Thursday Thoughts: Treating Trigger Points | Modern Manual Therapy Blog

Thursday Thoughts: Treating Trigger Points

In New York State we currently cannot do dry needling. We can debridge already open huge decubitus ulcers, do intravaginal and intraoral manual therapy (DCs cannot do any of these), but DN, forget it!

However, since I am getting licensed in Texas for my concierge practice for pro-athletes and high end clientelle, I decided to take KinetaCore's Functional Dry Needling Level 1 next month. I am excited!

I got away from treating TrPs directly many years ago. I used to do anything from ischaemic release- OW, DFM - more OW, to functional release - patient controlled OW. Treating the soft tissue pattern proximal and distal to the chain with light IASTM is much less threatening and often the TrP is improved. It makes zero sense to fight pain with pain.

I find these comfortable treatments much more helpful than "traditional" TrP OMPT techniques I listed above

  • IASTM to areas proximal and distal to the painful site
  • PNF agonist reversals or reciprocal inhibition using the antagonist of the muscle that has the TrP
  • postural correction and cervical retraction for upper trap TrPs that everyone complaints about "I have a knot in my shoulder"

If I am going to actually tackle a TrP which does seem to reproduce a headache, and no repeated movement or other manual therapy technique is tolerated, I still find strain counterstrain to be very useful since it only alleviates the pain positionally. Similar to a passive but non end range loading strategy, but held at mid range until the tenderness and tone resets.

I wonder how I will feel about directly treating TrPs after taking FDN next month. There will definitely be a course review, pics, and movies up after that weekend. Those of you doing DN out there, how much of your practice is it, and what has it replaced as a reset? For many, I hear doing less thrust manipulation or mobilization after learning and becoming proficient in DN.

Keeping it Eclectic...


  1. HI Erson,
    I have been practicing DN for the past 2 years and it has reduced the rate of me doing joint mobilising.It is very useful when indicated.

  2. Thanks for the input, between IASTM and DN, which would you choose first as an intervention and why?

  3. As a massage therapist I was taught general ischemic release/TnP release (positional). I find ischemic pressure on its own to be pretty unreliable. However, when combined with movement (pin and stretch, contract relax, reciprocal inhibition) ischemic pressure seems much more effective. It's also a little more comfortable for the patient. Other than that, I use IASTM upstream/downstream and directly on the painful area (lightly), as well as cross fiber friction and general swedish warming techniques.

  4. I have been doing it for 2 yrs and it will change your practice. It really helps reduce the tone of the muscle. You learn referral patterns of trigger points in the courses which helps a lot. I've definitely noticed that some trigger points (infraspinatus) present in a radiculopathy sort of way. The patient will have no neck pain but then when you hit the mrtp on the infraspinatus they will want to jump off the table. I saw a bodybuilder who had a bad trigger point and it was causing numbness down his arm/into his fingers. 1 session of DN to infraspinatus eliminated his symptoms. I saw him 6 months later at the grocery store and he said he was still pain free. Now with that being said, I put him on a good program because he was very upper trap dominant (many years of shoulder shrugs and not much scapula/cuff strength). I could have probably got him better without DN but it would have taken a longer time and he was a busy guy who traveled a lot for work. Dr. E, I have been combining your IASTM patterns in your course with DN and it seems to help (lateral calf pattern for plantar fasciitis).

  5. We do some biomedical acupuncture and some dry needling in the office. Like any tool that you first learn you get a little over zealous on utilization. The saying is "If you have a hammer, then everything is a nail." I was guilty of this with IASTM and with needling. Overall, looking back a couple years and honing in on the skill, you realize it is a great and quick way to reset tissue tone quickly and save your hands. You will eventually selectively pick the patients that should respond to the technique. The tissue tone reset helps clear up faulty movement patterns quicker and allows a great window to instruct therex and for the patient to actually "get it." There was a great Gray Cook video where he utilized it along with an SFMA eval and a simple exercise to obtain great, rapid benefit in a patient that demonstrates this concept. It does change things within your practice and for the better, as we all should be looking for tools to produce rapid, favorable outcomes.

  6. ... Gray Cook Video

  7. I've seen that when it was first released, great video, thanks for sharing!

  8. Yes, I imagine it is that way with almost any good tissue course, immediate improvement in outcomes (or any good manual therapy course), then you get back to your old patterns, or find ways to integrate it into your practice if you are a better clinician. I'm limited to who I can literally "practice" on in NY, and I'm not travelling to Tx that frequently to treat the athletes there, so it will take a while for proficiency!

  9. Great! Thanks for sharing! I was surprised when I got DN in the right QL last year, and purposely did not do any exercises to see how long the effect would last. The increased tone finally returned about 6 weeks later. That's a long reset!