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Dr. Travell “dry needled” with a harpoon

 •  • by Paul Ingraham
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I’ve been working on series of updates to the dry needling chapter in my trigger points book, gradually building it up to the point where it would make a good, substantive article on this topic in its own right. It must stay in the book, but here’s an interesting excerpt that I just have to share with everyone today.

A little context first, though: modern dry needling involves stabbing “trigger points” (sore spots in soft tissue of unknown origin) with acupuncture needles. Overlap between acupuncture and dry needling is partial/confusing, but the use of acupuncture needles for this purpose today is almost universal. No one’s using anything else. Which makes this rather interesting …

The term “dry needling” came from Dr. Janet Travell herself, many moons ago. In the original big red books, she used the term to describe lancing a trigger point with a hypodermic needle without actually injecting anything. Ouch! She did not go into any detail, but her method is definitely distinct from modern dry needling, which is much more directly “inspired” by acupuncture. Although Travell didn’t explain her rationale for dry needling, she did explain why she never used an acupuncture needle: she thought they were too fine!

There has never been a shred of empirical evidence that suggests that any rationale for dry needling is superior to any other. Like mutually exclusive religious beliefs, they clearly can’t all be right. The fact that Dr. Travell disapproved of acupuncture needles is fascinating and irksome — she is virtually worshipped, her book is still the bible of trigger point therapy … and yet no one using acupuncture needles today has offered an explanation of why they are ignoring her opinion on this. If she was wrong, then it casts doubt on the Mother of Trigger Point Therapy (doubt that is absent from nearly all references to her work). If she was right, then dry needlers have been barking up the wrong tree for a long time.

Or perhaps they are all wrong. Because how dry needling might work is a moot point if it doesn’t work. So …

And then the book continues with an evidence review that does not have a happy ending.

One hypothesis is that stabbing “inactivates” trigger points by wrecking the neuromuscular junction (motor endplate). Here’s four of those, at the ends of branching motor neurons, attaching to muscle fibres. Each one is about 3µm (.03mm) wide, roughly a tenth the diameter of an acupuncture needle. Trying to hit one of these like trying to use a spear to stab a raisin under a metre of Jello. Or a harpoon, if you’re using a hypodermic needle.

The “negative” trigger point book

My trigger point book is a 130,000-word beast, much longer than the average novel, and there are chapters in there I haven’t touched in a decade, like boxes in your attic that contain God-knows-what. Sometimes I open it to a random location, read three paragraphs that make my head explode, and I have to spend the morning bringing it up-to-date (instead of whatever 62 things were on my to-do list).

I never stop modernizing my books, and in the case of the trigger points book, “modernizing” mostly means making it more of a bummer for people who want to believe that trigger points are the key to all pain. It’s the only book about trigger points that discourages people from getting too overheated about trigger points. It’s all about managing expectations now, and the chapter on needling is an excellent example of this trend.

(If you think trigger points “don’t exist” and/or you’re still unclear on why I am not much more dismissive of the idea of trigger points than I am — I do still sell a book about them, after all, even if it is relatively “negative” — my position on this controversial topic is exhaustively spelled out here: Trigger Point Doubts. The highlights are covered by about dozen bullet points early in the article.)

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