ARE THEY ASKING THE RIGHT QUESTION?

The following announcement has just appeared on Myopain Seminars, one of the websites run by proponents of “dry needling”: The Federation of State Boards of Physical Therapy is working on developing a list of competencies needed for physical therapists to perform dry needling, and we would greatly appreciate your help! The Federation has developed a survey based on the Physical Therapy Practice Analysis, developed by the Federation in 2011. The survey contains a list of knowledge, skills, and activities that physical therapist have and undergo. Based on this list, the survey asks if each item is necessary to competently perform dry needling. This survey is the preliminary stage of determining the list of dry needling competencies. Although this is one of the first steps, it is critical. Please follow the link below to complete the survey. Additionally, the Federation asks that you share the survey with any colleagues or practitioners who may be performing dry needling. Please complete the survey no later than April 5, 2015. We truly appreciate your help in this endeavor! If you have any questions, please feel free to contact the Federation at any time.

Link: https://survey.fsbpt.org/TakeSurvey.aspx?SurveyID=m80049l

Before such a survey is undertaken, the really important question that needs to be asked and urgently addressed by the Federation is whether the currently available scientific evidence supports a continuation of the popular practice by its constituency of “dry needling” muscles and other deep tissues. Clearly, this form of treatment is irrational and therefore the answer must be an unequivocal NO!

3 Comments

  1. As I see it, the more important task to be carried out by the Federation of State Boards of Physical Therapy is that of ensuring its constituency of physical therapists adheres to its Code of Ethics.

    Principle 6 C of the current Code of Ethics mandates that Physical Therapists shall evaluate the strength of evidence and applicability of content presented during professional development activities before integrating the content or techniques into practice.

    There is now sufficient evidence* available
    to suggest that dry needling “myofascial trigger points,” as is currently being performed by physical therapists, lacks a sound scientific evidence base. The fact that many physical therapists currently offer this form of treatment is not relevant.

    The Federation of State Boards is in a unique position to help physical therapists to critically evaluate the various commercially sponsored professional development opportunities being offered under the banner of “dry needling”. Much more than a survey of members will be necessary to determine whether ethical practice is being maintained.

    *Shah JP, Thaker N, Heimur J, Aredo JV, Sidkar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM R 2015 Feb 24. pii: S1934-1482(15)00079-9. doi: 10.1016/.pmrj.2015.01.024. {Epub ahead of print] Review.

  2. To everyone “out there”:

    I know it may appear that I am talking to myself, and even that I may harbour an as yet undiagnosed psychiatric condition. But I do suspect that many health professionals read the material which is posted on Fibromyalgia Perplex, courtesy of Professor Wolfe. The ongoing discussions that I have seen taking place on other social media bear witness to this.

    There can not be many physical therapists from English-speaking countries who are unaware of the important debate that has been taking place over MTrP theory and practice. So far it has been a one-sided debate, as the other side is hoping that sooner or later some scientific evidence will turn up to support their strongly held position – a hypothesis that “trigger points” in muscles exist and are a primary source of nociceptive input to the central nervous system. Samuel Beckett’s play – “Waiting for Godot” – springs to mind.

    I do accept that if no one is actually listening, I have indeed wasted my time. But it is mine to waste! Rest assured that I will not waste it by seeking psychiatric opinions.

  3. The Human Resources Research Organization (humRRO) has duly prepared a report for the Federation of State Boards of Physical Therapy entitled “Analysis of Competencies for Dry Needling by Physical Therapists (July 2015)” based upon on a practice analysis it conducted. Link: http://www.fsbpt.org/Portals/0/documents/free-resources/Dry_Needling_Final_Report_Clean.pdf

    The report is notable for this flagrant example of the logical fallacy known as “begging the question”:
    “Dry needling is a skilled technique performed by a physical therapist using filiform needles to penetrate the skin and or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments and disability.”

    To beg the question is in some way to assume in your argument precisely what you are trying to prove by it. It is not arguable that insertion of a needle is a noxious stimulus and, by definition, changes (i.e. damages) tissue.

    But there are relevant and controversial matters contained within the definition that have been hidden or masked. It requires an enormous leap of faith to believe without scientific evidence that the damage done to the respective tissue(s) can in any way contribute to the evaluation and management of any “neuromusculoskeletal” condition.

    Rheumatologists need to be well aware of this nonsense when asked by their patients with Fibromyalgia whether or not to submit themselves to this modality of treatment. Those therapists who “dry needle” myofascial “trigger points” in these patients are doing so on the tenuous grounds that these nebulous lesions within muscles are sources of nociceptive input that can not only initiate but also maintain central sensitization etc. Such input has never been demonstrated.

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