I had been struggling with a particularly resistant case of Lateral Epicondylosis, which had a significant myofascial pain component of the forearm extensors. I had convinced myself that the TPs were no longer active, despite the ongoing discomfort the patient was complaining of. In desperation, I dry needled the extensor carpi radialis again and ‘boom’ a huge twitch response… A few days later the symptoms had cleared.

Myofascial TPs are tiny structures contained in the three dimensional skeletal muscle structure and the nidus (center) of the TP is less than a millimetre in diameter. The further you move away from the TP hotspot, the less likely you are to significantly influence the pathophysiology.

So, be sure that you have done the best possible job of searching for and destroying clinically relevant TPs; being 5mm off target just isn’t good enough.


The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise. Kuan TS, Hsieh YL, Chen SM, Chen JT, Yen WC, Hong CZ. Am J Phys Med Rehabil. 2007 Mar;86(3):183-9.