Skeletal Muscle Analysis

Skeletal muscle makes up roughly half of the human body’s weight, and musculoskeletal pain occurs commonly since muscles can be damaged from the wear and tear of daily activities. Muscles can become hypertonic causing postural abnormalities that can lead to muscular imbalances. These imbalances can cause myofascial trigger points that develop from muscle overload. A trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. This spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena (Simons, Travell, & Simons). Trigger points are contractures that occur at the point of

The two types of DN are deep and superficial.In deep DN the therapist will palpate the muscle for a taut band to identify the trigger point. The needle is penetrated into the skin until resistance is felt, eliciting local twitch responses, which are necessary in achieving the desired therapeutic effect. “The needle is then focused in this area or other neighboring areas by drawing the needle back toward the subcutaneous tissue without taking it out of the skin” (APTA, 2013) and then directing the needle toward other trigger points in the area. After the needle is removed, pressure should be applied to the area to prevent swelling and soreness, and the area should be palpated again to reassess for trigger points.

In superficial DN the needle is inserted only in proximity to the trigger point and latent twitch responses are not elicited. The needle is kept in the skin for 30 seconds and then withdrawn to the subcutaneous layer. If sensitivity in the area remains present, the needle can be inserted again for 2 minutes. “Superficial DN

may be used when patients do not tolerate deep DN, or when excessive cramping

One of the primary concerns for administering DN is needle aversion or phobia. “Physical therapists must recognize when patients present with significant needle phobia or other anxiety about being

treated with needles” (APTA, 2013). Additionally, patients with local skin lesions, local systemic infections, vascular disease, and metal allergies are contraindicated.

Patients with compromised immune systems and abnormal bleeding tendencies should be needled with caution, as should women in the first trimester of pregnancy

(APTA, 2013). All patients must give consent for DN especially when language barriers and cognitive impairments can interfere.

The treatment of trigger points through manual therapy and DN are proven techniques for alleviating pain and stiffness in skeletal muscle and increasing ROM.

Therapists can successfully treat patients by incorporating manual therapy techniques and dry needling into the patient’s plan of care. “Current scientific evidence strongly supports that awareness and working knowledge of muscle dysfunction and in particular myofascial trigger points should be incorporated into manual physical therapy practice consistent with the guidelines for clinical