J.R Smith (B.Sp.Sc., M.Chiro., Cert. Acup.), Member of SMA, ACSM, NSCA, ASCA
Utilising chiropractic, dry needling and acupuncture techniques, chiropractor J.R.Smith takes a highly considered approach to easing pain and rehabilitating injuries. Through the releasing of tight muscles, optimizing joint mechanics, decreasing the pain generating signals and strengthening weak muscles pain is eased.
J.R Smith was first introduced to myofascial trigger points over 25 years ago in the USA. He has since been fortunate to study from some of the most respected clinicians and researchers in this area. His practice now lies in the integration of dry needling techniques with other modalities of musculoskeletal therapy.
What is Dry Needling?
Dry needling is a method of using a fine acupuncture style needle in the clinical management of muscular pain by inactivating Trigger Points, including neural and biochemical effects that can contribute to pain relief.
Dry needling techniques may also be used to treat joints, fascia, tendons, scar tissue and sports injuries. Dry needling was researched and further developed by two medical physicians Dr. Janet Travell, MD, and Dr. David Simons, MD in the USA. Publishing their first groundbreaking book in 1983 entitled: Myofascial Pain and Dysfunction, Vol. 1: The Trigger Point Manual, The Upper Extremities.
Key Features of Trigger Points
- A tight band within a muscle
- Local and referred pain
- Decreased range of motion
- Muscle weakness
- Lack of muscle endurance
- Decreased blood flow
- Decreased pH
- Local inflammation
- Autonomic changes
- Central sensitization
- Twitch response
Causes of Trigger Points
There is a general agreement that the most common reason for the development of trigger points are muscle overload, such as sustained low-level muscular contractions or direct trauma.
Trigger points may develop during sport, occupational or recreational activities when a muscles capacity to adequately recover is exceeded.
The local reduction in the pain threshold with an increase of responsiveness by peripheral pain fibers (nociceptors) is termed as peripheral sensitization.
Myofascial trigger points are not merely a peripheral phenomenon, nociceptive input from MTP’s leads to effective segmental sensitization and hyper-excitability of dorsal horn neurons in the spinal cord (Mense 2010)
Researchers (Hong et al 1996) found that pressure sensitivity is higher in the Trigger Point site than at other control points in the muscle.
Findings revealed a local concentration of bio-chemicals that increase pain sensitivity such as (substance P, CGRP, Tumor necrosis factor, Interleukins 6 & 8, 5-HT and nor-epinephrine), these were all higher in the MTP’s zone compared to control points (Shah et al 2005).
These pain-producing chemicals may be released from the locally sensitized nerve fibers (nociceptors) but also from the muscle contraction within the tight band (Gerwin 2008).
Local Twitch Response (LTR)
When a clinician strums across active muscle fibers and it responds with a sudden reflex contraction, it is called a Local twitch response.
The LTR has been correlated with the degree of sensitization within the muscle.
Eliciting an LTR with needling has shown to have a positive therapeutic effect in releasing the local tension and downgrading the concentration of pain producing chemicals.
Acupuncture and Dry Needling
These two treatment terms are often confused and used interchangeably. Acupuncture is firmly based in Traditional Chinese Medicine (TCM), whereas Dry Needling is based on a Western Biomedical model.
Dry needling requires extensive training and practice including a firm knowledge of anatomy in order to develop the sensitivity and appreciate subtle changes in tissue compliance to find and deactivate trigger points.
Common Treatable Conditions
- Low back pain
- Hip pain
- Knee pain
- Neck pain
- Jaw pain (TMJ)
- Shoulder conditions
- Tennis Elbow (Lateral Epicondylitis)
- Golfers Elbow (Medial Epicondylitis)
TMJ Syndrome & Dry Needling
TMJ is the name given for a group of disorders affecting the temporomandibular joint (TMJ). These may be characterized by pain, a limitation of jaw opening, locking or a clicking noise at the joint.
Anatomically the TMJ acts like a sliding hinge that connects your jaw (mandible) bi-laterally with your temporal bone in the head.
The TMJ is involved in most of our daily life, for talking, eating, breathing and to express our feelings or emotions.
TMJ signs and symptoms
- Pain in the jaw next to, or in the ear
- Popping or clicking of the TMJ
- Limited opening of the jaw
- Pain on clenching or eating
- The jaw deviates while opening or closing
- Locking of the jaw
- Headaches/ migraines
Treatment is determined by the history and assessment of the specific dysfunction.
Manual therapies can be used for the treatment of TMJ disc displacement, movement disorders in combination with self-stretches and exercise.
Due to its underlying neurophysiological mechanism, dry needling can be use in the treatment of local and myofascial referred pain affecting the TMJ and its associated musculature.
Your dentist may recommend a mouth-guard in disorders such as bruxism and jaw clenching.
Tennis Elbow & Dry Needling
Pain on the outside of the elbow is one of the more common sites for elbow pain. Maximal tenderness is generally felt next to the bony protrusion on the lateral elbow called the (lateral epicondyle).
Tenderness may also be felt at the mid forearm and even radiate to the wrist and fingers, this will be aggravated by extending the wrist while trying to hold or lift an object with a pronated hand (palm down).
Tennis elbow may occur soon after an unaccustomed action or activity, or more insidiously with repeated gripping actions, even lifting a kettle for a cup of tea.
Although as its name implies, it is a common injury arising from a tennis backhand, other aggravating manual tasks may include cooking, knitting, working with tools, gym-work and using a keyboard for extended periods of time.
Tennis elbow is not a definitive diagnosis and may also be called an extensor Tendinopathy, lateral epicondylitis, lateral epicondylagia.
Other sources of pain:
• Cervical spine
• Thoracic spine
• Referred pain from shoulder muscles
• Elbow joint dysfunction
• Nerve entrapment
On examination grip force is reduced in combination with wrist extensor weakness, yet there is increased tightness and activation of the long finger extensors.
Pain may also be found on the opposite arm in long standing cases, due to central sensitization.
• Passive, active and resisted movements
• Palpation for myofascial trigger points
• Examination of scapular muscles
• Cervical spine
• Thoracic spine
• Neural tension tests
Treatment and management
• The initial treatment is focused on pain reduction and optimization of movement.
• Modification of activity and education as to the initial cause of pain, such as Load management, manual handling, racket grip, or technique modification
• Manual therapy of specific muscles and articulations
• Dry needling
• Soft tissue techniques
• Exercise for strength and coordination
Brukner & Khan’s. Clinical Sports Medicine. 2017. 5th Edition. 256-257
Dommerholt J. Dry needling-peripheral and central considerations. J Manual Manipul Ther. 2011; 19:223–37
Dommerholt J, C Fernandez-de-las Peñas. 2013. Trigger Point Dry Needling. An Evidence and Clinical-Based Approach. Churchill Livingstone.
Gerwin R.D. 2008. The taught band and other mysteries of the trigger point: An examination of the mechanisms relevant to the development and maintenance of the trigger point. Journal of Musculoskeletal Pain 16, 115-121
Hong C.Z. 1996. Pathophysiology of myofascial trigger points. J. Formos. Med Assoc. 95, 93-104.
Mense S, Simons G. 2001. Muscle Pain. Understanding its Nature Diagnosis, and Treatment. Lippincott, Williams and Wilkins
Mense S. 2010. How do muscle lesions such as latent and active trigger points influence central nociceptive neurons? Journal of Musculoskeletal Pain.
Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo micro analytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005; 99(5): 1977–84
Simons D, Travell JG, Simons LS.1999. Myofascial pain and dysfunction. The trigger point manual. Upper half of body. 2.: Lippincott, Williams and Wilkins.