Rotator cuff pain ranges from the tight, achy soreness and pain common with stress and overwork injury, to the more severe sports injuries involving tendonitis, sprain, strain, and partial tears of the rotator cuff, to what Chinese Medicine dubs “50 year shoulder”, or frozen shoulder in the west.
All the above injuries are very well treated with Dry Needling of Trigger Points and Motor Points. I began studying Dry Needling and Trigger points while at Pacific College of Oriental Medicine, a San Diego acupuncture school in 1990, studying Travell and Simon trigger point therapy first, and then going on to study motor point and fascial release methods.
Over time I developed my own unique system of of deep tissue Myofascial acupuncture that I combine with Classical channel based acupuncture along with traditional Chinese cupping, electrical stimulation, herbal and Nutritional medicine. This is the method I have been using with success in my San Diego acupuncture clinic for the past 20 years for shoulder pain and other forms of acute and chronic pain.
Why is rotator cuff pain so common?
The shoulder girdle is unique in both its structure and its function. Like the hip joint, the shoulder operates as a ball within a socket, but has a far greater range of motion in multiple directions and is, therefore, easily injured. And since the distal structures supported by the shoulder, the arms, hands, and fingers are themselves such complex joints and so central to all tasks human, the shoulders are under great stress.
Postural issues play a big role in the development of rotator cuff pain and injury. There are so many modern activities, such as driving, washing dishes, and typing, that, because they involve near vision tasking and manipulation of small objects in front of the body, cause forward translation of the head and shoulder girdle, leading to poor posture from tasking. This leads some muscles, like the upper trapezius, to be over-recruited, while others, such as the rhomboids, are left weakened, and incapable of effective firing. This leaves the overall shoulder joint at mechanical disadvantage.
Another factor in rotator cuff pain is that the shoulder, neck, and upper back are, like the face and scalp, areas where we carry the tension associated with stress, frustration, and anger. So, along with the gut, these are areas that develop tightness, poor circulation, and activated painful trigger points.
Dry Needling of trigger points is a style of acupuncture that involves the deactivation and stimulation of trigger points—hyperirritible spots in skeletal muscle that are associated with palpable nodules and taut bands in groups of muscle fibers. An example would be the lumps that many of us feel at the crest of the shoulder between the shoulder and neck.
The advantage of this technique is that trigger points are associated with predictable referral pain patterns which can often be mistaken for other kinds of injuries. TMJ for example, is often due to referral pain from trigger points in the masseter muscle, as opposed to actual degeneration of the temporal mandibular joint.
Myofascial Acupuncture is also based on a knowledge of the motor points found in muscles. This is the dry needling of Motor points. Also known as the neuro-muscular junction, this is where the nervous system connects to the muscular system via synapses between efferent nerve fibers and specialized bundles of muscular tissue, known as motor points.
In essence, motor points are the “brain cells” of the muscles, and are how the muscles and their associated connective tissues, the fascia and tendons, know whether to contract or relax. This is critical, because with many conditions, like carpal tunnel, or thoracic outlet syndrome, the patient has developed a nerve entrapment syndrome due to the compressive effects of tight bands and shortened muscle fibers. We see this a great deal with sciatic pain due to piriformis and quadratus femoris syndrome.
Most rotator cuff pain conditions are associated with trigger point and motor point pathology involving shortened, dysfunctional muscles. Even when the primary source of the pain are arthritic changes in the joint, relief can be obtained because, according to Hilton’s Law, when there are dysfunctional joints, the muscles that cross those joints will spasm as a protective mechanism. The way to release that spasming is to release the motor points.
By stimulating the motor points the muscles of the rotator cuff lengthens, improving functionality and reducing pain. Now shortened weak muscles can be safely strengthened. Needling adjacent trigger points is also very important for eliminating referred pain.
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.
Dry needling and myofascial trigger point acupuncture goes one step further. In addition to being profoundly relaxing, as above, when you relieve trigger points, you improve the blood circulation to the muscle tissues and eliminate referred pain.
Most rotator cuff pain conditions are associated to some degree with motor point pathology involving shortened, dysfunctional muscles. By stimulating the motor points the muscles actually lengthen, improving functionality, while creating a decompressing effect on joints, tendons, and tendon sheaths. and reducing pain. Now shortened weak muscles can be safely strengthened.
Dry Needling and Myofascial acupuncture have a profound affect on fascial tissue, as well. Fascia is a kind of “dense regular connective tissues containing closely packed bundles of collagen fibers oriented in a wavy pattern parallel to the direction of pull.” Our muscles “grow” into tendons that are attached to bones and all of this is organized by fascial tissue. Our internal organs are held in place by matrices of fascial tissue and ligamentation.
Essentially our entire body is a web of fascia into which all else is woven. Shortened fascia can be a critical component in shortened muscles, and the tendon, ligament, and joint pain that goes with it. Fascia is an integral component in “muscle memory”– where the muscle returns to after use. In chronic injury patterns we need to retrain the muscle and give it new places in which to rest, and motor point acupuncture is an effective way to reset the muscles.
It is not unusual after a dry needling or myofascial acupuncture treatment for the affected joints to “release” as after a chiropractic adjustment, gently, naturally, and safely. This can be followed by an immediate relief in pain. 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 itself has enormous restorative value.
Acupuncture and Dry Needling, like deep tissue manual therapies, works hand in hand with corrective exercise therapies such as the Feldenkrais method, Function First, or Egoscue. My favorite kind of patient is the one who wants to help herself. Acupuncture is passive. You lay there on the table and the therapist uses his skill to reduce inflammation and pain and create new mobility, so that you can next take matters into your own hands through therapeutic exercise regimes that retrain the muscles and help you discover how you are carrying tension. . As such, acupuncture can be a necessary “evil” that enables you to take it to the next level with your own efforts.
copyright eyton j. shalom, m.s., l.ac. dec 2012 all rights reserved use with permission