The trigger point true believers and dry needlers seem to think sore spots in the periphery are the "cause" or "source" of "pain."
This is a flawed mental trajectory, backward, inside out, upside down, and, well, just plain wrong. It supposes the following:
1. Set of tissue circumstances (not yet shown to be "real) --> "pain".
2. Solution: jab the tissue --> reduces "pain"
3. Mechanism? I don't know. Punishment of the body for merely existing?
A different (better-informed by pain science) mental trajectory is as follows:
1. Nervous system affects tissue; nervous system gets stressed, tells tissue the "wrong thing", tissue tightens up, possibly via efferent capacity of visceral afferent neurons into somatic tissue, especially cutis/subcutis (which is very thick) and neural tissue itself (peripheral nerves contain a lot of non-neuronal tissue).
2. Sore spots can be found on palpation.
3. They are the result of "pain" processing (i.e., they are areas of hyperalgesia secondary to central sensitization), not primary "causes" of pain.
Blaming tissue for pain is like blaming the screen for a bad movie, instead of the projectionist. Then poking holes in it to try to change the movie. It seems.. I don't know.. sort of futile, superstitious even.
Not to say peripheral soreness can't be "treated" however - a sore spot is just the peripheral end of a continuously looping verb called the nervous system - it usually will respond to exteroceptive attention paid to it, take advantage of novel stimulation to self-regulate/improve output behaviour. It can be projectionist, screen, movie, all the actors and directors and producers of any given movie, all at the same time.
Tissue though, tissue is just a surface acted upon from within. It does not act unless instructed to do so. And it is entirely innocent where pain is a problem.
TEACHING PEOPLE ABOUT PAIN
90 minute slide presentation by Lorimer Moseley, David Butler, Mick Thacker and Adriaan Louw, from WCPT 2011.
I took a look around in the abstracts from WCPT, and found an interesting poster abstract under "Pain Management" (see image). Here is a better link to it.
I'd like to point out a simple concept known as "mutual exclusivity". This means, two ideas can be so incompatible, so contradictory, that they can't both be true at the same time.
So, what is a person supposed to believe? A meat theory that has at its core a bunch of ritual behaviour, i.e., poking at never-proven-to-exist "trigger points" in "muscle" with needles? Or a nervous system based theory that has demonstrated its veridicality as seen in the screenshot of this abstract, where results from needling are obtained whether the needles are put into a real hand or a rubber hand? They cannot both be right.
Look. Here's the thing: if you took the entire human nervous system and laid it out in a straight line, it would be 100,000 miles long (Angvine). If you are a manual therapist or a needler of some persuasion or other, you would be at one end of that long line, the "affective" end. At the other end would be the "effector" function of that nervous system, which consists of output to muscles, joints, tissues, everything. Anything you might do to it has to go through the whole long system before any change can happen in the tissue you hope to "affect". In other words, you can't "do" ANYthing directly to tissue, without the nervous system's permission. The only reason a nervous system doesn't look linear is because it's all cleverly folded up into something that looks like a human organism.