14 Thus, of the four traditionally used criteria for the diagnosis of trigger points, the local twitch response and predictable or classical myofascial pain referral patterns should be discarded. Moreover, the gluteus medius and quadratus lumborum were the only muscles that had pain referral patterns that were moderately reproducible 10 and according to Hong et al (1997), only 39% of active myofascial trigger points produced localized twitch responses when needled. Additionally, Sciotti et al 13 reported just 21% for inter-examiner agreement and an average error rate of 3.3 cm to 6.6 cm for identifying the actual location of the trigger point within the muscle. In 2007, a literature review by Tough et al 9 concluded, “there is a lack of robust empirical evidence validating the clinical diagnostic criteria for trigger point identification and diagnosis.” In addition, Myburgh et al 10 found poor inter-tester reliability for determining the actual location of trigger points furthermore, Lucas et al 11 identified just 1 study that reported agreement between examiners on tenderness within the muscle but not the location of the trigger point itself. 8 Thus, it can be argued that while acupuncturists primarily developed acupoints, the myofascial trigger point concept originates from Western medicine. David Simons added the word “myofascial” to trigger point and published the seminal text Myofascial Pain and Dysfunction: The Trigger Point Manual in 1983. Nevertheless, Lewit 7, a physiatrist from Czechoslovakia, published the first article on dry needling in 1979, noting that the needle insertion itself rather than the injectate appeared to be the cause of the analgesic response. 2 Although trigger points were first described as “nodular tumors and thickenings” by Balfour 3 in 1816, muscular calluses by Froriep 4 in 1843 and fibrosis by Gowers 5 in 1904, Steindler 6 is wildly recognized as coining the term trigger point in 1940. Moreover, the Chinese introduced new points as recently as 1949. 1 While an original set of 349 acupoints was established between 259 and 282 AD, additional points were implemented during the 16 th century.
While the insertion of needles without injectate is common among physical therapists and traditional Chinese acupuncturists, the theoretical construct guiding the evaluation, diagnosis and treatment dramatically differs between professions.Īcupuncture was first developed over 4000 years ago. MDs) and State Boards have sought attorney general opinions or legally challenged the practice of dry needling by physical therapists. states, acupuncturists and even some medical associations (i.e.
The practice of dry needling by physical therapists carries its fair share of controversy among oriental medicine practitioners.
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