relieved after having reproduced the pain spontaneously felt.

‘ Either Acupuncture or DN, deepen palpation allows finding musculoskeletal tender points interpreted for millennia as Ashi points by the Acupuncturist and since 50 years as TPs by Professionals in DN’. 
Both are treated by insertion of acupuncture needles either compact or hollow with the possibility for the latter (the BMN) to associate Acupuncture and DN respectively with Mesopuncture and Wet Needling _WN.

The Distal Trigger Points 
Evolution of the DN treatment, as including distal TPs in DN, brings DN nearer to Acupuncture

Some authors recommend to research and treat the distal TPs, away from the primary TPs.  This recommendation involving, in the TPs treatment, the distal TPs is similar to the conventional diagnostic and therapeutic approach, performed in Acupuncture, since a lot of years, for research and treatment of local and remote APs.

·                     The facts 
About 75% of pain is caused by TPs. Over 74% of common TPs are located remote to the area where the patient feels pain.

·                     Therefore, in a Patient too sensitive to be needled in the area of the primary pain source, the treatment can be initiated with distal needling. A recent study demonstrated that distal points needling reduce proximal pain by means of the diffuse noxious inhibitory control.

·                     Distal TPs are listed in Pain guides available on the internet. Then they will be adapted to the particularism of each patient.

In summary
Insertion of a needle into a TP, confused with an AP, could be likened to Acupuncture. 
Injection of a liquid drug into a TP could be equated with Mesopuncture.
Research and involvement of remote TPs in the DN treatment is a classical approach in Acupuncture.   

. Dry Needling N°2- Trigger Point - BMN

. Dry Needling N°2- Trigger Point - BMN

Extension of the Dry and Wet Needling activity field

Dry needling can be appropriate and very helpful for Patients with chronic pain, of undetermined origin but clearly identified not to be of internal organ origin especially when other interventions have failed, although DN initiated being limited to the local area of pain only: Extending its field of activity in the treatment of any non-visceral chronic pain by TPs is also a classical approach to Acupuncture… …

DN and needles

·                 Hypodermic needle, 1981.

In 1981, having found that, the effectiveness of the alone needle insertion, was identical to the liquid drug injection, TRAVELL & SIMONS recommended the use of a single hypodermic needle, without injection.

“In comparative studies, DN was found to be as effective as injecting an anesthetic solution such as procaine or lidocaine in terms of immediate inactivation of the TP”. 

DN focuses only, on treating the locally musculoskeletal pain and dysfunction by inserting hypodermic needles into the locally painful area.

TECHNIQUE OF THE DN

Dry Needling DN is a treatment technique used in conjunction with other treatments to inactivate the TPs and treat pain and dysfunction they cause.

The interventionist therapist will not have to stimulate, in principle, any distal or auricular AP during the treatment with DN but he can find more than one TP in a muscle and more than one muscle with numerous TPs.

It was used originally in DN, a sterile hollow hypodermic needle, inserted in an empty or 'dry' syringe body (empty as opposed to a syringe filled with injectable solution used, in the Wet Needling) inserted through the skin and muscle, to reach directly the TP, without drug injection: Proper placement of the needle into the TP causes a localized muscle contraction.

Currently, is used an acupuncture needle, controversial use by Acupuncturists because Acupuncture Needle involves Care or Acupuncture session.

Whatever it is the needle is inserted into the TP, located in an area, the Taut Band, where the muscle is stretched, contracted and sensitive: The perceptible or visible flexion of this band of muscle fibers confirms the correct insertion of the needle into the TP.

It is an involuntary spinal cord reflex, in which the muscular fibers of the stretched muscle band contract, due to a reflexive relaxation and elongation of the muscle fibers, improving the overall muscular flexion and relieving altered motions.

Repeated movements of the needle, for about one minute in situ, in its insertion point, without completely removing it, help to inactivate the TP allowing, in the absence of pain and by an involuntary spinal cord reflex, the overall muscle contraction, its lengthening and improving flexibility. 

These manipulations can be painful, a fortiori if, more than one TP in a muscle requires needling and more than one muscle with multiple TPs, is involved: Perhaps a few drops of anesthesia would be appreciated, interesting possibility when using the BMN.

Mechanism of Action

The exact mechanisms of the therapeutic effects of the needle insertion into the TP are not fully understood, although the principle behind DN is known as being the reflex arc.

Studies, Dr. Jay Shah and colleagues and other Authors, have shown that Dry Needling,

·                 Disrupts mechanically the integrity of the dysfunctional endplates within the trigger area.

·                 Causes, locally, favorable biochemical changes which aid in reducing the pain, partially.

·                 Involves supra-spinal pain control via midbrain periaqueductal gray matter.

DN also affects the central nervous system about the perception and modulation of pain.

**- No mention is made of the role of connective tissue, its fundamental substance particularly, like the role described thereto, in Acupuncture, in the management of the therapeutic effect due to the implantation of the acupuncture needle in the soft tissue, into the APs location in the connective tissue.

Another hypothesis about the healing mechanism

  Dry Needling injures and causes minor bleeding within the tissues. The minor trauma elicits a local inflammation, recognized by the body as an acute problem area, requiring an increased blood flow while usually this area has a poor blood circulation. By increasing bleeding and blood flow into the tampered area the body tries allowing the area to heal.

·                 Acupuncture Needle, 1999.

In 1999, on the second edition of their book, Travell and Simons advocated, for disabling the TPs, to use an acupuncture needle, thin, compact and less painful than a hypodermic needle, wider in diameter.

This recommendation allowed the Professionals to mitigate the insertion and manipulation pain of the hypodermic needle into the TP, already spontaneously painful.
Moreover, hypodermic needle was described in unflattering terms, by the Therapists, as causing a searing pain and discomfort. 

The use of an acupuncture needle and confusion of many TPs with APs has aroused among Acupuncturists, a deep and sustainable controversy, yet noticeable today but also including some signs of lull.