Originally posted on January 28, 2011
by Charlie Merrill, Pt, MS
I still remember my excitement the first day of training in Trigger Point Dry Needling (TDN). I was visibly buzzing. I was about to learn one of the most powerful soft-tissue techniques available to any health care provider. It was a landmark moment that forever changed how I treat patients.
I was one of the first 20 people in Colorado trained in TDN and we were prepared to use each other as pin cushions for 3 days straight! As I sat in a room full of novice needlers (PTs and MDs), I wasn’t sure if the buzz was nervous energy or if I knew in my heart that this was one of the most significant learning opportunities of my career. Maybe it was a bit of both.
A year later, after completing several courses and hundreds of treatment sessions, I became an advanced level practitioner. I already had a Masters degree in Physical Therapy and my TDN training was the culmination of thousands of hours of study and practice. So, I went back to the clinic ready to needle everyone and everything I could get my hands on. I needled myself, my wife, my aunts and uncles, my mom and dad, my friends, my boss, my PCP, my dermatologist, my tax guy, my colleagues, and most significantly my mother in law (how many people wish they could do that?).
Reactions to TDN are as varied as the people I have treated. On my treatment table I have seen people break down in tears, laugh uncontrollably, sweat, swear, get chilled, kick me, hit me, shake, fall asleep, and just lie there talking to me as if I was doing nothing to them. TDN has the potential to elicit just about any response you can imagine and these reactions carry with them strong benefits beyond the physical improvements. My wife cries almost every time I treat her as all of the emotional components of her injury come pouring out. Almost without exception she is pain free within a day or two. Is it magic?
After 5 years practicing TDN, the power of this technique still surprises me. Being experienced with TDN has afforded me the opportunity to treat professional cyclists, runners, and triathletes at the highest levels of their sport. I helped a patient with chronic plantar fasciitis get back to marathon training after 1 visit. I treated a person with severe arthritis who couldn’t even walk to the mailbox, and who can now chop wood and walk miles at a time. Within days after TDN, a dad with acute, incapacitating back spasms was lifting his kids without a hint of pain. And, I helped a soldier with PTSD and whole body pain return to leading his platoon in physical training without any limitation. Not everyone I see responds quickly or miraculously, but amazing results are the norm. It is this “magic” that keeps patients coming back, despite the “needling” part of trigger point dry needling.
For those who aren’t familiar with TDN, please read more about it here.
Here is What I know
- Take the time to explain TDN to everyone at their first visit – it’s critical. It allays fear and anxiety when people understand what to expect. This step is often as important as the needling itself.
- I evaluate the injury fully. Determining what is hurt is the easy part. Figuring out why takes time and critical thought, but is essential to success. For example, if someone has heel pain and I only treat the foot, we both end up frustrated. Getting beyond the “what” to the “why” of an injury is the only way to complete resolution.
- If a patient is hesitant about TDN, I won’t use it at the first session. If they decide to try it later, the response is often much better.
- Pain and injury in the extremities (arms, legs, hands, and feet) nearly always has a spinal component. Needling the spine will clear up the extremity problem faster and more effectively.
- The people who tolerate TDN the best are not the ones with the high pain thresholds. They are those who stay relaxed, breathe, and manage anxiety well.
- TDN is not “painful” – it is uncomfortable to varying degrees. The sensation can even be enjoyable, especially when you experience great results and start to correlate the sensation with wellness.
- Following TDN, people may feel worse for 12-24 hours, but then feel better each subsequent day.
- Many people feel energized and elated after a session, because of chemical reactions TDN generates – it’s a good sign of a positive response.
- Movement lessens any negative effects of treatment. People who walk, cycle, or stretch immediately after TDN feel best.
- Heat works better than ice. Tylenol is ok, but avoid anti-inflammatories – see our prior newsletter titled “The Bad News about Ibuprofen – July 29, 2010”
- More TDN is not always better, but not doing enough can make things worse. Getting to that “sweet spot” is an art that I have mastered after 5 years.
- It is not unusual for people to feel best 2-3 weeks after treatment. The effects of TDN are long lasting and it can take that long to recover completely from the treatment.
- The more intense the sensation (the bigger the twitch from the muscle), the better the results. When a muscle twitches, I know I’ve hit the trigger point.
- People have a love-hate relationship with TDN. I know it helps people because they come back to get more, despite the discomfort. These are not masochists. These are kids and grandparents and people from all walks of life.
- Athletic people respond quickly to TDN. High training volumes create excessive muscle tension that is alleviated readily with TDN.
- If the muscle I needled was tight because it was weak, it needs to be strengthened to keep it from tightening again. Suddenly, people are motivated to do home exercises because it means fewer needles next visit.
- People with very loose joints, who dislocate often or are very limber need to be treated carefully. This group needs to get stronger to appreciate the full benefit of TDN.
- TDN alone can’t always fix a complex problem. Other manual therapies like joint mobilization, myofascial release/ART, and therapeutic exercise complement TDN and lead to full recovery.
After 5 years of needling thousands of people, the basic principles that guide me remain the same. However, I’ve learned to be more aggressive with some patients and less so with others. With a better feel for different trigger points, I nearly always get a twitch response, so treatments are more efficient. I am skilled at knowing when to continue to treat a muscle and when to move on. I am more likely to share patients with one of our other therapists for some IMT or Body Talk to optimize the patient’s recovery between sessions. And, I have an intuitive sense for when needling is the ideal choice for people and when other manual therapies or strengthening exercises are more important.
At Alta, we feel strongly that seeing an experienced therapist guarantees a positive experience. Whether using TDN or a combination of treatment approaches, expect results. Trigger Point Dry Needling is an extremely powerful tool. Check it out. Unfortunately, I won’t be able to teach you how to needle your mother in law…
