Dry Needling + High-Power Laser for Pelvic Trigger Points

For those with chronic pelvic pain, or Chronic Pelvic Pain Syndrome (CPPS), hidden pain points (Myofascial Trigger Points) within the pelvic muscles may be one of the important factors keeping the cycle of pain going, particularly when the muscle is held in a state of contraction, so that there may be deep pain, referred pain, or discomfort around the perineum, the testicles, the base of the genitals, and the area around the pelvis, and so that the control of the muscles and nerves involved in ejaculation may also be disturbed.

Where problems of function or of the control of ejaculation are related to the tightness and chronic pain of the muscles around the pelvis, the doctor may consider using the Doctor's Selection procedure, which consists of Dry Needling together with High Power Laser and Peripheral Magnetic Stimulation | PMS, so that each supports the other in reducing the pain points, releasing the contraction, and supporting the recovery of the working of the nervous system and the muscles.

This article will explain the principles of Dry Needling, High Power Laser, and Peripheral Magnetic Stimulation (PMS) in treating chronic pelvic muscle pain (CPPS) at PYONG MEN.

What are hidden pain points in the pelvis

Hidden pain points (Trigger Points) are areas of muscle held in a state of contraction at a particular spot. When this area is pressed or stimulated, there may be local pain, or pain referred to another position that appears unrelated (Referred pain).

In the group of pelvic muscles, these pain points are often found in the Levator ani, the Obturator internus, and the muscles around the base of the genitals, which is the area involved in sexual response and in the control of pressure within the pelvis.

When the pain points accumulate over a long time and are not released, the pelvic muscles may enter a state of Hypertonicity, or held contraction, with the result that local blood flow decreases, local ischaemia arises at tissue level, and the sensitivity of the nerves around the pelvis may increase.

This state may make the patient feel deep pain, dragging pain, burning, tightness, or a blocked, full feeling, or have pain related to sitting for a long time, urination, passing stool, or sexual activity, the symptoms and the causes differing from one person to another.

What is Dry Needling

Dry Needling is a procedure using a specialist medical needle, inserted precisely into the hidden pain points in the muscle. The aim is to stimulate the muscle in that area to release (Deactivate Trigger Point), reduce the force of constriction, and help restore local blood flow.

This procedure differs from traditional acupuncture, because Western Medical Dry Needling relies on the principles of anatomy, the musculoskeletal system, and the position of the pain points as the basis for determining the position and the depth of the needle.

In treating chronic pelvic pain, Dry Needling can help reduce the tightness of the muscles related to the Pudendal nerve and of the muscles in the neighbouring area.

The part played by High Power Laser

High Power Laser is a medical light-energy technology used to reduce local inflammation and support the process of tissue recovery. It can be used together with Dry Needling to help reduce inflammation around the pain points and support the recovery of the tissue after the procedure.

The part played by Peripheral Magnetic Stimulation | PMS

Peripheral Magnetic Stimulation | PMS is a non-invasive technology using magnetic field energy to stimulate the peripheral nerves and the muscles at the position required.

PMS can be used to stimulate the working of the nervous system and the muscles, or Neuromuscular control, particularly in those whose pelvic muscles work out of balance, are held in contraction, release poorly, or who also have sensitivity of the nerves around the pelvis.

The part played by PMS in a plan of care for CPPS may include:

• Supporting the stimulation of the working of the peripheral nerves and the muscles
• Helping the patient perceive and control the working of the pelvic muscles better
• Supporting the relaxation of the pelvic muscles in those with overactivity or hypertonicity
• Helping balance the working of the nervous system and the muscles in those with neuromuscular imbalance

When Dry Needling, High Power Laser, and PMS work together in one plan of treatment

Chronic pelvic pain (CPPS) does not usually arise from hidden pain points alone, but is a cycle involving the muscles, the nervous system, blood flow, local inflammation, and a pattern of muscle control that is out of balance.

Care therefore usually has to use several procedures together, in order to correct the root cause according to the mechanism of the symptoms, for example:

Dry Needling aims to release the hidden pain points in muscles such as the Levator ani, the Obturator internus, and the muscles around the base of the genitals, in order to help reduce the held contraction at particular spots and the constricting force on the tissue.

High Power Laser supports the reduction of local inflammation, reduces irritation of the tissue, and promotes recovery in the area with symptoms or the area around the pain points after the procedure.

Peripheral Magnetic Stimulation | PMS supports the stimulation of the peripheral nerves and the muscles, helping with neuromuscular control, the perception of how the pelvic floor works, the relaxation of the muscle, and functional recovery, particularly in those with pelvic floor overactivity or who control its release poorly.

Used together appropriately, these procedures and technologies may help a plan of care cover the "local pain points", the "inflammation of the tissue", and the "control of the working of the pelvic muscles" more fully. The result, however, depends on the cause, the severity of the symptoms, how long they have lasted, and the response of each individual patient.

The process of the Doctor's Selection procedure

At PYONG MEN, the pelvic Dry Needling procedure together with High Power Laser belongs to the Doctor's Selection group, which means a procedure carried out by a specialist physician in rehabilitation medicine, and chosen according to the result of the assessment of each individual patient.

In general, the process begins with Pelvic Floor Mapping and Trigger Point Assessment, in order to identify the position, the severity, and the pattern of the hidden pain points in the pelvic muscles, and also to assess the relation of the symptoms to the surrounding structures, such as the Pudendal nerve, the core muscles, the pelvic bones, and the working pattern of the pelvic floor.

After that, the doctor will consider whether the patient is suited to Dry Needling at particular spots, and may use High Power Laser in the same area or in the neighbouring area, to support the reduction of inflammation and the recovery of the tissue.

In those found to have pelvic muscles held in contraction, controlling their release poorly, with neuromuscular imbalance, or with symptoms related to nerve sensitivity, the doctor and the rehabilitation team may consider using Peripheral Magnetic Stimulation | PMS as part of the Advanced Pelvic Neuro-Vascular Protocol, to support a more appropriate adjustment of the working of the nervous system and the muscles.

The number of sessions of the procedure depends on the severity of the symptoms, the position of the pain points, the degree of contraction of the muscle, and the response of each individual patient. According to the plan of care at PYONG MEN, the use of Dry Needling together with Laser may lie between 1–5 sessions within the overall plan, depending on the doctor's assessment, while PMS may be considered alongside according to the suitability of the symptoms and the goals of recovery in each case.

In some cases, a plan of care for CPPS may include Transrectal QMR, Focused Shockwave Therapy, the Advanced Pelvic Neuro-Vascular Protocol, and training in the control of the pelvic muscles, so that the care covers the muscular system, the nervous system, circulation, and the actual use of the muscle.

Who may be suited to this procedure

The approach to care with Dry Needling, High Power Laser, and PMS may suit those assessed as having hidden pain points or abnormality in the working of the pelvic muscles, who may also have symptoms such as:

• Pain in the perineum, deep dragging pain, or a blocked, full feeling around the pelvis
• Pain in the testicles, the base of the genitals, or the area around the anus, particularly when sitting for a long time
• Pain while ejaculating or repeated pain after ejaculation
• Frequent urination, incomplete urination, or the feeling that the pelvic muscles do not release
• Tender spots or referred pain from Trigger Points around the Levator ani, the Obturator internus, or the muscles around the base of the genitals
• Pelvic floor muscle overactivity, or pelvic muscles held in contraction
• Poor control of the relaxation of the pelvic muscles
• Neuromuscular imbalance, or a pattern of muscle working that is not coordinated
• Symptoms that may be related to nerve sensitivity in the pelvic area
• Premature ejaculation that may be related to the contraction of the pelvic muscles out of rhythm

The suitability of the procedure is considered individually, after clinical assessment by a specialist physician, since the symptoms of CPPS may have several causes together.

In brief

• Pelvic Dry Needling uses a medical needle to release the hidden pain points in muscles such as the Levator ani and the Obturator internus
• High Power Laser is used alongside to support the reduction of local inflammation and help the tissue around the pain points recover better
• Peripheral Magnetic Stimulation | PMS uses a magnetic field to support the stimulation of the peripheral nerves and the muscles, helping with neuromuscular control, the relaxation of the pelvic muscles, and functional recovery
• All 3 procedures can be used together to promote the treatment of chronic pelvic pain, CPPS, since this condition usually arises from several related causes, such as the muscles, the nervous system, blood flow, local inflammation, and a pattern of muscle control that is out of balance

Frequently asked questions (FAQ)

1. Is Dry Needling painful? Most patients may feel the response of the muscle at a particular spot when the needle touches the area that is a pain point. The sensation during the procedure depends on the degree of tightness of the muscle in each case. This procedure is carried out by a specialist physician in rehabilitation medicine.

2. How does Dry Needling differ from traditional acupuncture? Western Medical Dry Needling uses the principles of anatomy and the musculoskeletal system as the basis for determining the position and the depth of the needle, aiming specifically at the hidden pain points in the muscle.

3. How many sessions are needed before a result is seen? The number of sessions depends on the severity of the symptoms, the results of examination, and the response of each individual, and is generally within 1–5 sessions.

4. Is Dry Needling alone enough? Dry Needling is usually used together with other procedures in a plan of care for CPPS, so that the causes of the symptoms are managed more fully.

5. What side effects are there? After the procedure, there may be local pain or slight bruising in the short term. The doctor will explain the further considerations before beginning the procedure every time.

6. Who should not have Dry Needling? Those with an abnormality of blood clotting, those with an infection in the area where the procedure would be done, or those with another health condition the doctor assesses as unsuitable, should consult the doctor to consider an option of care that is more suitable.