Trigger points are exquisitely tender points within muscles which like to refer pain, usually some distance from where the trigger point is located.¹

For example a trigger point within the upper trapezius muscle which sits on top of the shoulder, between the neck and the shoulder tip, typically refers pain to the side of the neck, the temple and even the jaw. They often contribute to a tension type headache, especially if found on both sides of the neck.²

But how reliably can these trigger points be identified on physical assessment? In other words, if I was to assess you and then another physiotherapist were to assess you afterwards, how likely would we both agree that a trigger point either is or is not present?

Physiotherapist love trends. The current trend which has been around for a good number of years now is that all pain, especially persistent pain is a result of some level of central nervous system (CNS) dysfunction, an output of the brain effectively.

As such it is argued we should now forget about structure and the periphery and simply target the central nervous system when treating clients. This basically means talking therapy and exercise, so vociferously promoted by the biopsychosocial pain model zealots. Hands on treatment is now considered an act of high treason and anyone admitting to doing so risk being shamed and admonished. As for acupuncture or dry needling, such techniques are considered by these folk as being so worthless you’d be better off rolling around in a thorn bush for the good it would do you.

Now of course the CNS plays a role in how we perceive pain, how could it not? Given how inextricably linked the peripheral (which supplies the spinal structuctures and limbs etc) and central nervous systems are both physiologically and anatomically, one will of course influence the other. For some, pain may be due to a combination of both peripheral and central nervous system 'wind up'.

Acupuncture, medical acupuncture, dry needling...call it what you want...has been shown to activate proprioceptive afferent receptors in muscle tissue, in particular the type 11 (flower spray type) which which contribute to numbing feeling associated with the needle sensation or ‘de qi’.^1,2 Given the pain modulatory benefits of acupuncture are mainly attributed to sensory effects, the activation of these proprioceptors may be important from a mechanisms point of view.²

Manual therapy also activates proprioceptors (sometimes referred to as ergo or mechanoreceptors) about the muscle spindles and articular structures.³ When looking at the manual therapy literature and listening to experts⁴ discuss the proposed mechanisms which underpin its benefits, the role of proprioceptor activation is considered not only in terms of contribution to pain modulation, but also from functional point of view. In other words, manual therapy is associated with pain modulation, but can also be used to facilitate movement and exercise, help normalise faulty movement patterns etc.

So, my musing for this morning is should acupuncture research be focussing more on functional effects? i.e to what extent may acupuncture impact on specific functional outcomes which assess mobility, strength and control etc? Is acupuncture when combined with specific exercise more effective than one or the other on it’s own? What happens when manual therapy, exercise and acupuncture are combined?

There are two main types of incontinence, Sometimes a mixed type can occur.

Stress incontinence:

May be due to pelvic floor weakness, a result of disturbances to the normal function of the pelvic floor muscles and fibrous tissue. This may be due to the presence of trigger points within the muscles, it may also be inherited. Those with stress incontinence are more prone to leaking with coughing, sneezing, laughing, exercises, lifting etc. Treatment options include pelvic floor muscle retraining (with a physiotherapist), electrical stimulation, and medication. In some cases surgery may be required.

Urge incontinence:

Results in the feeling of needing to urinate more frequently and being unable to control the urge. Sometimes the urge results in an increase in visits to the bathroom only and without incontinence, this would be referred to as an overactive or 'irritable bladder'.This type of incontinence is due to a sensitivity of the bladder wall and disruption of the neuronal mechanisms which control the bladder wall and sphincter. This can greatly affect health related quality of life and may result in a social isolation. Treatment options include physiotherapy, electrical stimulation, medication and in some cases surgery. Medical acupuncture has also been shown to be an effective form of treatment for urge incontinence as is now being more widely recommended to complement or replace the need for medication.

Medical acupuncture has been shown to:

• Reduce the number of urges and improve health related quality of life.^1,3
• Reduce the frequency of bathroom visits, reduce the numbers of urges, improve bladder capacity as well as improves urinary distress inventory and incontinence impact questionnaire scores.²
• Electro acupuncture applied to the point SP6, referred to by urologists as PTNS (percutaneous tibial nerve stimulation), has shown to be effective and efficacious in treating overactive bladder in 220 patients.⁴
• Other studies have shown that electro acupuncture compares favourably with the tolterodine drug treatment ⁵ and is a viable long term therapy.⁶

Our clinical approach is to use Medical Acupuncture alongside diet, lifestyle and exercise advice as part of an integrated approach.

If you need help and would like to explore a medical acupuncture based course of treatment, and for further information, please call the clinic on 01-2834303.

Pelvic girdle pain in pregnancy (PGP) symptoms are normally felt about the pelvis, the buttocks and groin areas. They are aggravated by walking, bending and lifting which hinder the sufferer’s daily activities. It can also affect sleep with symptoms milder in the morning and worse in the evening.

PGP is the leading cause of sick leave during pregnancy in Sweden and other countries.

75% of women who experience PGP during pregnancy will improve within 12 weeks after delivery, 25% will go on to develop chronic pain.¹

Medical acupuncture has been shown:

• To relieve pelvic and low back pain in late pregnancy.²
  When combined with stabilising exercises, to be an effective compliment to standard treatment.³
• To be more effective in providing PGP relief compared to stabilising exercises when used on own.³
• To reduce pain, improve daily activities, improve emotional reactions and loss of energy according to the Nottingham Health Profile questionnaire.⁴
• Combine well with pelvic support belts in the treatment of PGP.⁵
• To also be an effective treatment for women who experience nausea and dry retching in early pregnancy.⁶

Medical acupuncture treatment has resulted in no maternal or obstetric negative side effects such as premature delivery in 417 pregnant women treated and after 3152 treatments.^3,6,7,8