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Diagnoses that Trigger Point Dry Needling Hits a Home Run On

We’re not a fan of pairing treatment options (ex: trigger point release) with diagnoses (ex: rotator cuff pain) because physical therapy is about so much more than just treating a diagnosis. Physical therapy is about identifying specific weaknesses, muscle imbalances, flexibility or mobility restrictions, and then systematically improving them. However, after being a physical therapist for a while, you see patterns develop.

The patterns we are talking about are what we’ve found with our 15+ years of combined experience. It’s not a “if X, then Y” approach. On the contrary, it’s about “the following diagnoses do well when we include dry needling in a comprehensive” approach. In light of that, we are going to answer the question – What conditions respond best to trigger point dry needling?

Defining Trigger Point Dry Needling

Before we answer that question, we should define exactly what “trigger point dry needling” is. Trigger point dry needling is not different from dry needling. Without getting too in the weeds of dry needling science, there’s multiple approaches to dry needling.

One of those approaches is locating specific trigger points in muscles that have referral patterns. Trigger points are where the muscle dysfunction is located while referral patterns are where you feel the discomfort from the trigger points. It’s very common to feel the discomfort in a completely different location than the trigger point. Dry needling the trigger point calms down the discomfort in the referral pattern. If you’re interested in reading more about what dry needling is, this blog post will give you a good overview.

One other quick note before we get started. This is not an all-inclusive list. Dr. Emily and Dr. Sarah utilize dry needling with about 50% of clients they work with. There are many other conditions that respond very well to dry needling – like low back pain and plantar fasciitis – that didn’t make the top four. Just because other things aren’t on the list doesn’t mean that dry needling isn’t helpful for those conditions. Rather, these are the diagnoses we most frequently see consistent and reliable improvements in pain with.

The Top Four Targets for Trigger Point Dry Needling

Trigger Points with Rotator Cuff Problems

The large majority of individuals who have rotator cuff issues have pain in the front of their shoulder. However, the rotator cuff is located in the back of the shoulder. The image below of the infraspinatus (part of the rotator cuff) explains why this is the case.

trigger point infraspinatus
Trigger points (TP) in the back of the shoulder often cause pain in the front of the shoulder. The infraspinatus is the most commonly involved rotator cuff muscle when there is rotator cuff dysfunction. If you’re curious if your infraspinatus is irritated, try rolling a lacrosse ball over the back of your shoulder on the wall. Feel pain? If so, odds are your infraspinatus is ticked off.

In the clinic, we see this very frequently. It’s one of Dr. Sarah’s favorite diagnoses to treat because when it’s properly identified, individuals experience amazing relief – typically on the same day of treatment!

IT-Band Syndrome

The most common advice for IT-Band syndrome is foam rolling, stretching, and sometimes – depending on who you see – strengthening of associated hip muscles. There’s also a large disagreement on the internet regarding whether you can or can’t stretch the IT-Band. (Spoiler alert: you can’t. But we’ll stay off that soapbox for now).

What you don’t hear about IT-Band syndrome is there’s typically quite a bit of trigger points in the vastus lateralis. The vastus lateralis is one of four muscles in the quadriceps, which is the big muscle on the front of your thigh. Vastus lateralis is located on the outside part and is directly underneath the IT-Band.

As you can see in the image below, trigger points in the vastus lateralis cause pain that is referred to the location of where you feel pain from IT-Band syndrome. Because of this, dry needling the quad – and oftentimes including hip muscles that refer to the same spot as well – are very effective at treating IT-Band syndrome.

trigger point - ITB Syndrome

Migraines and Trigger Points

By now, you’re starting to get the gist. When there’s pain in one spot, it often comes from a different location. The same thing happens with migraines. The muscles causing the discomfort often aren’t where the discomfort is located.

A picture says a thousand words – and there’s easily 10+ different referral patterns that can cause headaches, but the images below show the three most commonly affected muscles we see. We also have an entirely separate blog post diving into migraines that you can read here if you’re interested.

trigger point - headache

Hip Myofascial Pain

There’s a mean (relatively little) muscle in the hip (butt, technically) called the gluteus minimus. That muscle can cause pain that goes all the way down your leg. This discomfort is commonly mistaken for sciatica. If you’re not sure if you have hip myofascial pain or sciatica – or if you’ve never heard of hip myofascial pain before but have pain going down your leg – check out this blog post for clarity.

The referral pattern for the gluteus minimus is shown in the photo below. It’s the same as the past three diagnoses we discussed. Dysfunction in one location causes pain in a different location. In the clinic, Dr. Emily sees – and successfully treats – hip myofascial pain (this referral pattern) on a regular basis. More often than not, she’s able to get people feeling better on the first day.

trigger point - hip pain

Wrapping Things Up

The big takeaway from this blog post is that where you feel the pain is most often not where the dysfunction is located. As physical therapists, we are trained to recognize these referral patterns and dry needle based on the cumulation of our experience and science. We’ve found that most clients experience relief in the first session when they have one of these conditions.

If you’ve been struggling with rotator cuff problems, IT-Band syndrome, migraines, or hip myofascial pain, schedule a visit. Relief is closer than you think it is – despite what you may have heard.

All photos taken from Dr. Sarah’s dry needling coursework.

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