On this edition of “Wannabe educators not even bothering to look for research”, we tackle a myth that quite literally has nothing to do with us (kind-of). I mean, it’s about our profession, and evidence-based practice, and not being able to willfully lie in the allied health field, but, the CEO is a DPT living in NY, where dry needling by a PT is not permitted.
3 ridiculous myths are being used to support this myth:
MYTH #1. Trigger points don’t exist… if you believe that, I suppose you also believe that the osteophytes don't exist, osteochondritic lesions don't exist, fascial contractures don't exist, and neuropraxias don't exist.
MYTH #2. Systematic reviews are the highest form of evidence. We have covered this in so many posts, it is getting a little ridiculous, but… systematic reviews are critique of original research and not research itself, they are secondary sources that should reflect the body of evidence, and cannot, if done well, contradict the body of evidence. They should exist separate from the “levels of evidence” and be considered the same level of evidence as a good textbook or our courses at the Brookbush Institute (which include systematic review)
MYTH #3. “Active is better than passive”. I don’t know who came up with this quote, but they should be dragged out back, #Rocktape should be placed over their mouth, and they should be forced to spend 2 hours attempting to find any evidence of this ridiculous garbage. Again, there is literally no evidence to support this quote. In fact, we have cited several studies (in our courses) that demonstrate when done alone, dry needling, ischemic compression, mobilizations or manipulations are more effective than active exercise or conventional physiotherapy alone. Please don’t troll me on this… we have also cited studies to demonstrate and support the far more effective integrated practice. We are continually working to build the best evidence-based, systematic outcome-driven approach possible. This includes the optimal combination of effective techniques chosen on the basis of reliable assessment findings (Current model: Release, mobilize, lengthen, activate, integrate, condition)
So Much Research!
Dry needling is one of the most well-supported interventions in physical rehabilitation. In the following slides more than 20 randomized controlled trials (RCTs) (the highest level of evidence) are cited. There are very few modalities in our field that have the benefit of 20+ RCTs. Additionally, we could not fit citations for the 100s of experimental and observational studies that have also been performed supporting this technique.
Randomized Control Trials have Demonstrated that Dry Needling is Effective for:
- Neck Pain
- Shoulder Pain
- Low Back Pain
- Pelvic Pain and Renal Cholic
- Greater Trochanteric Pain
- Knee Osteoarthritis
- Patellar Pain
- Hamstring Tightness
- Plantar Heel Pain
- Fibromyalgia
RCTs are a form of research that is generally used to compare an intervention to sham or other interventions. Additional research also suggests that dry needling is more effective when used to treat trigger points, is likely more effective when used as part of an integrated approach, is more effective when used to address assessed impairments, and has demonstrated both short- and long-term efficacy.
No Bias Here!
And, before we get trolled for being biased…The CEO is a DPT in NYC and cannot legally perform dry needling, nor do we have any courses on dry needling. We have created this post for the sole purpose of continuing to support truly evidence-based practice, and to attempt to put a stop to another myth that is floating around the social media sphere (a.k.a. the hater-verse). The evidence on dry needling is so compelling it makes us angry that physical therapists are being obstructed from adding this to an integrated approach to practice in any state, much less our own.
Original Research vs. Reviews:
We must reiterate that systematic reviews are secondary sources (like textbooks). Just as we would not necessarily expect someone to use our courses (which include systematic review) as citations to trump the evidence of high-quality original research, it is always a problem to use systematic reviews to build an argument. It is essentially using the conclusion of an author, to support your own conclusions. It’s kind-of like using someone else’s opinion to support your own. Most importantly, well-done reviews and secondary sources should reflect the trends implied by high-quality studies. If a systematic review opposes the findings of a dozen RCTs, the problem is not the RCTs; the problem is absolutely the review. RCTs are mathematical analysis of data, systematic reviews are critique by an author which always has more potential for bias.