Over the years, I have consistently been asked two questions:
Edo, when are you going to do research?
It seems that the research continues to have limited support of DN; what say you?
As to the first question,
I have been involved with other lead authors over the years and am currently the clinical expert in a study at a local university. So stay tuned!
I am not surprised that the current research is resulting in a paucity of support for dry needling. Results show it being similar to, mildly better than, or no different from sham treatment1. The focus of the research has been to target the trigger point and not the cause of neuromuscular dysfunction and the impact this has on movement which, I feel, is the reason we continue to see very positive clinical results with our functional model, and why we continue to have a huge demand for training3. If we take a view such as that of manipulation in which the cavitation of the joint is not necessarily to “break up” fibrosis but to access the nervous system to make a change, we would then take the position that the “trigger point” (sensitive/dysfunctional neuromuscular junction) is the access point to the nervous system to impact change and improve the environment of the body to improve function.
We need to also ask ourselves, What is a trigger point, When do trigger points develop, and Is the “dysfunction” more normal rather than the presence of pathology? Is this “tightness”, “motor-banding” and sensitivity associated with a calibration and fine-tuning of the neuromuscular system that becomes dysfunctional/symptomatic when overly stressed? (ie. trauma, repetitive strain, chemical irritation, etc.)
I understand that the somatic referred pain coming from the trigger point may be the pain that the patient is complaining of, but that does not give us a diagnosis to treat. Those “active” trigger points are a component of the patient’s symptoms, not the only propagation of their functional impairment, and may be a normal response and protective mechanism of the neuromuscular system.
I may have just added a number of additional questions for us to contemplate, research and address in the assessment of our patients.
To be concise in a response to a rather complex issue…
Trigger points are not the issue. The cause of them is. To progress our understanding of why the functional model seems to be more effective, we need to study the peripheral, segmental, and central neurological aspects of muscular pain and the impact that a needle can have on the neuro-bio-chemically-electric properties of the muscle. Optimistically, that will support why we see a positive clinical response to dry needling.
1. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. (2017). Journal of Orthopaedic & Sports Physical Therapy, 47(3), 133–149. https://doi.org/10.2519/jospt.2017.7096
2. Pickar, J. G. (2002). Neurophysiological effects of spinal manipulation. The Spine Journal: Official Journal of the North American Spine Society, 2(5), 357–371.
3. Ga, H., Choi, J.-H., Park, C.-H., & Yoon, H.-J. (2007). Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. Journal of Alternative and Complementary Medicine (New York, N.Y.), 13(6), 617–624. https://doi.org/10.1089/acm.2006.6371