effectiveness of dry needling in treating chronic shoulder pain

Hi there,

I have an old shoulder injury which I did to my right shoulder. The first a suspected rotator cuff tear and the second, well I'm not quite sure what I did to it. I have had a MRI and two ultrasounds all showing very non specific pathologies.

Over the last 12-18 months I developed pain in the biceps tendon and subsequently it was suspected that I also had a subacromion impingement. Because my shoulder was giving me grief, I ended up getting a cortisone injection to help progress rehab and into the bicep sleeve.

I have just started to see a new physiotherapist and trialled dry needling on the infrasprinatus muscle. It's my understanding that by trialling dry needling, my physiotherapist is hoping to get 'better blood flow' into the muscle so that I can start rebuilding the muscle. He believes that there is some muscle wasting and given that I have tried rehab for nearly three years, I guess it is worth trying.

However, I found dry needling to be quite painful. I've had acupuncture before and it has not necessitated the pain I experienced yesterday. Could it be because there is a lot of inflammation in the muscle? Also I had referred pain to the anterior part of the shoulder and it was interesting because I initially thought that the pain was near the long head which is the most painful spot and but after that eased, I had the dull ache in a slightly different spot (possible short head which has shown in my last ultrasound to be slightly thickened).

What I am interested in is the effectiveness of dry needling for treating chronic shoulder injuries and how it really works in improving muscle function.

Advice is greatly appreciated.
angie

Sounds like a lot of jabbing to me! I would discuss the results of your first dry needling with your therapist as they can advise and progress or alter treatment as they feel the results of the first indicate. I feel that it is to early to comment on the results of their first treatment and your symptoms as each case is different.

In general pain induced by needling can be beneficial as it causes a response to the stimulus. I have had acupuncturists say you won't feel much and other that twist and turn the needles until I feel pain, which some say is necessary to elicit a response. It's a wide field of discussion but I would not think one needs a cortisone injection into their biceps tendon! Ouch...

Hi there,

Thanks for getting back to me. I'm glad that it wasn't supposed to hurt as much as it did. I thought maybe it was because there was a lot of inflammation around the infrasprinatus muscle but it's still quite sore today and the tightness should have only lasted for at most 1-2 days.

So thank you for the advice. I'm going to call my physio and get him to think about what he can do. I have a feeling he just manipulated it too much. Plus I've never had it done where they have put the needle in so deep, let alone to initiate such a response.

Cheers.
Angie

Oh and cortisone into the biceps tendon -- not so bad compared to the dry needling. By the way is dry needling also known as acupuncture or is the method totally different? I'm confused on that part.

Here's a simple definition of Dry Needling

Dry Needling is a cost effective and efficient technique for the treatment of myofascial pain and dysfunction. The approach is based on Western anatomical and neurophysiological principles. Not to be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture (Travell & Simons 1999)

Physicians Dr Travell and Simons defined a myofascial trigger point as a "Hyperirritable spot in a skeletal muscle." The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena.

Myofascial trigger points (MTrPs) are commonly seen in both acute and chronic pain conditions. Hendler and Kozikowski site Myofascial trigger points as the most commonly missed diagnosis in chronic pain patients.

Over the years it has been shown that it is possible to deactivate TrPs by injecting them with a large number of disparate substances (Lu & Needham 1980) The only reasonable inference drawn from this is that the pain relief obtained is not dependent on the specific properties that the substance may contain but rather on the stimulation of the needle used for the injection itself.

One of the first physicians to employ Dry Needling extensively for this purpose was Dr Karel Lewit of Czechoslovakia . Lewit (1979) reported favourably on the use of this technique in a series of 241 patients with musculoskeletal pain. . The work of Hong and Jennifer Chu support Lewitt's work and emphasize the therapeutic importance of eliciting a LTR (local twitch response).

Dry Needling may mechanically disrupt the integrity of the dysfunctional endplates within the trigger area - resulting in mechanical and physiological resolution of the TrPs. A fascinating new study by Jay Shah shows biochemical changes in the TrP following twitch elicitation. This was done by real time blood micro- sampling of the TrP as it was needled.

Many years of work by Drs David Bowsher and Peter Baldry amongst other show a strong pain inhibitory role played by Opioids released by needling stimulation of A delta receptors.

Dr Chan Gunn in his I.M.S. approach and Dr Fischer in his segmental approach to Dry Needling strongly advocate the importance of clearing TrPs area in both peripheral and spinal areas.

Today many Medical doctors, Physiotherapists, Chiropractors and Acupuncturists are using Dry Needling effectively and extensively within their practices for the treatment of Myofascial Pain & Dysfunction

Or I rather like this description.

What Is Dry Needling?

Yun-tao Ma

Dry needling technique is a modern Western medical modality that is not related to Traditional Chinese acupuncture in any way. Dry needling has its own theoretical concepts, terminology, needling technique and clinical application.

Dry Needling was first developed in 1940’s by Janet Travell, MD, former medical adviser to White House (JFK’s physician). Thus, dry needling a.k.a biomedical acupuncture is based on modern understanding of human anatomy and patho-physiology and on modern scientific research, drawing heavily on leading-edge neurological research using modern imaging techniques such as Functional MRIs of the brain.

Different terminology for dry needling technique have been created; for example trigger point needling, dry needling technique, intra muscular stimulation (IMS) and biomedical acupuncture are all in use.

It is important to remember that physical therapists who are increasingly using dry needling - particularly for pain management and trauma rehabilitation :

* do not claim to practice acupuncture,
* do not use acupuncture TCM theories, meridian acupoints and terminology,
* do not use acupuncture diagnosis like tongue and pulse
* do not use acupuncture needling techniques

Practice dry needling by physical therapists is a worldwide trend; dry needling presently is used in the USA (7 states), UK, Australia, New Zealand, Canada, Germany, France, Brasilia and many other countries.

Please, note: Traditional Chinese Acupuncture (TCM-style acupuncture) is based on ancient Chinese concepts of meridian systems, such as Qi or energy channels, using tongue and pulse assessment, and uses a variety of needle manipulation techniques. TCM Acupuncture does not share any medical ground with Dry Needling Techniques. It is pointless to compare hours of training for TCM acupuncturists and medically trained physical therapists. Definitely physical therapists will have more oranges and TCM acupuncturists will have more apples.

Thanks muchly! That helps clarify a whole heap of things. I think the reason why I'm still sore from it is because my physio created too much stimulus in a very sensitive area. So next silly question, what are myofascial trigger points? I know that they can refer pain, and are very tender to touch but I don't understand how they cause pain or inhibit muscle function.