Don’t be deceived by this title. Yes, trigger point dry needling (TDN) is within the scope of physical therapy. Yes, while there is a paucity of evidence, TDN probably works in some instances-likely more to “meaning effect” and placebo than anything else (which of course is fine but in states with informed consent forms it probably works as a nocebo). My concern is the nocebo effect of TDN on our profession.
The irrational exuberance around TDN within the #physicaltherapy profession is ironic if not downright damaging. We fight and defend for direct access, expanded scopes of practice, evidence as the core basis of our interventions, and being recognized in the healthcare chain as force multipliers within the musculoskeletal world yet state legislators in many states are hearing PT’s fight for the right to stick needles into patients. TDN is hardly a transformative intervention and regardless it does not define #physicaltherapy. The trouble is the neuromarketing image that many are getting right now suggests that physical therapists are defined by repeatedly sticking needles into patients regardless of diagnosis rather than “neck up” skills of clinical reasoning, examination, and strong interactional skills. While the comparison to acupuncturists is the most FAQ to differentiate TDN vs. acupuncture, we jump into the “needle” and “philosophy” differences and conveniently forget that the acupuncturist is totally defined by one intervention and that TDN is but one tool in an arsenal for PT’s to consider.
Some other observations about TDN that I find troubling. We have PT students seeking TDN clinical instructors and consumed with the technique at the expense of basis skill sets. We see brash PT’s (ok arrogant PT’s) ignoring many pleas by physicians to NOT use TDN on their patients and yet the PT’s go on anyhow since they have an anchoring bias to TDN and an ignorance to referral sources demands and then we talk about a branding problem in PT! I get that many MD’s need briefings on TDN, its application for the right patient, with the right diagnosis, at the right time yet even after those briefings physicians are entitled to demand that their patients don’t get TDN as many of them can’t get past the “do no harm” edict and view TDN as “harm”. The marketing of TDN is becoming quite comical as PT practices try to get a leg up on their competitor by going to a weekend course and then declaring them experts (full disclosure-EIM where I am a founder/partner provides TDN training!!). This is so reminiscent of the days where some PT clinics bought an isokinetic devices (e.g. Cybex) and marketed their “differentiation” to the MD’s which then compelled the competitor to purchase the same (and boy were the equipment manufacturers happy). My last observation is the idea that sticking needles into patients is not anything new for PT’s. I have been board certified ECS and did EMG’s for 20+ years and never saw PT’s wanting to adopt this technique to the degree that they want to adopt TDN for clinical use. Keep in mind, we have had and continue to have our battles to perform EMG/NCS but we never defined ourselves as PT’s by the ability to perform the studies and neither should we define our practice by this one currently in vogue intervention.
My hope is that the pendulum of TDN will swing back to some sense of balance and realize it is one of many and not THE intervention that PT’s can access. At some point and with evolving evidence, (which I am confident will come), TDN will likely be an entry level skill and some other intervention or machine in PT will then have its day of an overly enthusiastic adoption-let’s hope though that its image doesn’t have the same neuromarketing impact.