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Intramuscular Manual Therapy

Intramuscular manual therapy, also known as trigger point dry needling, is a technique used to treat painful conditions that are related to small contracture knots in muscles. Several of these contracture knots together create a palpable taut band and what is called a trigger point.

Initial causes of trigger points may include posture, repetitive movements, compressive forces, trauma, and restrictive joint biomechanics. The nature of trigger points can easily lead to a self-sustaining pain cycle—pain that may be localized and/or referred to other parts of the body. As an example, wrist pain may in fact be caused by trigger points in the shoulder, neck, or trunk muscles and not by something wrong in the wrist. Therefore, knowing pain referral patterns is critical for identifying trigger points and for effectively using intramuscular manual therapy.

The procedure of intramuscular manual therapy involves inserting a solid filament needle directly into the trigger point. The needle insertion causes a local muscle contraction—called a local twitch response—and alterations in the affected tissue, including favorable biochemical, neurological, and mechanical changes. These changes help to break up the trigger point, improve the communication between the muscle and the nerves that innervate it, and reduce or eliminate the associated pain. And once pain is reduced, patients can then begin appropriate stretching, strengthening, and stabilization programs.

Intramuscular manual therapy can be used to treat chronic conditions as well as acute conditions caused by a sports-related injury or an accident. Some of the musculoskeletal conditions that can be treated include the following:

• Low back and neck pain (including radiculopathy)
• Shoulder and arm pain (e.g., impingement, tendonitis, carpal tunnel syndrome)
• Hip and leg pain (e.g., sciatica, muscle strain, calf tightness/spasms)
• Headache, face, and jaw pain

Intramuscular manual therapy can be performed only by therapists who have undergone extensive training.