This past weekend I had the pleasure of upgrading my skills in trigger point dry needling with Josh Lerner of Myopain Seminars. For our patients who get confused about this term I can’t blame you. “Dry needling" refers to a Western style of needling that emerged more or less independently of East Asian acupuncture techniques over the past century. It’s called “dry” because non-acupuncturist clinicians used to think they needed to inject substances into trigger points to get the clinical results they later found they could achieve with a solid needle. (Some doctors still have this misconception, even though experimental research strongly suggests that the benefits patients receive from techniques like cortisone shots and PRP may correlate more strongly to the needling than the substance injected.)

The primary researcher into trigger point dry needling was Dr. Janet Travell, an amazing figure who was a great influence across health disciplines and was actually a physician to John F. Kennedy and Lyndon B. Johnson. Her pivotal work, Myofascial Pain and Dysfunction, was published in the 1980s and is still heavily referenced to this day. One of my first teachers and founder of the school where I earned my master’s, Dr. Mark Seem, was heavily influenced by Travell and made the study of trigger point needling mandatory in our curriculum alongside Japanese style acupuncture and basic TCM. We were all required to buy Travell’s two weighty, red trigger point manuals, which can be spotted on the bookshelf of many a manual therapist and pain expert.

Though the needles are essentially the same as acupuncture needles, and there is certainly overlap with traditional acupuncture techniques, for this style of needling we refer to orthopedic testing, pain referral patterns, and the palpation of tight and tender bands in muscle (trigger points). It's not a suitable technique for some due to the discomfort involved in the needling procedure, however it can be extremely helpful for orthopedics, headache/migraine, and other forms of chronic pain, and is a tool I'm happy to have in my toolbox.

Even as an acupuncturist who has regularly used trigger point needling for two decades, it was wonderful to refine my abilities with up-to-date palpation and needling techniques as well as the anatomy and pain science review. I learned that there is no specialty among medical doctors that specifically studies and treats muscles — there’s no “myologist”— and it’s up to complementary specialists like us to help patients with pain syndromes generated by muscular dysfunction.

As I learned in the Myopain course, muscular trigger points can be a primary driver of centralized pain syndromes. This means they can play a unique role in ramping up the central nervous system’s receptivity to nociceptive signaling, causing sensations of referred pain beyond the actual trigger point. Runaway patterns of chronic pain are amplified by the spinal cord and brain. Patients with this type of pain can benefit greatly from skillful dry needling— without the need for Botox, cortisone, or other injected substances.

Since acupuncturists are the most highly trained and experienced needlers, with thousands of hours of training under our belt before we even obtain a license, it only makes sense that we should be experts in trigger point dry needling in addition to other acupuncture styles.

Onward towards the best possible care for our patients!

What is trigger point “dry needling”?

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