If you’ve talked to more than one acupuncturist, you’re probably aware that there are quite a few different styles and traditions of acupuncture serving as a basis of treatment. Most acupuncturists in the United States are educated and board-certified in a mainstream approach based on traditional Chinese medicine (TCM), a consensus approach developed in China about 50 years ago. It follows closely along the diagnostic pathways of herbal medicine, the predominant healing practice in Chinese medicine. Some practitioners consider TCM-style acupuncture contrived. Other traditions fall under the umbrella of classical acupuncture, predating the Cultural Revolution, or may be referred to as meridian acupuncture, Five Element acupuncture, by region such as Korean, Japanese or American acupuncture, or mention certain microsystems such as scalp or auricular acupuncture, and so forth. It is nearly impossible to ascertain which system is superior. They all have strengths and weaknesses, and much of their efficacy is probably derived from the particular practitioner’s expertise in a given style.
The effectiveness of acupuncture in the context of musculoskeletal disorders and pain conditions has also piqued the curiosity of healthcare providers outside of East Asian medicine. Research in the field of biophysics and clinical research and expertise contributed by a wide range of clinicians, from orthopedists and neurologists to physiotherapists and massage therapists, have expanded our grasp of soft tissue dysfunction, and of the power of acupuncture to help restore physiologic functioning.
Of pivotal importance here is the work of doctors Janet Travell and David Simons, who developed a deep and wide-ranging understanding of myofascial pain by identifying so-called trigger points and implementing treatment approaches to release them. Several other therapists and researchers have continued their work and created offshoots, each with its own specific focus. They include John F. Barnes, famous for his myofascial release techniques; Clair Davies and several other bodyworkers who made trigger point therapy accessible for self-care; Thomas W. Myers, who focused on a modern interpretation of meridians in the myofascial system; and John Sharkey, who developed so-called “dry needling” for the release of trigger points in muscle tissue. Several doctors trained in East Asian medicine have also contributed their insights and expertise to the treatment of sports injuries and myofascial dysfunction. They include Wang Ju-Yi, Matt Callison, Whitfield Reaves, Marc Seems, and quite a few others.
Our knowledge in this area has grown exponentially in the last few years, in part due to the availability of modern diagnostic techniques including imaging and tissue biopsy, as well as the advances in anatomy & physiology, biochemistry and biophysics. We are realizing that Chinese doctors of yore, in many instances, were right on point with their strategies, but also recognize that modern technology allows us to develop insights that were not accessible to doctors and researchers until just a couple of decades ago.
So, what’s so special about motor point and trigger point acupuncture? Matt Callison, who taught at my alma mater, Pacific College in San Diego, for many years, used electromyographic studies to precisely locate motor points, the small areas in muscles having the lowest resistance to electrical conductivity. By stimulating this area in a muscle, he was able to create a comprehensive map of motor points for acupuncturists. These points can be accessed and stimulated with acupuncture needles to obtain a muscle twitch. This action resets the communication between the motor nerve reaching the muscle and chronically contracted muscle fibers, resulting in better functioning in the affected muscle and improved balance between agonist and antagonist muscles. A good number of the motor points Callison identified coincide with traditional point locations along the channels of acupuncture.
So-called trigger points comprise a much larger number of locations in muscle and other soft tissue, usually identified through practitioner palpation on individual patients. Trigger points are often clustered in certain regions of the muscle and can create somewhat predictable pain referral patterns. The points, or bands, in the muscle belly and tendinous attachment are of different sizes and shapes. They can be tender to the touch and may resolve if pressed for a certain amount of time, which produces ischemia and essentially forces chronically contracted muscle fibers to give up the fight and relax. Sometimes, trigger points are not tender and do not cause referred pain but may cause muscle imbalances nonetheless.
Matt Callison cautions that the aggressive needling of the numerous trigger points in an injured area, muscle tissue as well as other soft tissue, (as opposed to specific and limited motor points) may not be the most productive path to healing when considered from a Chinese medicine perspective, where economy and focus are highly prized. He cites studies that demonstrated resolution of pain and tenderness in both motor and trigger points by treatment of the motor point alone.
Practitioners of Western approaches, such as “medical” acupuncture and “dry needling,” often dismiss the theories and philosophies on which Chinese orthopedic acupuncture is based, and believe that trigger points, palpable taut bands in muscle, should be located and addressed with needle stimulation until they release. This approach can be effective in the short term but may require prolonged treatment because it does not address blockages and imbalances in the underlying energetic currents, which are described as stagnation of the flow of qi in Chinese medicine. Ultimately, an approach to healing rooted in Chinese medicine is a holistic approach. As acupuncturists, we treat the person, not the symptoms of disease. Striving to restore balance will facilitate healing and the amelioration of symptoms.
© 2018 Christiane Siebert