Trigger Point Therapy Explained Simply

1. What It Is About

In trigger point therapy, sites in the muscle are treated that can be felt with the fingers and hurt when pressed. The name comes from these points. Treatment is carried out in very different ways: by hand, with massage, with stretching exercises, with injections into the point or with dry needling. In dry needling, a very fine needle is inserted into the point, but no active substance is injected. The oldest studies included in this evaluation date from the mid-1950s. Since then, many individual techniques have developed. What they all have in common is the starting point: the point is determined by palpation and pressure, not by an image of the body and not by a blood test. In contrast, the needle thickness, the number of sessions and the question of whether a brief muscle twitch should be triggered during needling vary. 908 studies were evaluated, including 200 controlled studies in humans and 423 observational studies. The controlled studies in humans almost all concern the musculoskeletal system, that is, muscles, tendons and joints.

2. What Studies Show

Dry needling is the best studied. There are review articles that combine the results of several individual studies. They mainly concern pain in the upper body, that is, neck, shoulder and back 9. A review with 884 participants examined injections with anaesthetics for pain in the head and neck originating from muscles and their fascia 1. Another review with 734 participants examined whether exercise therapy complements the rest of the treatment of such muscle points 3. A third, with 586 participants, classified nerve blocks for headaches in the back of the head 2. For the shoulder there is a review with 496 participants on dry needling for pain and restricted movement of the arm 5. One study with 320 participants dealt with the elbow, one with 273 participants with the hip 6, 7. For tension-type headaches there is a review with 370 participants 8. Comparisons were also researched: a review with 241 participants compared dry needling with hand treatment for pain in the neck and upper back 4. It is therefore well established above all that review articles exist on these questions that summarise several studies. They concern muscles, tendons and joints; other body regions are studied far less frequently. In addition to the summary articles there are many individual observations: of the 908 evaluated studies, 423 are observational studies and 200 are controlled studies in humans. In a controlled study the participants are assigned to different treatments so that the results can be compared. Within the controlled studies in humans, musculoskeletal pain ranks first with 129 studies, followed by safety questions with 39.

3. What Remains Unclear

First, it is open whether the point itself can be located reliably. It is determined by palpation. Whether two examiners independently find the same site is an open question. Sonography has been tested to make the point visible, but a standard is still lacking. It is also open whether the brief muscle twitch contributes to success in dry needling or is merely an accompanying phenomenon. This question is explicitly raised in the literature 10. Finally, it is unclear which control group is the right one: sham needling, another needle position, waiting time or a medication. From studies in which several agents are combined, it cannot be deduced which component is effective. Whether the needle itself, the reaction triggered or the accompanying stretch makes the difference therefore remains open.

4. What This Means in Everyday Life

The trigger point is a palpation diagnosis: it is found by hand, not with a device. Research is markedly thinner for other regions. One controlled study in healthy participants measured, after trigger-point massage, how the heart is controlled via the nerves that work without our input. This is a measurement value, not a disease course. Much is handled differently: needle thickness, number of sessions, control group. It is still only a hypothesis that a pre-defined determination of the point, in which the examiner does not know which treatment the person receives, could reduce differences between practitioners. The next step would be to clarify which control is appropriate; a subsequent trial would have to define the control group and the endpoints in advance.

All Details with Study Numbers and Sources: Detailed Page on Trigger Point Therapy. For Children: Trigger Point Therapy for Children.