Pain, as a reflex, so does pain in autonomous disorders and diseases of the locomotor apparatus, which are associated with trigger points can be treated by various techniques of physical therapy. Some of those techniques are post isometric relaxation, stretching, massage, neurodynamic techniques or techniques of positional liberation.
Puncture on surface and deep dry puncture are INVASIVE techniques that provide greater efficiency and availability of body parts where conservative treatment is not able to improve the clinical picture.
Dry puncture is in the domain of physiotherapists because it is a physical percutaneous stimulus through different types of acupuncture needles. It is called DRY because it does not introduce any substance during the treatment. Physical agent is mechanical action of the needle to the tissue. This is an effective technique that induces the regeneration process in muscle alterations.
Myofascial pain syndrome MBS
MBS is Neuromusculoskeletal clinical picture as a different set of symptoms caused by myofascial trigger points TRM (MTT). MTT are hypersensitive points that are in the stack. They are tense muscles, painful on touch and pressure and cause reflex pain, motor dysfunction, and autonomic phenomena.
Judging by the integrated hypothesis, the nature of the disordered trigger points is a neuromuscular dysfunction of the motor skeletal muscle fiber boards with alteration of electrical activity. Then excessive release of acetylcholine (ACh) at the junction occurs. As a result of the so-called energy crisis, local contracture occurs at the junction of actin and myosin that creates FEEDBACK, and thereby causes and stimulates action on nociceptive and autonomic nerve fibers. Key factors in the etiology of trigger points are ischemia, low Ph and subsequent release of inflammatory factors.
Research has proved that there are greater presence of inflammatory mediators, increased levels of certain electrolytes, bradykinin etc, in trigger points. Increase of these factors, as well as the increase of neuropeptides, catecholamines and cytokines is associated with painful syndrome and inflammatory processes in distant parts of the body where there are no trigger points.
MBS as part of the clinical picture may occur due to a pathological condition or as an accompanying element in a complex clinical picture.
Treatment of trigger points is a very important and sometimes the most important step in the healing process for many diseases and conditions:
- Radicular syndrome
- Post-traumatic tendinopathy
- Retractile capsulitis
- Epicondylitis (tennis elbow, casting elbow)
- Discus hernia, ischialgia
- Ligament injury
- Degenerative and inflammatory rheumatism
- Muscle cramps
- Some neurological conditions such as Parkinsonism, because it reduces irritation of neuromuscular plate
Treatment can be divided into 2 phases:
- The first phase is the pain control, which consists of the inactivation of trigger points.
- The second phase is the one where correction of dysfunctions caused by trigger points occurs.
Deep dry puncture showed greater efficiency than application of lidocaine injections and analgesics, when considered from a long-term effect and treatment effect point of view. Rapid enters and exits of acupuncture needles, creates piercings of the trigger point, which further breaks the painful zones.
- Analgesic effect is closely associated with hormonal, nervous and immune systems.
- Neurological-neuromuscular effect is achieved by annulling sum at the anterior plate and is directly connected to muscle contraction – pathological or physiological.
- Reactive inflammation occurs 3 hours after the treatment and it is gone after 24h, which stimulates the body to self-heal.
- New axon terminals are created on the third day after the treatment where there is reinnervation zone in puncture part, thus creating a new round between the nervous system and muscle boards (muscle bundle) which is enveloped in trigger points.
Different researches came to the conclusion that the mechanisms and effects of dry puncture are more complex than neurological responses, inhibition of pain through the nervous system, regulation of neurotransmitters or chemical substances, which are in charge of the operation and transfer of impulses through the nervous system to the immune and inflammatory responses of the body that link to healing. As such, dry puncture represents the most efficient and fastest way of invasive technique that achieves superior effects in rehabilitation of various forms of diseases and disorders of the body.
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Medical Advisor, Swiss Medica doctor