I am reprinting this article on Trigger Point Acupuncture and Dry Needling that I wrote way back in the year 2009, for my dear friend Anthony Carey, M.S., the owner of Function First here in San Diego. Function First is a system of corrective exercises first developed by Pete Egoscue, and refined by Anthony, whose Master’s degree is in Kinesiology, the study of how muscles function.
The Trigger Point Problem: Shortened Muscles and Fascia
Muscles function by moving, but they move, only by virtue of contraction. The Trigger Point problem arises when muscles are in states of constant contraction, as we all experience with stress tension. We can also injure our muscles from activities in which we experience a rebound tightening of a muscle, such as when your 90 lb dog suddenly bolts with your arm at the end of its leash. Overuse of a muscle, whether through work, such as typing, or sports, such as the repetitive use injury you get from throwing a ball, is the third way trigger points in our muscles get injured
Shortened Muscles and Active Trigger Points Equals Pain
How Trigger Points form in Muscles and Fascia
Muscular contraction of muscle fibers occurs when our brains send messages via the motor nerves, and/or the sympathetic nervous system, to contract. The junction of nerve to muscle is called a motor point. Motor points, and their related tissues trigger points, are the contracted culprits responsible for much chronic pain. Stress, repetitive use, overuse, and trauma can each cause the our latent trigger points to activate and cause our muscles and fascia to painfully shorten. Acupuncture and Dry Needling releases motor points and trigger points so that muscles can do their job, which is to contract and release, in a complex ballet of agonist and antagonist.
For example, when you touch your nose with your index finger the agonist is the biceps, which, with its related fascia, shortens as it brings your forearm to your face. At the same time the triceps and its fascia, the antagonist of the biceps, lengthens. Do this once; its fine. Do it 100 times with a 20lb dumb bell and most likely your biceps will be left a little shorter. This is why stretching after exercise is so vital. Now imagine doing various movements on a daily basis, like typing at a computer with a bad posture and lots of stress tension, and you can imagine your body being left with imbalances.
Function First, or the The Egoscue Method , correct these kind of imbalances by evaluating which muscles and fascia are not “firing” well, which are over compensating and which are under compensating. Trigger Point Acupuncture and Dry Needling sets the stage for correcting these imbalances by releasing the motor points and trigger points of the affected muscles and fascia so that their fibers can return to normal more easily.
And now the article, reprinted from the Function First archives.
Trigger Point Acupuncture and Dry Needling: The Inflammation Alternative
Thursday, July 23rd, 2009
Definition and Brief History of Trigger Points
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. (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.)
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.
Trigger Point Acupuncture and Dry Needling
This method of pain relief is now called “Trigger Point” Acupuncture and Dry Needling in states where Physical Therapists are permitted to insert needles into the body. (In some states, like California, it is outside their scope of practice, just as surgery is). Trigger Point Acupuncture and Dry Needling dovetails with the Chinese system of orthopedic acupuncture based on the so called “tendino-muscular” meridians, which corresponds to the sheaths of fascia that travel up and down our bodies.
However, the practice of trigger point acupuncture and dry needling 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. It also requires the training and experience in using dry needles to release trigger points and motor points.
How Painful Trigger Points Become Activated
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 muscles and fascia 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 clinically a link between the presence of active trigger points and the presence of diffuse inflammation in the body. We know, scientifically, that constant and poorly managed stress places us in the “fight or flight” response that elevates our stress hormones like cortisol.
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 and Dry Needling
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 and Dry Needling 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 trigger point acupuncture or dry needling 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.
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.
Acupuncture and the Function First Exercise Alternative for Pain
Acupuncture and Dry Needling, like deep tissue manual therapies, works hand in hand with the Function First system. 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 create an environment of reduced inflammation and pain, so that you can take matters into your own hands through exercise. As such, acupuncture can be a necessary “evil” that enables you to take it to the next level with your own efforts.
Function First with Anthony Carey was of enormous benefit to me in the rehabilitation of my own neck, shoulder, and back chronic pain. While I definitely treat myself with acupuncture on a regular basis to enable myself to keep as active as I do, I continue to this day to do my Function First exercises on a daily basis.
Eyton J. Shalom, M.S., L.Ac., is the owner of BodyMind Wellness Center at 3577 Louisiana St. in North Park, San Diego. He is expert in the practice of Myofascial Trigger Point Acupuncture for Sports Injuries and Chronic Pain, as well as the use of Chinese Herbal Medicine and Ayurveda in the treatment of Dermatological, Gastrointestinal, and Immune Disorders.