Page 53 - Journal of Special Operations Medicine - Winter 2016

combination of excessive ACh release, sarcomere con- Additionally, postprocedure pain and swelling in the
traction, and the release of inflammatory markers and treated site is possible; however, damage caused from a
sensitizing biochemicals aggravates the taut band of an small, single, solid filament needle is minimal. The size
MTrP, which creates an “energy crisis.” This energy of acupuncture needles is actually quite small. Acupunc-
3
crisis consists of increased metabolism, local ischemia, ture needles have a diameter of 160μm to 300μm when
and hypoxia due to the prolonged contracted state that compared to that of muscle fibers, which ranges from
causes an increase in the release of sensitizing elements, 10μm to 100μm. This would not pose a significant risk
1
causing further pain and increased ACh release. This for scar tissue formation or any form of long-term soft-
3
vicious cycle is thus the foundation of the chronic nature tissue damage. 1
of an MTrP.
When dry needling is performed in the thoracic region,
Further scientific evidence from an ultrasound study of there is risk for tension pneumothorax. Again, proper
musculature with MTrPs supports the therapeutic ef- regard for the anatomy of the thoracic region and a
fect of TrP-DN. Recent advancements in ultrasound conservative approach to needling shallow tissues in
16
shear-wave imaging technology allowed researchers to the chest and back, with proper training and technique,
calculate the shear modulus or level of stiffness in a cer- could easily mitigate this very rare occurrence. An ade-
tain material—in this case, soft tissue—by transmitting quate understanding of the anatomy coupled with clean
high-intensity pulses through the tissue, the speed of procedures and use of the small-diameter acupuncture
which was tracked and used to determine tissue elas- needles would minimize any local tissue damage or risk
ticity. In this study, conducted at the Department of for infection.
16
Physical Therapy at the University of North Georgia,
ultrasound shear-wave elastography was used to study Minimizing Narcotic Dependence
changes in muscle stiffness in the trapezius muscle be-
fore and after TrP-DN therapy. The results indicated By using TrP-DN to control musculoskeletal pain disor-
that the shear modulus in the muscle was reduced af- ders, we can minimize the use of pain medication given
ter TrP-DN. The study further compared findings in the to our Soldiers. Ultimately, medication may provide
prone and sitting positions, as well as palpable stiffness temporary relief of symptoms but does not address the
changes. Their findings indicated that dry needling, as source of the pain. SOF Soldiers who are given long-
2
well as a patient’s posture, affected the shear modulus of term narcotic treatment for pain are at high risk for
tissue surrounding MTrPs. In addition to sonographic complications. The military’s rate of complications from
16
elastography, MTrPs can be visualized by magnetic res- prescription medication addiction has been labeled a
onance imaging, which reveals that active MTrPs are public health crisis, with numbers consistently growing
larger than latent MTrPs, and are characterized by re- each year. 17,18 The incidence of dependence on prescrip-
duced blood flow. This research is limited, however; tion and narcotic medication in the military is twice that
15
thus, many providers and patients remain skeptical of of the civilian population. Soldiers with chronic injuries
TrP-DN. and who may be assigned to special units for rehabili-
tation have a 25%–35% rate of dependence. 17,18 This
complication rate is significant when compared with the
Mitigating Risk
low rate of serious adverse outcomes associated with
SOF Medics perform many advanced procedures with TrP-DN.
high risk for severe complication; these range from surgi-
cal cricothyroidotomy to myoplastic amputation. Given The most common adverse events are mild instances of
this advanced scope of practice and the nature of TrP- bleeding, bruising, and pain. The most significant ad-
DN therapy, the risks associated with TrP-DN are mini- verse event, tension pneumothorax, was documented as
mal. Local soft-tissue damage due to excessive needle very rare, occurring in 0.01 of 10,000 treatments. The

manipulation may cause ecchymosis, swelling, and, in analgesic effect of TrP-DN could help minimize the SOF
extreme cases, vessel damage. Additionally, local infec- Medic’s dependence on narcotic treatments and even
tion could occur; however, the minimally invasive acu- non-narcotic analgesic treatments for severe musculo-
puncture needle carries a very low risk for infection if skeletal pain.
proper aseptic technique is used. For example, battlefield
auricular acupuncture generally uses acupuncture stud Conclusion
needles that remain in place for a long time and is taught
to SOF Medics across the force. The battlefield setting There is significant stigma surrounding TrP-DN. This is
is generally considered to be an extremely dirty environ- because little research has been done and there is poor
ment. In contrast, TrP-DN would be performed in the understanding of the physiology behind the treatment.
controlled environment of an aid station or team house. Due to the nature of the needle insertion of TrP-DN,

Trigger-Point Dry Needling 37