Definition and Brief History
The alleviation of pain in the body that originates from a focus or foci of neural hyperactivity in one or another of the different structures which together form the musculoskeletal system has its origin in England in the late 1930's. It was there, at University College Medical School, that researchers discovered that referred pain from a focus of irritation in muscle and or other connective tissues or fascia may be felt in broad, diffuse, and specific areas, such as muscles, joints and even teeth.
This was significant, as pain from these foci of irritation did not and do not follow the dermatomal or nerve root distribution of neurological pain common to actual nerve injury. In fact, it was demonstrated by Drs. Good, Kelly, and Travel, in England, Australia, and the U.S., that each individual muscle in the body, when affected by these "irritant foci", has its own unique and specific pattern of pain referral that is predictable and mapable.These foci of irritation came to be called, over time, "myofascial trigger points." It was discovered that the common characteristic of the various trigger points, regardless of the tissue, was electrical hyperactivity. It was also discovered that it is possible to "de-activate" these acutely tender points through the insertion of a needle, and in the process relieve the pain and inflammation that is common to sports injuries, degenerative pain like arthritis, or painful conditions such as headache or TMJ.
This method of pain relief is now called "Trigger Point" or "Myo-fascial" acupuncture. I prefer the latter nomenclature, as the technique I have developed over the past twenty years involves deactivation of trigger points, stimulation of motor points, needling into fascia, tendons, ligamentous tissue, and even just below the skin or the skin itself. It also involves the use of therapeutic "cupping", electrical stimulation, and application of counter-irritants and heat. The system of trigger points mapped out by Travell and Simons dovetails, somewhat, with the Chinese system of acupuncture points specific to pain, called "Ah Shi."
However, the practice of trigger point acupuncture requires a thorough knowledge of western anatomy, as well as the precise location and referral pattern of the trigger points found in the various muscles, tendons, ligaments, joint capsules, periosteum, and even skin of the body. Trigger points occur, most often, in the thick portion of muscle bellies, particularly in the region of the motor point, but are also found in their origin and insertion.
Cause of Myofascial Trigger Points
Trigger points can form in weak, overused muscles, such as occurs in repetitive stress injuries in keyboard use. But they can also occur in very strong, but overused muscles, such as occurs in runners who rest inadequately, or other athletes. I recently deactivated the forearm and wrist trigger points in a patient that routinely does 1000 pushups at a stretch.
Trigger points may also occur in trauma from direct injury, such as a blow or sprain, as in the patient with sudden onset shoulder pain after being pulled suddenly and unexpectedly by her 110 pound dog Many of us are familiar with the "tension" lumps found in both the shoulders and low back, properly called "fibrositic nodules." These nodules also contain trigger points.
Effect of Trigger Points The problem of trigger points is not just that they are at the source of much myofascial pain; but that a muscle containing active trigger points undergoes shortening, and becomes weaker and less capable of the task at hand. This can then lead to a cascade of compensatory biomechanics, that further increase pain within the affected and allied muscles.
Role of Stress
I have observed a link between the presence of pervasive, active trigger points and the presence of shortened tight muscles, a bowstring pulse, and high levels of stress responses. We know, scientifically, that constant and poorly managed stress places us in the "fight or flight" response that elevates our stress hormones like cortisol. My informal theory is that this mechanism imitates an overuse syndrome in that our muscles are held as if ready to run or fight. This is work, and places our muscles into anaerobic sources of respiration and concomitant lactic acid burn. This creates various chemical cascades that may contribute to both inflammation and the formation of active trigger points.
Treatment of Trigger Points and Stress with Acupuncture One of the great things about acupuncture of any kind is that is places you into the relaxation response, similar to what is achieved by meditation. Acupuncture reduces our body's biochemical responses to stress, lowers blood pressure and reduces inflammation and pain.In terms of hormones and neurotransmitters it does this by increasing the secretion of our body's natural opiates, endorphins; and by increasing secretion of natural cortisone-like anti-inflammation drugs in the adrenal glands.
Myofascial trigger point acupuncture goes one step further. In addition to being profoundly relaxing, as above, when you relieve trigger points, especially the ones in the muscle belly associated with motor points, the muscle responds by actually lengthening; this has a decompressing effect on joints, tendons, and tendon sheaths. It is not unusual after a myofascial acupuncture treatment for the affected joints to "release" as after a chiropractic adjustment, gently, naturally, and safely. This is generally followed by an immediate relief in pain. Nothing releases a tight muscle and trigger points like a carefully placed acupuncture needle. Generally the patient feels an immediate effect while still on the table.
It is also typical that after acupuncture treatment to feel extremely refreshed, as if after a deep sleep. One will often sleep profoundly well the night of a treatment, which has enormous restorative value.I have found myo-fascial acupuncture, along with herbal medicine, stretching, therapeutic exercises such as Function First or Egoscue, massage, exercise, and progressive relaxation practices such as body scanning and mindfulness extremely effective in the treatment of even the most difficult cases of fibromyalgia, myofascial pain, and migraine.
To be continuted, the role of Herbal Medicines and Damp Heat in the Muscles
Copyright Eyton J. Shalom, M.S., L.Ac. San Diego, CA October 2011
All Rights Reserved, Use With Permission
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