Dry Needling: Neck Pain

Prevalence and Introduction to Neck Pain

Cote et. al. estimated that neck pain can affect up to 70% of Americans at one time or another. 2004). Neck pain is the fourth most common cause of disability in America, after back pain and depression (Murray, et al. 2013). It is not just a pain in the neck. Neck pain can be described as soreness in the neck muscles. This can make it difficult to turn the head or complete simple daily tasks. Although acute, non-specific neck pain is usually resolved without intervention, there are several factors that can lead to persistent neck pain. These include being older, experiencing radicular signs, smoking history, obesity, psychosocial factors, and having pain in multiple locations (Vos, et al. 2008).   

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Muscular Involvement in Neck Pain

Direct injury to the neck muscles (e.g. whiplash-associated disorders), repetitive overuse injuries, e.g. postural strain, or injury directly (e.g. sports injuries) can cause neck pain. If pain is present elsewhere, the neck muscles may become secondary to neck pain. Research by Vos et. al. has shown that neck pain can occur alongside other painful conditions like temporomandibular disorders (temporomandibular disorders), headaches, low back pain, joint pain, and low-back pain. 2008). What is it that causes neck muscles to be so painful?

Muscle Strain

Alterations in the resting head position can cause strain on the neck muscles, which can lead to overuse or overloading. In a five-minute reading task, prolonged sitting with the head forward and the neck flexed has been shown by Hamaoui and colleagues to increase biomechanical stress at the seventh cervical vertebrae and the first thoracic vertebrae. 2016). The researchers attempted to quantify the strain on neck muscles by measuring the ratio between the gravitational moment that pulls the head forward and the muscle moment that counteracts that force. The moment required to counteract the forward force may vary by task and body position (Hamaoui, et al. 2016). Long-term forward head and neck flexion positions and postures can increase biomechanical strain on the soft tissues, muscles, and hair of the neck and head (Vasavada and al. 2015). Certain occupations, such as dentists and office workers, that involve more sitting or forward head-bending are associated with higher neck pain prevalence (Hayes et. al. 2009; Jun et al. 2017), and there has been an increase in neck pain due to mobile device use. Even a ten-minute sitting time has been shown to increase neck discomfort in people with and without neck pain (Xie et. al. 2016).

Trigger Points

Trigger points may develop when a muscle is overloaded or used excessively, such as by a forward-looking posture. Trigger points are hyperirritable areas in a muscle contracture. They can become painful, compressed, or stretched out. Trigger points may refer to pain in other areas of the muscle, but it is not always obvious (Donnelly et. al. 2019). Although the mechanisms that trigger point formation and perpetuation remain elusive, the integrated trigger points hypothesis suggests that a stressor within a muscle can cause hypoxia (Gerwin et. al. 2004).

The initiating event in neck pain could be either a chronic postural strain or a traumatic event such as whiplash. No matter what the initiating event was, local chemical changes take place within the muscle and activate pain receptors. A series of biochemical changes occur that result in reduced blood flow, acidic pH, and eventually excessive acetylcholine levels. This may lead to excessive muscle contraction and taut band formation. These changes can eventually lead to sensitization and an expansion of the pain in the body beyond where the injury occurred (Dommerholt span>).

Trigger points that cause neck pain may occur in the superficial or deep muscles of your neck. Evidence is growing to show that chronic neck pain sufferers may experience changes in their ability to activate deep neck muscles and their morphology.

Neck Pain Analysis and Findings

Magnetic resonance imaging studies of deep neck muscles from a morphology standpoint have shown that after a neck injury, both the deep extensor as well as the deep flexor muscles can develop fatty deposits within the muscle tissue (Elliott and al. 2006; Elliott et al. 2010). These changes were more severe in deep extensor muscles than in suboccipital muscles, and multifidi muscles, especially at the C3 spine level (Elliott, et al. 2006) which may affect their ability to develop contractile force.

People with chronic neck pain may have a decreased ability to activate deep neck flexor muscles compared to healthy controls. The decreased activation of deeper neck muscles could lead to neck stability being less effective. This may explain why some people still experience neck pain. The cervical spine’s ability to support itself and stabilize it may cause further strain on the soft tissues and joints. This can pose challenges for treatment, as it is possible to cause changes in the muscle composition and activation in the deeper neck muscles of people suffering from chronic neck pain.

Dry Needling and Neck Pain

Manual therapy, stretching, strengthening, and other evidence-based treatments for neck pain are all supported by the evidence (Blanpied, et al. 2017). Dry needling is also recommended as part of a multimodal approach for chronic neck pain in people with mobility impairments (Blanpied and al. 2017). Dry needling neck pain, a skilled intervention that uses a thin filiform to penetrate the skin to stimulate a trigger point and produce a local twitch response, is done in 2017. The ability to dry needle one large neck muscle called the trapezius (in people who don’t have neck pain) has been demonstrated to increase blood flow and oxygen saturation. 2012).

There is increasing evidence that dry needling combined with other interventions can improve neck pain in people suffering from neck pain (Liu and colleagues). 2015; Gallego-Sendarrubias et al. 2020; Navarro-Santana et al. 2020; Fernandez-De-Las-Penas et al. 2021). Combining trigger point dry needling and pain neuroscience education is more effective in reducing pain intensity, disability fear, movement anxiety, and pain severity than traditional care for chronic neck pain patients (Valiente–Castrillo, et al. 2021). Passive stretching and dry needling have been shown to be significantly less painful than stretching alone, reduce pressure sensitivity and pain intensity, as well as improve the neck active range and muscle strength in the short-term (Cerezo–Tellez, et al. 2016). It is important to understand how dry needling best fits into a comprehensive treatment plan for neck dysfunction.

Recent randomized controlled trials in neck pain patients compared dry needling with sham needling. The results showed that dry needling did not provide any additional benefit when combined with a multimodal treatment plan that already included manual therapy, exercise, and manual therapy (Gattie and al. 2021). Although the study’s methodology was not clear, the results suggest that dry needling may be an added benefit to an already extensive program. Evidence suggests that dry needling might have additional benefits when compared with other treatments like manual trigger point therapy. In this example, both manual trigger points treatment and trigger point dry needling can result in neck pain relief and improvement in function. However, trigger point dry needling can also positively impact pressure sensitivity (Llamas Ramos et. al. 2014).

The benefits of dry needling neck pain

Dry needling the cervical area has the advantage of reaching deeper structures, such as the deep neck extensor and flexor muscles. There is not enough evidence to prove that dry needling of the deeper neck muscles can affect recovery. This includes muscle morphology, activation, and even muscle morphology. Dry needling of the superficial neck extensors (trapezius and levator scapulae), showed an improvement in pain-related disability, pain catastrophizing, and cold hyperalgesia in whiplash-associated patients (Sterling and al. 2015).

Individuals who are too sensitive at the neck to allow needle insertion or palpation can benefit from dry needling trigger points. (Tsai and al. 2010). Dry needling neck pain trigger points in the wrist extensor muscle has been proven to reduce pain in the neck in people with active trigger points (Tsai and al. 2010). Dry needling, when used in a complete treatment program, can help neck pain sufferers regain their pain-free function. The key to pain-free functioning is to adopt strategies that reduce strain on the neck and head muscles.

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