Trigger Point Needling - An integrated Mechanisms Based Approach

What follows is an attempt to further rationalise the use of an integrated mechanisms based needling approach in the treatment of myofascial pain related to the presence of trigger points.

I have provided a list of references which have influenced my understanding of the proposed neurophysiological mechanisms which may occur at the various levels. However some of the effects listed are based on clinical observation and discussion with colleagues.

The following mechanisms may apply when a myofascial trigger point is accurately located using the diagnostic criteria and then needled using:

  1. A local needling approach using electrostimulation
  2. A segmental approach in addition to or as an alternative to a local approach
  3. Enhanced central regulatory effects
trig points

1) Local needling effects


  • Axon reflex - CGRP, ATP - trophic, analgesic and vasodilatory effects
  • Anti-inflammatory effects


  • Fascial signalling - influencing the shape and size of fibroblasts promoting improved function and mobility
  • Deactivation of the dysfunctional motor endplates and reduction in local EMG activity at TrP sites


  • Normalise local muscle tone and restoration of muscle contractile function due to TrP deactivation
  • Improved neural tissue mobility and function

2) Segmental needling effects


  • Enkephalinergic pain modulation at dorsal horn - effect suppresses nociceptive input arising from the TrP as well as other structures within the segment including muscle, articular and neural (nervi nervorum) tissue


  • Suppress spinal segmental motor reflex activity at ventral horn normalising general muscle tone through the dorsal and ventral segments
  • Needling muscle tissue will result in an initial increase then time dependant decrease in segmental SNS activity due to modulatory effects at intermediolateral horn relating to the myotomal segment being needled
    • Upper limb: T2-T9 paraspinal and/or medial forearm region
    • Lower limb: T10-L2 paraspinal and/or medial leg region
    • Dorsal spinal at the corresponding segmental levels


  • Improved spinal and peripheral articular mobility due to segmental pain modulatory effects and normalisation of muscle tone through the segment/s
  • As a result may improve neural tissue mobility and function

3) Extra-segmental needling effects

Sensory (specific and nonspecific effects)

  • Extra/multi segmental descending pain inhibition due to activation of the PAG
  • Activation of the endogenous opioid analgesic system - a learned, possibly target directed effect

4) Central Regulatory needling effects

Sensory (specific and nonspecific effects)

  • ‘Deactivation’ of the limbic system
  • Central regulation of autonomic tone at the level of the hypothalamus
  • Other neuroendocrine regulatory effects

Additional Notes

1. Local Approach with Electro - Stimulation

  • Enhance local sensory and motor effects of needling with electro-stimulation using the Pointer Excel II 5-10’’ x 3 bursts at the TrP site
  • Follow with with inline electro-stimulation at 2 Hz x 4 -8 points along the local taut band for 10-20 mins to enhance the segmental and extrasegmental effects

2. Segmental Approach - use with or as alternative to local approach

  • Needling will have segmental effects regardless of where in the myotomal segment the needle is located
  • Use additional paraspinal or peripheral somatic segmental points to enhance segmental pain modulation OR if unable to treat TrP locally due to pain sensitivity
  • Also useful for treating articular pain within corresponding segments
  • Use paraspinal (T1-T12) or peripheral (medial forearm or tibial region) to modulate SNS tone through upper and/or lower limb segments in cases of chronicity where higher levels of catecholamines and vaso reflexive change maybe contributing to TrP sensitisation and the energy crisis
  • EA at 2 Hz may be used to enhance the segmental effects

3. Use of Central Regulatory Points

  • Needling will have central regulatory effects regardless of location
  • Use additional central regulatory points to further modulate central autonomic tone and de-activate the limbic system in with higher levels of cognitive affective dysfunction
  • Typically classical Acupuncture points may be used and ‘access points’ to the central nervous system for example LR3, ST36, LI11, LI4

By Simon. 


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