Deep Dry Needling Research Articles

Treatment of temporomandibular myofascial pain with deep dry needling

Objectives: The present study was designed to evaluate the usefulness of deep dry needling in the treatment of temporomandibular myofascial pain. Study Design: We selected 36 patients with myofascial pain located in the external pterygoid muscle (30 women/6 men, mean age=27 years with SD±6,5). We studied differences in pain with a visual analog scale and range of mandibular movements before and after intervention. Results: We found a statistically significant relationship (p<0,01) between therapeutic intervention and the improvement of pain and jaw movements, which continued up to 6 months after treatment. Pain reduction was greater the higher was the intensity of pain at baseline. Conclusions: Although further studies are needed, our findings suggest that deep dry needling in the trigger point in the external pterygoid muscle can be effective in the management of patients with myofascial pain located in that muscle. Key words:Temporomandibular joint, myofascial pain, external pterygoid muscle, trigger point, deep dry needling.

Response: Re: Dry Needling in the Management of Musculoskeletal Pain

To the Editor: We congratulate Dr. Kent for having worked with Dr. Chan Gunn for 25 years. In the study published by Ceccherelli et al,[1][1] the comparison was made between superficial and deep dry needling for patients suffering from low back pain (LBP) of myofascial origin. In the Methods section

Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders

To investigate the effects of dry needling over active trigger points (TrPs) in the masseter muscle in patients with temporomandibular disorders (TMD).Twelve females, aged 20 to 41 years old (mean = 25, standard deviation +/- 6 years) diagnosed with myofascial TMD were recruited. Each patient attended two treatment sessions on two separate days and received one intervention assigned in a random fashion, at each visit: deep dry needling (experimental) or sham dry needling (placebo) at the most painful point on the masseter muscle TrP. Pressure pain threshold (PPT) over the masseter muscle TrP and the mandibular condyle and pain-free active jaw opening were assessed pre- and 5 minutes postintervention by an examiner blinded to the treatment allocation of the subject. A two-way repeated-measures analysis of variance (ANOVA) with intervention as the between-subjects variable and time as the within-subjects variable was used to examine the effects of the intervention.The ANOVA detected a significant interaction between intervention and time for PPT levels in the masseter muscle (F = 62.5; P < .001) and condyle (F = 50.4; P < .001), and pain-free active mouth opening (F = 34.9; P < .001). Subjects showed greater improvements in all the outcomes when receiving the deep dry needling compared to the sham dry needling (P < .001).The application of dry needling into active TrPs in the masseter muscle induced significant increases in PPT levels and maximal jaw opening when compared to the sham dry needling in patients with myofascial TMD.

A Case Study Looking at the Effectiveness of Deep Dry Needling for the Management of Hypertonia

Backgrounds: The patient is a four-year-old child with spastic tetraparesia.Findings: A decrease in spasticity was observed in all the muscles being treated with deep dry needling, measured with th...

Hemiparetic Shoulder Pain Syndrome Treated with Deep Dry Needling During Early Rehabilitation: A Prospective, Open-Label, Randomized Investigation

Objectives: The purpose of the trial was to evaluate the efficacy of dry needling of myofascial pain syndrome trigger points to relieve the hemiparetic shoulder pain resulting from a cerebrovascular accident (CVA, stroke). Methods: A prospective, randomized, comparison cohort investigation was performed in the setting of a large inpatient rehabilitation unit with 400 admissions (mainly CVA or head injury) an- nually. Potential study subjects, who complained of shoulder pain on the hemiparetic side, were enrolled and randomly assigned to standard rehabilitation treatment plus deep dry needling (Group 1) or to standard rehabilitation treatment alone (Group 2). The Rivermead Motricity Index was used to assess the motility on admission and discharge, and to calculate the percentage of potential improvement achieved during rehabilitation (effectiveness and efficiency). A Pain Visual Analog Scale was used to serially assess pain. At the end of the trial, a self-report questionnaire evaluated whether patients could rest for a longer period of time in a wheelchair and sleep better in bed than they could before treatment. Results: One hundred and one CVA survivor patients entered the study. Those receiving dry needling, in addition to standard rehabilitation therapy, reported significantly less pain during sleep and physiotherapy. Their sleep was also more restful than that of the non-needled control subjects. The patients treated with dry needling reported a significant reduction in the frequency and intensity of pain and a reduction of pain during daytime and rehabilitation exercises in compar- ison to the standard therapy alone control group. A statistically significant inverse correlation was found between shoulder pain and mobility.

Superficial versus deep dry needling.

Ninety percent of my patients with myofascial trigger point (MTrP) pain have this alone and are treated with superficial dry needling. Approximately 10% have concomitant MTrP pain and nerve root compression pain. These are treated with deep dry needling. SUPERFICIAL DRY NEEDLING (SDN): The activated and sensitised nociceptors of a MTrP cause it to be so exquisitely tender that firm pressure applied to it gives rise to a flexion withdrawal reflex (jump sign) and in some cases the utterance of an expletive (shout sign). The optimum strength of SDN at a MTrP site is the minimum necessary to abolish these two reactions. With respect to this patients are divided into strong, average and weak responders. The responsiveness of each individual is determined by trial and error. It is my practice to insert a needle (0.3mm x 30mm) into the tissues immediately overlying the MTrP to a depth of 5-10 mm and to leave it in situ long enough for the two reactions to be abolished. For an average reactor this is about 30secs. For a weak reactor it is several minutes. And for a strong reactor the insertion of the needle and its immediate withdrawal is all that is required. Following treatment muscle stretching exercises should be carried out, and any steps taken to eliminate factors that might lead to the reactivation of the MTrPs. DEEP DRY NEEDLING (DDN): This in my practice is only used either when primary MTrP activity causes shortening of muscle sufficient enough to bring about compression of nerve roots. Or when there is nerve compression pain usually from spondylosis or disc prolapse and the secondary development of MTrP activity. Unlike SDN, DDN is a painful procedure and one which gives rise to much post-treatment soreness.

Management of myofascial trigger point pain.

Successful management of myofascial trigger point (MTrP) pain depends on the practitioner finding all of the MTrPs from which the pain is emanating, and then deactivating them by one of several currently used methods. These include deeply applied procedures, such as an injection of a local anaesthetic into MTrPs and deep dry needling (DDN), and superficially applied ones, including an injection of saline into the skin and superficial dry needling (SDN) at MTrP sites. Reasons are given for believing that DDN should be employed in cases where there is severe muscle spasm due to an underlying radiculopathy. For all other patients SDN is the treatment of choice. Following MTrP deactivation, correction of any postural disorder likely to cause MTrP reactivation is essential, as is the need to teach the patient how to carry out appropriate muscle stretching exercises. It is also important that the practitioner excludes certain biochemical disorders.