So, I was talking with a friend of mine the other day who is a P.A. She started talking about the use of Trigger Point therapy and dry needling.
I called B.S. - saying there’s no such thing as muscle knots. She says you can actually see the knots using ultrasound and see the knot release with needling.
Then sent me this link:
Could you guys translate what I am missing here?
I don’t know that anyone has argued that they don’t exist, probably a better question is what does it mean and does it need to be treated. Much like other imaging on really any joint you can find a result, but the question is does it actually dictate needing treatment or is it just a common finding that you could find on anyone even the asymptomatic population (most likely). I’m not aware of anything linking pain directly to the trigger points other than theoretically and even then it seems like you are going to be getting in to a gray area regarding psychological factors and perceptions of pain in all my experiences with fibromyalgia or myofascial pain patients
So, to call this study awful is likely an insult to the word awful. The fact this was used as a citation is horrendous. The entire thing looks like an 8th grade science project, with about the same level of evidence. If you are going to use a method such as thermography, you need to be able to show that the measurement is both reliable and valid. This study provides citations for neither of those. The “Journal of Medicine and Life” is an obscure journal from Romania in which, according to submission for the journal "The editors encourage the authors to provide the names of at least five potential reviewers from outside their institution who have not been collaborators or coauthors within the last three years and have not provided advice or critique of the submitted manuscript. " No chance of bias being present there.
Honestly, my BBM review piece has more citations this month than this “article.” What is hilarious is that what they cite for efficacy of thermography (citation 9) actually concludes there are few studies evaluating the accuracy and reliability of infrared thermography for the diagnosis and assessment of MTrPs. Of the few studies present, there is no agreement on skin temperature patterns in the presence of MTrPs." Not exactly resounding evidence for the efficacy of their procedure.
If she is citing the knot “releasing with needling” there is a good chance they are citing some paper by Shah and Gerber. We’re besties to the point where I wrote a letter to the editor on the crap last year. The message is below:
The study by Gerber et al titled “Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects with Chronic Myofascial Pain” [1] raises several concerns, which limit the conclusions of the paper, and should be addressed. Foremost, the primary outcome reported of a myofascial trigger point (MTrP) transitioning from active to either latent or absent has been shown repeatedly to be unreliable. The references used by the authors to justify MTrPs being an objective and reliable finding do not support this conclusion. Some of those references were merely a review of the hypothetic construct of trigger points with no mention of diagnostic reliability [2] or are from textbooks that do not contain research data [3,4]. The authors reference Tough et al [5], who concluded “there is as yet limited consensus on case definition in respect of MTrP pain syndrome. Further research is needed to test the reliability and validity of diagnostic criteria.”Maigne et al [6] actually showed that palpation as diagnostic criteria had no identifiable reliability. In addition, the systematic review by Myburgh et al [7] showed “the methodologic quality of the majority of studies for the purpose of establishing trigger point reproducibility is generally poor.” These studies do not present a strong argument that trigger points are reliably identified.
The authors’ claim that experience makes the examiners more calibrated also disregards the evidence. Even when experience was taken in to account, the study by Myburgh et al [8] could only yield a kappa of 0.63. Other systematic reviews of the literature on palpation of trigger points show greater degrees of variability between clinicians. Gerber et al [1] list a kappa of 0.74, significantly greater than what the literature has shown, but there was also no blinding or asymptomatic control with which to compare.
Second, the authors’ conclusions regarding clinically significant reduction in pain are not supported robustly by the data. The majority of statistically significant changes in pain, disability, and range of motion frequently failed to even reach a minimally clinical detectable difference. Measures such as cervical range of motion had differences below 5!, which is within the standard error of measure of the device.
Third, the authors did not perform an intention-totreat analysis and excluded those who were lost to follow-up. Even more concerning was that the subjects were dichotomized into responders and nonresponders, but it was not disclosed how this was done. This results in the n for every group in Table 3 being less than the sum of the patients in the study. One must wonder whether the authors included nonresponders would these small changes still even be statistically significant. This study also did not have a control group or even an independent assessor, which significantly increases the risk of bias.
Furthermore, the authors’ conclusion of dry needling being an effective treatment is not corroborated by the references cited. In their systematic review, Tough et al [5] actually stated that “needling was not found to be significantly superior to placebo.” The other citation, by Kietrys et al [9], does indeed recommend the use of dry needling in the conclusion of its abstract, yet the study showed that at 4 weeks dry needling was less effective than lidocaine and no more effective than sham when accounting for the 95% confidence interval.
What is more interesting as to the effectiveness of dry needling is the link shown between patient expectations and effectiveness of dry needling. The review performed by Linde et al [10] showed there is a
direct correlation between patient expectations and attitudes and effectiveness of treatment, even at 6-month follow-up. Lee et al [11] took this one step further and conducted a study using the exact same
treatment but varying the verbal instructions. The patients who were instructed that the needles were a treatment displayed greater activation of the ventral striatum on functional magnetic resonance imaging than those who were given neutral instructions. The literature alludes that it is the context of the treatment, not the treatment itself, that elicits a response.
Collectively, this study by Gerber et al [1] has multiple flaws, including a lack of control group, long-term follow-up, and accounting for nonresponders. These flaws, combined with unreliable outcome measures, clinically insignificant changes, and even a misrepresentation of the literature limit its usefulness to the scientific community.
I’m still waiting on my Christmas card from those two
There are a few different ways to treat trigger focuses. Manual Trigger Point Therapy, Dry Needling Perth and the blend of these two procedures, have been demonstrated to be exceptionally powerful. Manual Trigger Point Therapy incorporates explicit controls to the muscles, sash and connective tissues. Dry Needling incorporates the utilization of clean expendable needle therapy needles to improve dissemination and blood stream to the influenced muscle trigger point territories. This assists with advancing recuperating and decrease torment. The more exact the treatment is on the influenced trigger point, the better the outcomes.