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Myofascial Trigger Points are Explained!
As the diagram shows, trigger points, tender points or myofascial trigger points are synonymous. The picture shows the current models of why some patients have muscle tender points that seem to worsen with stress or other “triggers”. The clinical scenario is usually depicted as follows: when the clinician palpates known muscles along its origin to its insertion, the patient subjectively feels pain that seems to shoot, refer or “trigger” down a nonspecific, nondermatomal, nonmyotomal pattern. Often times, the pain is purely localized but the clinician can palpate these points readily, and under experienced hands, the clinician can feel the taut band or area of very tight soft tissue or muscle in relation to the surrounding “nontender” muscles or structures. Many times, mere palpation leads to a localized histamine release and cause immediate redness at the site of direct pressure. I tell my students to palpate with the thumb and press firmly enough to cause the nail beds of the thumb to turn white to apply enough baseline pressure.
Common sources of trigger points correlate to many known acupuncture points and it is for this reason, understanding myofascial points can give us a glimpse of what is happening at the known acupuncture points when they do correlate.
Our next blog article will show How Acupuncture May Help Cure trigger points or at least treat it. We will also present some new insights into trigger points that can pave the way for adjunctive treatments such as supplements, herbs and nutrition
Bron, C. Etiology of myofascial trigger points. Current Pain Headache Rep. 2012. 16:439-444
Dommerholt, J. Bron, C. Franssen, J. Myofascial trigger points: An Evidence –Informed Review The Journal of Manual & Manipulative Therapy Vol. 14 No. 4 (2006), 203 – 221
Acupuncture can effectively treat tender or painful muscles!!
As the diagram shows, acupuncture can essentially reverse myofascial trigger points. As a review of the previous blog, the current understanding is that persistently tight muscle fibers, known as taut bands, come about from stress, injury or damage. The taut bands are perpetuated by the sympathetic “fight or flight” response from ongoing stressors in the environment. Because of the tightness, blood flow is compromised in the muscle causing accumulation of the waste products. Along with the release of potent inflammatory mediators, there is a vicious cycle of poor local circulation and accumulation of waste products causing what is called an energy crisis in the muscle. This crisis leads to deterioration of muscle membrane integrity and even abnormalities in the mitochondria itself!! (1) At the level of the neuromuscular junction, there is perpetuation of the Acetylcholine at the junction that can contribute to persistent tightening of the muscle fibers.
Acupuncture Reverses these phenomena by simply first releasing the taut band from its tight configuration. Needling allows for depletion of available acetylcholine stores. Simultaneously, local inflammatory mediators increase blood flow to the areas or ischemia and leading to myofascial trigger “release” or “fasciculations” in the muscle. Further needling can cause localized bleeding which further nourishes the areas of ischemia and hence kickstart the repair process.
Recent meta-analysis of the trigger point needling shows excellent treatment for the condition (2). We will review the article at length at future blog posts so stay tuned!!
1. Dommerholt, J. Bron, C. Franssen, J. Myofascial trigger points: An Evidence –Informed Review The Journal of Manual & Manipulative Therapy Vol. 14 No. 4 (2006), 203 – 221
2. Kietrys, D. Palombaro, K. et. al. Effectiveness of Dry Needling for upper – quarter Myofascial Pain: A Systematic Review and Meta-analysis. J of Orthopaedic & Sports Physical Therapy 2013 September 43:9: 620 – 635
CANCER SYMPTOMS ARE IMPROVED WITH ACUPUNCTURE IN LUNG CANCER PATIENTS
According the an article in June 2013 of Current Oncology shows that Pain in lung cancer patients, most of whom (91%) had Non-Small Cell Lung Cancer and 74% had either Stage 3B or 4 lung cancer. The results summarized in the infographic, show that Pain improved dramatically in terms of the average pain score and also decreased the incidence of moderate to severe pain. Other notable benefits of acupuncture improved perception of well-being and less significantly, improvements in appetite and nausea.
The points used include 6 body points:
and 3 auricular points
(Shenmen, Subcortex, Zero)
THE MAIN CONCLUSION OF THE STUDY: ACUPUNCTURE IS A USEFUL ADJUNCT AS A PALLIATIVE TREATMENT FOR CANCER SYMPTOMS, PARTICULARLY PAIN AND PERCEPTION OF WELL-BEING, IN ADVANCED STAGE LUNG CANCER PATIENTS
Acupuncture has a rich tradition of treating all sorts of diseases and conditions but we (in science, the medical and scientific community, aka “western medicine”) are only scratching the surface of how acupuncture seems to work. This is partly because we are employing fairly new tools that were not at our disposable a few decades ago, let alone thousands of years ago when acupuncture was born. It is also mostly due to the limitations of clinical research. We have only begun to apply rigid statistical methods to figure out how drugs work in medicine. The revolution of “Evidence – Based Medicine” or EBM was still largely a new practice when I was in medical school in the late 1990s.
Acupuncture on the other hand, relied on accurate record keeping of the techniques, the ideas employed and most importantly, the observations made. It is what I consider to be a purely empirical system. Historically, philosophy and tradition sought to explain what was observed with acupuncture and by that alone, it is impossible to prove or disprove how acupuncture works from the Traditional Chinese Medicine point of view. We can only test the observations. So for instance, if it has been observed that Urinary Bladder point 40 (UB – 40) can help with back pain, there is no way to test the theory of in TCM which explains that pain occurs when there is a pathological blockage of your chi at the precise location you feel pain. Acupuncture releases or unblocks this path so that chi can flow freely in its respective meridian channels (running throughout your body) and ideally, be in perfect balance with nature and the universe around you.
Instead, Western Evidence based medicine (EBM) can only seek to get hundreds if not thousands of back pain patients, apply UB-40 to a certain group and then apply a “sham point” or placebo to another group and then analyze the statistically and clinically significant results to possibly “prove” that UB-40 can indeed help with back pain. That design takes millions of dollars to carry out but it is vital and necessary to carry out in order to justify using acupuncture for back pain treatment. What about acupuncture for fertility and allergies or heart disease? From an evidence based medicine point of view, there is not enough evidence but this DOES NOT mean it is unproven. It simply means we lack the tools and resources to study every single condition that acupuncture CAN and CANNOT treat. Personally, I still use acupuncture for many conditions outside pain and there are different philosophies in TCM to guide the acupuncturists to choose the appropriate points. I developed the course, not to prove or disprove the philosophies of TCM.I chose to present the current medical and scientific models of how we currently think acupuncture works for pain management, neurology, orthopedic, rehabilitation and musculoskeletal medicine because western medicine is only scratching the surface with the fairly new tools at our disposal. It may seem limited in scope there is no boundary to define how far we can go with technology and how we can truly study acupuncture. This chapter is every bit about how much we know and how much we don’t know but I focus here on the application of acupuncture as it is studied from an evidence-based perspective. With that, the most well studied clinical application of acupuncture is in the area of pain management. As we shall see, the discoveries made may pave the way for future explorations of how acupuncture may or may not work for certain clinical condition.
So this is the essence of “Medical” Acupuncture – It doesn’t mean you have to be a medical doctor to apply or practice it. It means you are: 1) maintaining an open mind 2) utilizing Medical and Scientific language to communicate how acupuncture MAY work , 3) Using current technological tools tools to enhance our understanding of acupuncture, 4) respecting the tradition and history of acupuncture but realizing the EMPIRICISM is more important than philosophy. At the end of the day, we will use what we feel “works” for the patient. Trying to understand “how” it works is less important.
This blog is dedicated to expanding our medical understanding of acupuncture by presenting landmark case studies, clinical trials and meta-analyses from respected peer-reviewed journals to educate health professionals on acupuncture. As you will see the breadth of the available medical and scientific literature is robust but so much more needs to be done! This is attitude of the modern Medical Acupuncturist.
PMAI set up a web seminar for Medical Acupuncture for doctors and for medical students who want to learn about acupuncture. This web seminar should be booked in our booking or contact us section.
PMAI set up web conferencing to groups of doctors anywhere in the world. PMAI professionally prepares the topics for acupuncture suited to your needs. Our Licensed Medical Acupuncture will assist your needs in this event.
PMAI set up a web conference for students who are attending the online course with us. PMAI’s medical professors will teach the students and prepare the lessons for this event. Students will be online and should interact with Licensed Medical Acupuncture.
Acupuncture Training For Physicians By Best Medical Acupuncture Institute Acupuncture is a form of alternative medicine which is in great demand these days. If you are a qualified and experienced acupuncture therapist, there would be no dearth of patients stepping inside your office for treatment. Performance Medical Acupuncture Institute provides Acupuncture Training Online Programs for medical professionals as well as medical students who want to grow in the field of medical acupuncture. The Acupuncture Training for Physicians that is provided at PMAI is focused on their respective areas of medical treatment and is designed to facilitate them in prospering in their respective fields. While the Acupuncture Training for beginners is somewhat different that matches their needs and learning capability.
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