Myofascial Pain Relief from a Needle

Nearly everyone experiences muscle pain from time to time—feelings of tightness, a tingling sensation when you stretch, or difficulty bending joints. But if the pain persists or worsens, and common sports injuries like a sprain, torn ligament or broken bone can be eliminated, you may be looking at some myofascial issues.

Myofascial pain comes from the body’s skeletal muscle and connective tissue. When muscle has been overused, it can result in myofascial trigger points (“knots”) or other mobility restrictions. 

“Myofascial issues are common in athletes and people with stress or postural-related muscle tension,” says John-Paul Hezel, MD, a physiatrist in the Division of Sports Medicine at BIDMC. “When your muscle is forced to repetitively contract, it tightens. This can happen in your back, shoulder, hip, leg or really in any area in your body with soft tissue.”  

There are many treatment options for general symptoms of myofascial pain, including massage, foam rolling and other soft tissue manipulation, like active release therapy or using the Graston technique (“scraping” of the muscle using a massage tool). Heat and stretching may also help. 

Sometimes, however, the muscle may need a more targeted treatment, especially when trigger points have formed. “Trigger points can cause pain not only in the local muscle, but also in related areas of the body. Symptoms related to this muscle restriction often won’t get better unless the trigger point is released,” Hezel says.   

The treatment for this pain? A needle.

Dry needling is a technique used by physiatrists and physical therapists for the treatment of pain and movement impairments. The technique uses a “dry” needle—one without medication or injection—inserted through the skin into areas of the muscle.   

“The needle elicits a twitch response and relaxation of the muscle,” Hezel says. “The needle I use is larger than an acupuncture needle, which is easier to maneuver so that you can really find the release point.”  

Hezel often performs “wet needling” with a small amount of lidocaine (numbing medication), which still results in the critical response of eliciting a twitch. Without the twitch—such as in a classic trigger point injection with just medication—the patient’s chances of feeling better are much lower.

Some patients experience immediate pain relief after the simple, outpatient treatment. “You may experience some soreness from the needle itself that can last a few days post-treatment, but once that feeling subsides, your muscle will feel more relaxed,” Hezel says. “Most people can return to normal activity within a day or two.” 

Dry or wet needling is appropriate for nearly all patients who do not have a significant needle phobia or other anxiety about being treated with needles. Read about the effects of needling from the National Institutes of Health.