Current Pain and Headache Reports

, Volume 16, Issue 5, pp 407–412 | Cite as

Trigger Point Needling: Techniques and Outcome

  • Simon VulfsonsEmail author
  • Motti Ratmansky
  • Leonid Kalichman
Myofascial Pain (RD Gerwin, Section editor)


In this review we provide the updates on last years’ advancements in basic science, imaging methods, efficacy, and safety of dry needling of myofascial trigger points (MTrPs). The latest studies confirmed that dry needling is an effective and safe method for the treatment of MTrPs when provided by adequately trained physicians or physical therapists. Recent basic studies have confirmed that at the site of an active MTrP there are elevated levels of inflammatory mediators, known to be associated with persistent pain states and myofascial tenderness and that this local milieu changes with the occurrence of local twitch response. Two new modalities, sonoelastography and magnetic resonance elastography, were recently introduced allowing noninvasive imaging of MTrPs. MTrP dry needling, at least partially, involves supraspinal pain control via midbrain periaqueductal gray matter activation. A recent study demonstrated that distal muscle needling reduces proximal pain by means of the diffuse noxious inhibitory control. 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.


Myofascial pain Myofascial trigger points Dry needling Treatment Musculoskeletal pain Trigger point injections 



No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Lewit K. The needle effect in the relief of myofascial pain. Pain. 1979;6(1):83–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Dommerholt J. Dry needling in orthopaedic physical therapy practice. Orthop Pract. 2004;16:11–6.Google Scholar
  3. 3.
    Alexander RW, Bradley LA, Alarcón GS, et al. Sexual and physical abuse in women with fibromyalgia: association with outpatient health care utilization and pain medication usage. Arthritis Care Res. 1998;11(2):102–15.PubMedCrossRefGoogle Scholar
  4. 4.
    Dommerholt J, Moral O, Gröbli C. Trigger point dry needling. J Man Manip Ther. 2006;14(4):E70–87.CrossRefGoogle Scholar
  5. 5.
    Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 2010;23(5):640–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82(7):986–92.PubMedCrossRefGoogle Scholar
  7. 7.
    •• Sikdar S, Shah JP, Gebreab T, et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil 2009;90(11):1829–38. This article is of great interest for it allows a simple, cheap, and noninvasive method for imaging myofascial trigger points. There is great scope for further study, especially in outcome studies correlating trigger points with clinical findings.PubMedCrossRefGoogle Scholar
  8. 8.
    Chen Q, Bensamoun S, Basford JR, Thompson JM, An KN. Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil. 2007;88(12):1658–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99(5):1977–84.PubMedCrossRefGoogle Scholar
  10. 10.
    • Srbely JZ, Dickey JP, Lee D, Lowerison M. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med 2010;42(5):463–8. This study confirms the understanding of the segmental pattern of myofascial pain. PubMedCrossRefGoogle Scholar
  11. 11.
    Hsieh YL, Chou LW, Joe YS, Hong CZ. Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle. Arch Phys Med Rehabil. 2011;92(7):1098–105.PubMedCrossRefGoogle Scholar
  12. 12.
    Niddam DM, Chan RC, Lee SH, Yeh TC, Hsieh JC. Central modulation of pain evoked from myofascial trigger point. Clin J Pain. 2007;23(5):440–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Itoh K, Minakawa Y, Kitakoji H. Effect of acupuncture depth on muscle pain. Chin Med. 2011;6(1):24.PubMedCrossRefGoogle Scholar
  14. 14.
    Huang YT, Lin SY, Neoh CA, Wang KY, Jean YH, Shi HY. Dry needling for myofascial pain: prognostic factors. J Altern Complement Med. 2011;17(8):755–62.PubMedCrossRefGoogle Scholar
  15. 15.
    Pérez-Palomares S, Oliván-Blázquez B, Magallón-Botaya R, et al. Percutaneous electrical nerve stimulation versus dry needling: effectiveness in the treatment of chronic low back pain. J Musculoskelet Pain. 2010;18(1):23–30.CrossRefGoogle Scholar
  16. 16.
    Ay S, Evcik D, Tur BS. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2010;29(1):19–23.PubMedCrossRefGoogle Scholar
  17. 17.
    Simons D. Muscular pain syndrome. In: Friction J, Awad EA, editors. Advances in pain research and therapy. New York: Raven; 1990. p. 1–41.Google Scholar
  18. 18.
    Venancio Rde A, Alencar Jr FG, Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009;27(1):46–53.PubMedGoogle Scholar
  19. 19.
    Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Zengin FO, Bayik Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int. 2005;25(8):604–11.PubMedCrossRefGoogle Scholar
  20. 20.
    Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994;73(4):256–63.PubMedCrossRefGoogle Scholar
  21. 21.
    •• Tsai CT, Hsieh LF, Kuan TS, Kao MJ, Chou LW, Hong CZ. Remote effects of dry needling on the irritability of the myofascial trigger point in the upper trapezius muscle. Am J Phys Med Rehabil 2010;89(2):133–40. In this study, the effects of remote dry needling appear to be associated with the activation of the diffuse noxious inhibitory control system. This has importance for treating those patients who are too sensitive for direct needling of involved muscles.PubMedCrossRefGoogle Scholar
  22. 22.
    Graven-Nielsen T, Babenko V, Svensson P, Arendt-Nielsen L. Experimentally induced muscle pain induces hypoalgesia in heterotopic deep tissues, but not in homotopic deep tissues. Brain Res. 1998;787(2):203–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Reinert A, Treede R, Bromm B. The pain inhibiting pain effect: an electrophysiological study in humans. Brain Res. 2000;862(1–2):103–10.PubMedCrossRefGoogle Scholar
  24. 24.
    Ga H, Choi JH, Park CH, Yoon HJ. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. J Altern Complement Med. 2007;13(6):617–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Huguenin L, Brukner PD, McCrory P, Smith P, Wajswelner H, Bennell K. Effect of dry needling of gluteal muscles on straight leg raise: a randomised, placebo controlled, double blind trial. Br J Sports Med. 2005;39(2):84–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Lee JH, Lee H, Jo DJ. An acute cervical epidural hematoma as a complication of dry needling. Spine (Phila Pa 1976). 2011;36(13):E891–3.CrossRefGoogle Scholar
  27. 27.
    McCutcheon LJ, Yelland M. Iatrogenic pneumothorax: safety concerns when using acupuncture or dry needling in the thoracic region. Phys Ther Rev. 2011;16(2):126–32.CrossRefGoogle Scholar
  28. 28.
    Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009;16(2):91–7.PubMedCrossRefGoogle Scholar
  29. 29.
    White A, Hayhoe S, Hart A, Ernst E. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ. 2001;323(7311):485–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Peuker ET, White A, Ernst E, Pera F, Filler TJ. Traumatic complications of acupuncture. Therapists need to know human anatomy. Arch Fam Med. 1999;8(6):553–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Andersen SA. Bilateral pneumothorax associated to acupuncture. Ugeskr Laeger. 2011;173(43):2724–5.PubMedGoogle Scholar
  32. 32.
    Kennedy B, Beckert L. A case of acupuncture-induced pneumothorax. N Z Med J. 2010;123(1320):88–90.PubMedGoogle Scholar
  33. 33.
    Lee WM, Leung HB, Wong WC. Iatrogenic bilateral pneumothorax arising from acupuncture: a case report. J Orthop Surg (Hong Kong). 2005;13(3):300–2.Google Scholar
  34. 34.
    Su JW, Lim CH, Chua YL. Bilateral pneumothoraces as a complication of acupuncture. Singapore Med J. 2007;48(1):e32–3.PubMedGoogle Scholar
  35. 35.
    Yamashita H, Tsukayama H, Tanno Y, Nishijo K. Adverse events in acupuncture and moxibustion treatment: a six-year survey at a national clinic in Japan. J Altern Complement Med. 1999;5(3):229–36.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Simon Vulfsons
    • 1
    Email author
  • Motti Ratmansky
    • 2
  • Leonid Kalichman
    • 3
  1. 1.Institute of Pain Medicine, Rambam Health Care Campus and Rappaport School of MedicineHaifaIsrael
  2. 2.Pain Rehabilitation Unit, Loewenstein Rehabilitation Hospital (affiliated with Tel Aviv University)Ra’ananaIsrael
  3. 3.Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health SciencesBen-Gurion University of the NegevBeer ShevaIsrael

Personalised recommendations