On "Effectiveness of trigger point dry needling…" Cotchett MP, Munteanu SE, Landorf KB. Phys Ther. 2014;94:1083-1094.

Abstract

It was with interest and some concern that we read the report by Cotchett et al1 published in the August 2014 issue of PTJ . Although the authors reported statistically significant differences in first-step pain and foot pain in favor of trigger point dry needling over sham dry needling, it appears that the actual palpatory methods used by Cotchett et al1 to identify the location of the target trigger points and, therefore, the entry point, angulation, and depth of needle insertion have not yet been found to possess accurate diagnostic validity or acceptable intra- or inter-examiner reliability for muscles in the foot or lower leg. Therefore, the results of the study by Cotchett et al,1 including the reported frequency counts of myofascial trigger points in specific foot intrinsic and lower leg muscles, should be questioned, or at least viewed cautiously. There are several original trials, literature reviews, and meta-analyses that support our contention on this issue. In a recent systematic review, Tough et al concluded, “There is a lack of robust empirical evidence validating the clinical diagnostic criteria [for trigger point identification or diagnosis] proposed by both Travell & Simons (1999) and Fischer (1997).”2 In another systematic review on the reliability of physical examination for the diagnosis of myofascial trigger points, Lucas et al concluded, “There is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points is conflicting.”3 In addition, a predictable pattern of pain referral and the local twitch response are each no longer considered sufficient or necessary for diagnosing trigger points.2–4 Yet, regardless of the existing evidence, Cotchett et al1 still decided to use “a characteristic pattern of referred pain” and “a local twitch response” as 2 …