Author Response

Thank you to Dunning and colleagues for their letter to the editor¹ on our study.² The comments primarily focused on the reliability of trigger point examination and the optimal dose of dry needling for plantar heel pain. We thank the authors for their comments and provide a broad response below.

First, and importantly, we clearly outlined that one of the limitations of our trial was that there was a lack of evidence for the reliability of trigger point examination. Although we accept this as a limitation, clinicians still use the method outlined in our work, and as such, our pragmatically designed trial is a worthwhile addition to the evidence relating to the dry needling intervention outlined in our study. Just because a reliable and clinically usable method of trigger point examination is not yet available does not in any way indicate that current methods should not be evaluated for their effectiveness in robust randomized trials.

Second, the optimal dose of trigger point dry needling for plantar heel pain is unknown. This is a conundrum of many musculoskeletal interventions at present and is not isolated to dry needling. With this in mind, we developed a pragmatic, consensus-driven dry needling treatment, using a recognized research method, which was supported by experts worldwide.³ We believe that the protocol we developed was an advance on what had been used previously.

We again thank Dunning and colleagues for their comments. We hope that clinicians take note of our findings in light of the limitations we outlined and that other researchers use our trial to inform future trials on this intriguing intervention.

• © 2014 American Physical Therapy Association