Page 50 - Journal of Special Operations Medicine - Winter 2016

and even medications, when appropriate. However, be- endplate zones in muscle fibers. This distinction is im-
1
cause of our operational tempo and a culture of fighting portant not only for the provider but also in explaining
through injuries to complete the mission, even these mi- the treatment to patients who might doubt the efficacy
nor injuries often lead to chronic musculoskeletal issues. of the treatment or equate it to traditional Chinese
An MTrP is defined as a hyperirritable palpable nodule acupuncture.
located in taut bands of skeletal muscle fibers that may
commonly demonstrate a referred pain pattern. This
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pain may directly limit a patient’s tolerance for rehabili- Trigger-Point Dry Needling
tation and, ultimately, recovery. Nearly 10% of the US
civilian population suffers from various forms of chronic TrP-DN Compared With Similar Methods
musculoskeletal disorders. A study conducted in 2006 Within the realm of invasive stimulation of MTrPs, TrP-
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revealed that 62.8% of military personnel suffered from DN is often compared with other therapies such as in-
musculoskeletal injuries annually, which totaled almost tramuscular electrical stimulation, ultrasound guided
1.6 million injuries per year. 8 mini-scalpel release, laser therapy, and injection therapy
using anesthetic agents. Although the most closely re-
Acute trauma and repetitive stress injuries may lead to lated therapy might be considered injection therapy,
the development of an MTrP. Furthermore, prolonged there are significant procedural differences. Dry needling
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poor posture, sleep deficiencies, vitamin deficiencies, and is distinct from the injection form of MTrP treatment
joint problems may predispose a patient to the stress in- whereby local anesthetics are injected into the tissue sur-
juries associated with trigger-point development. Physi- rounding the trigger point. Additionally, some authors
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cal activities that cause repetitive musculoskeletal stress suggest that although dry needling may provide as much
are a key factor in the development of myofascial stress analgesia as injection therapy using lidocaine, it leads to
and trigger-point formation. These risk factors are all more post-therapy soreness; however, they most often re-
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part of the SOF lifestyle, whether on a combat deploy- fer to a study by Dr Chang-Zern Hong, who compared
ment or in a training environment. the effects of TrP-DN using a syringe, not an acupunc-
ture needle, to the effects of lidocaine injections. 1
The development of chronic pain syndromes is often
due to inadequate treatment resources and poor patient In current practice, TrP-DN is performed with an acu-
compliance. Many limitations and constraints are placed puncture needle. Given the current treatment proce-
on SOF Medics because we are constantly deployed to dures and lack of comparative research, it cannot be
remote locations throughout the world. In these austere reasoned that acupuncture needles cause more soreness
environments, the SOF Medic is typically the only medi- than lidocaine injections. Additionally, in a systematic
1
cal provider available. Moreover, because many SOF review conducted by the British Medical Acupuncture
Medics are deployed more than they are in garrison, Society of 23 studies, it was observed that when using
they have a limited arsenal with which to combat these injection therapy, the injected substance had no deter-
more serious musculoskeletal injuries and chronic pain minable effect on the outcome and that injection ther-
syndromes. apy was not therapeutically superior to TrP-DN. Other
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methods, such as electric stimulation, laser therapy, and
mini-scalpel release, may be useful in certain scenarios;
Dispelling Myths
however, the equipment and training required to per-
Although many people consider TrP-DN a form of acu- form these treatments preclude them from consideration
puncture, TrP-DN does not incorporate the same philos- here (Figure 1).
ophy. In fact, the only real factor the two methods have
in common is that they both use thin, filiform, solid Treatment Method
needles commonly referred to as acupuncture needles. Common indications to perform TrP-DN include symp-
Although Dr Chan Gunn, a pioneer of dry needling, did tomatic and active MTrPs, either with or without re-
refer to TrP-DN as a form of acupuncture, Gunn pro- ferred pain. Contraindications to TrP-DN are similar
moted targeting motor points rather than established to those of most other percutaneous interventions and
acupuncture points. His thinking was built on rigor- include systemic and local infection, trauma at the site,
1
ously scientific neurologic concepts and not the energy coagulation disorders, immune system suppression, and
meridians of Chinese acupuncture. Chinese acupuncture the current use of anticoagulants. Considerations also
links specific anatomic locations to physiologic changes; must be made for patients with recent surgical histories
however, there is no link between MTrP locations and involving tissues that communicate with involved joints.
acupuncture points. In fact, there is no research, to our The clinical decision to include TrP-DN as part of the
knowledge, that supports the idea that MTrPs have any patient’s treatment plan is based on a thorough history,
distinct positions besides simply being close to motor physical examination, and assessment.

34 Journal of Special Operations Medicine Volume 16, Edition 4/Winter 2016