Are we missing the point with myofascial trigger points and dry needling?
Jace Brown and I just published a clinical commentary in the Journal of Manual & Manipulative Therapy that challenges the way many of us were originally trained in dry needling or have been taught to think about MTrPs and provocative palpation findings.
The traditional model frames MTrPs as local tissue lesions that initiate a bottom-up nociceptive cascade. But if that were the whole story, why do provocative palpation findings consistently appear in conditions where muscle is clearly not the primary pain driver — radiculopathy, osteoarthritis, migraine, adhesive capsulitis?
We argue they shouldn’t always be read as evidence of a local lesion. They’re better understood as a fluctuating clinical signal shaped by peripheral nociception, spinal and supraspinal modulation, pain phenotype, and patient-provider contextual factors — all of which interact bidirectionally.
This doesn’t diminish the clinical value of dry needling. It expands our understanding of why it works — and for whom. The central reframing question we propose:
Does provocative palpation represent a peripheral nociceptive driver or a centrally mediated expression of a sensitised nervous system?
That distinction matters for how we select patients, explain treatment, and interpret response.
Click this link to read the article: Have we missed the point? Myofascial trigger points, dry needling and a case for a bidirectional reframe.Â
Kearns, G. A., & Brown, J. (2026). Have we missed the point? Myofascial trigger points, dry needling and a case for a bidirectional reframe. Journal of Manual & Manipulative Therapy, 1–7. https://doi.org/10.1080/10669817.2026.2665282
