Myofascial Dry Needling uses acupuncture needles as a tool in the treatment of trigger points for persons with myofascial pain syndrome (muscular pain). Dry needling is an invasive procedure in which a needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction "knots", which are related to the production and maintenance of the pain cycle. Deep dry needling for treating trigger points was first introduced by Czech physician Karel Lewit in 1979. Lewit had noticed that the success of injections into trigger points in relieving pain was apparently unconnected to the analgesic used. Other forms of needling such as periosteal tapping are thought to elicit an inflammatory response in a chronic tendon / ligament insertional injury to stimulate healing, similar to the theory behind shockwave therapy. Electroacupuncture is similar to myofascial dry needling with the application of a small current to the needles. Studies have shown this to be slightly more effective in some cases than use dry needling alone.
Dry needling of a myofascial trigger point will often elicit a local twitch response (LTR), which is an involuntary spinal cord reflex in which the muscle fibers in the taut band of muscle contract. The LTR indicates the proper placement of the needle in a trigger point. Studies have shown dry needling that elicits LTRs improves treatment outcomes and it has been hypothesized work by activating endogenous opioids. Inserting the needle can itself some pain although when done by well-trained practitioners that is not a common occurrence. For those that don't like needles there are alternatives to myofascial dry needling.