Trigger Point Dry Needling for Treating Cervical Dystonia
by Kathy Beard
Presented at the ST/Dystonia, Inc Symposium
Elizabeth City, New Jersey September 2010
I was first diagnosed with cervical dystonia (or torticollis) in January 2007 after I had experienced sudden onset headaches the month before in December 2006. I showed simple torticollis, slight right lateral and retro. General feeling was one of discomfort, ache in trapezius muscles, stiff neck rotation, fuzzy head due to the low level cervicogenic headaches.
I received my first Botox injections March 2007 and continued every 3 months for two and one half years with 300-400 units being injected bilaterally. A small degree of relief was felt immediately following treatment with ~85% relief from the third week to the ninth week. The Botox effect wore off at week 10 with three weeks remaining before the next set of injections returning me to the state of fatigue, muscle discomfort and headaches.
My August 2009 treatment did not work opening the way to try Trigger Point Dry Needling, TrPDN, in September. For a year now, TrPDN has been the exclusive treatment for my dystonia and this past summer has been wonderful. I have resumed activities that I had not been able to do while receiving Botox, and my friends and family who knew me during my Botox years have been surprised by my appearance, exclaiming:
“Your neck is straight!”
“I have never seen you so alive and full of energy since you got dystonia!”
“Is your illness gone? You look great.”
“It is wonderful having you back to your old mischievous self!”
These responses, my overall improved well-being and my increased active involvement in life lead me to share my TrPDN experience with others.
Trigger points are muscle knots or nodules bounded by taut bands. These knots lead to spasms preventing the muscle from fully relaxing. Contraction of the muscle causes compression and irritation of nerves. These irritated nerves then cause spasms of all muscles to which they are connected leaving one feeling muscle tightness and pain. With TrPDN very thin, solid, flexible filament needles are inserted at the trigger point sites. The needle is moved gently back and forth through the trigger point allowing the muscle to relax through involuntary contraction which is felt as a ‘grab’ or twitch’. In the case of dystonia where the muscle tone is neurologically mediated, the muscles tend to be quite rigid and will grab the needles tightly. Another positive effect that TrPDN has on the nodules is an increase in certain chemical levels. There is also an effect upon the electrical component of the area. The net result is one of increased blood flow to the region leading to healing of the nodule.
A TrPDN treatment with Frank Gargano, DPT, OCS, MCTA, begins with him observing my posture and head angle for cervical deformity dystonia. Next, I lay on my back on the table and he performs a manual examination, assessing many areas of my head, face, neck and midback. He applies pressure to key areas in muscles, joints and tendons. Interestingly, each examination is different in regard to the points that are painful and it appears to depend on the reason for the flare up. We have found that activities which involve forceful or sustained contraction of the upper trapezius or sternocleidomastoid muscles can trigger a dystonic response. After he identifies the trigger points he inserts very thin filament needles at depths ranging from one to two inches focusing primarily on the suboccipitals, upper trapezius, sternocleidomastoid, splenius capitus, levator scapulae, cervical plexus, spinal accessory nerve points and midback muscles. The long needles are used to reach the deep trigger points near the bone that cannot be reached with massage. The filament needles are then removed after recording what trigger points were treated.
Spinal manipulations, focusing on C 1-2 with adjustments also being made into the thoracic and thoracolumbar junction, are performed immediately following the dry needling. This is an important step in the total treatment of my cervical dystonia. The manual manipulations compliment the TrPDN by allowing normal movement of the spine which had become restricted from the increased “central muscle tone” caused by the dystonia. I then finish the session with application of heat to further help the muscles relax, increasing blood flow to bring healing to the area. Presently I am receiving treatments every two to three weeks. I perform physical therapy stretches that incorporate upper cervical flexion to balance the cervical muscles and work the anterior muscles to relax the posterior muscles, the ones usually in tone.
Side note: I began having migraines one year after diagnosis of dystonia. This contributed to the increased muscle tone in my neck. In April 2010, I had septoplasty surgery and turbinate reduction on my nose to straighten my septum. Since then my migraines have diminished and I rarely exhibit the neuro tone of the migraines.