Trigger Point Dry Needling for Lateral Epicondylitis

dry needling for tennis elbow

Many people with chronic pain disorders that do not respond to pharmaceutical therapy are turning to needle therapy for pain. Dry needling for lateral epicondylitis is gaining popularity because it resolves trigger point pain in a safe and effective manner.

What Is Dry Needling?

Needling has been used in a variety of formats to treat pain throughout history. However, dry needling is based on modern scientific evidence and has been proven to be safe and effective in multiple studies. Dry needling has been found to be especially effective as physical therapy for myofascial trigger points, which are the underlying cause of many chronic pain disorders such as lateral epicondylitis. Myofascial trigger points, also known as MTrPs, are round nodules located in the fascia of skeletal muscles. When these are touched or palpated, they can elicit pain and tenderness. If subjected to repeated manipulation, these trigger points can cause changes in the nervous system which then affect muscles, tendons, and other components of skeletal muscle. The resulting irritation and inflammation can cause stiffness, weakness, and ongoing pain.

Dry needling these trigger points has a variety of goals. Palpating and identifying trigger points can be used as a confirmation of diagnosis without needing expensive and invasive tests. Dry needling these points can inactivate them by overwhelming and shutting down the nerve that relays pain signals from the trigger point. This is why many people feel initial tenderness when the needle is applied. Last, because these points affect muscles and nerves in the region, dry needling can relieve pain and other symptoms related to neuromuscular dysfunction. Dry needling is often used in conjunction with other types of physical therapy. For example, a physical therapist may use dry needling to stop pain and inflammation so they can then use myofascial release and range of motion exercises to improve the muscle tone and texture in the affected area.

What Happens in a Dry Needling Session?

When a patient gets dry needling, the therapist will identify the myofascial trigger points causing their chronic pain. They will then insert a sterilized needle into the trigger point. They may insert it in a few locations or just one, depending on the size and severity of the trigger point. The needle is inserted straight down into the outer layers of the skin and usually does not cause bleeding or irritation.

Dry needling a trigger point will cause a reflexive muscle contraction in the muscles being affected by the point. This is a small and painless contraction called a local twitch response. The deactivation of the trigger point combined with the local twitch response will lead to biochemical changes in the tissue that decrease pain, muscle cramps, and other unpleasant symptoms.

Why Choose Needle Therapy for Pain Related to Lateral Epicondylitis

Needle therapy for pain is a safe and effective approach to many different kinds of chronic neuromuscular and musculoskeletal pain. Lateral epicondylitis has been shown in studies to be especially responsive to this therapy. Because lateral epicondylitis is a chronic issue that takes years or even decades to develop, it may require several treatments before the problem is completely resolved. While many people find this frustrating, they get relief in just two or three sessions and often see their pain totally resolved.

To treat lateral epicondylitis with dry needling, the practitioner first takes a thorough history and performs a basic physical exam. They then examine the affected area, looking for myofascial trigger points and muscle tightness all over the forearm as well as the neck and shoulder. Any identified trigger points are then treated in just a few minutes with the patient lying on their back.

Lateral epicondylitis usually involves myofascial trigger points in the muscles of the arm, such as the brachioradialis, extensor carpi radialis muscles, extensor digitorum, and even the triceps. These muscles all connect directly or indirectly to the area of the lateral epicondyles of the elbow. However, neck and shoulder muscles such as the scalenes, teres major and minor, supraspinatus, and infraspinatus also may be involved. Because needling practitioners have a solid anatomy knowledge base, they can quickly identify and treat the muscles causing the chronic pain.

The treatment concludes when the trigger points have been eliminated or the patient requests that it end. Moderate pressure may be applied to the myofascial trigger points that were treated to prevent excessive bruising or soreness. Some practitioners like to use a hot or cold pack to reduce redness and soreness. In keeping with universal precautions, the needle will be discarded in a container for sharp medical waste. Other treatment modalities to treat the region may also be used at this time. The patient usually goes home with instructions to stretch the treated areas regularly and use heat or cold for soreness. While some people experience soreness for up to two days after the treatment, this is rare. Most people feel sore for only a few hours. Improvement in the chronic pain should occur within 48 hours of the treatment, although it may take 2-3 visits to completely resolve the underlying causes.

Effects of Dry Needling for Lateral Epicondylitis

Dry needling has been shown in studies to effectively treat lateral epicondylitis. While there may be initial soreness after the therapy, this should improve quickly. Most people see a noticeable decrease in muscle spasms, pain, and tightness in 48 hours. Completely resolving the pain may take a few visits, but patients see immediate improvement in their pain. In addition, treating trigger points with dry needling has been linked to increased range of motion and more muscle strength in the affected muscles.

How Are People Trained to Perform Trigger Point Dry Needling?

The exact licensing method for getting trained to practice trigger point dry needling varies by state. Most therapists are already health care professionals such as physical therapists or nurses who then undergo training to get certification in myofascial trigger point dry needling therapy. National certification requires over 100 hours of training both in class and in the field followed by a rigorous exam that includes written questions and a practical skills segment. These therapists also must be trained in universal precautions and the sanitary handling and disposal of needles.

Dry needling for pain is not an immediate solution, but rather a gradual one that stops chronic inflammation by addressing the core issues underlying it. However, trigger point dry needling is a safe, effective, and permanent way to cure chronic pain disorders such as lateral epicondylitis without surgery, addictive medications, or invasive treatments. Many patients get permanent relief from chronic lateral epicondylitis pain with dry needling.

Range of Available Unique Physical Therapy Treatments at Nydnrehab


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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