When implementing a clinical intervention protocol, it can sometimes be a little hard to decide on the sequencing of the different elements. Should you start with massage/soft tissue work or should you do the needling first?

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Effective needling relies heavily on patient feedback. It is not always apparent from muscle twitch responses that the clinician is close to the ‘hotspot’ of the TP. Those little indicators from the patient that you are ‘getting close’ to something are really useful. If needling is, however preceded by other interventions, the patient’s ability to give this kind of feedback is reduced. In short, the patient is desensitized.

It is therefore my suggestion that you consider the cascade above, to help sequence the interventions you intend to provide.