In the treatment of neuromuscular trigger points, especially in patients with myofascial pain syndrome, the acupuncture needle is inserted into the skin, fascia and often the muscle directly at the site of the myofascial trigger point.  Proper needling of a myofascial trigger point will elicit a local twitch response.  The LTR indicates proper placement of the needle in a trigger point.  Research has indicated that proper trigger point needling improves treatment outcomes. Conditions responsive to this type of acupuncture approach include arthritis, back pain, brachial plexus entrapment, bursitis, carpal tunnel syndrome, chronic pain, dental occlusion problems, headaches, joint immobility, migraines, muscle cramping, neck pain, postural distortions, repetitive strain injuries, skeletal problems, sciatica, scoliosis, spinal disk herniation, sports injuries, sprains, strains, TMJ dysfunction, stress, and whiplash.