What follows is an attempt to further rationalise the use of an integrated mechanisms based needling approach in the treatment of myofascial pain related to the presence of trigger points.

I have provided a list of references which have influenced my understanding of the proposed neurophysiological mechanisms which may occur at the various levels. However some of the effects listed are based on clinical observation and discussion with colleagues.

The following mechanisms may apply when a myofascial trigger point is accurately located using the diagnostic criteria and then needled using:

1. A local needling approach using electrostimulation
2. A segmental approach in addition to or as an alternative to a local approach
3. Enhanced central regulatory effects

How does Acupuncture work?

Needling activates specific nerve endings within the muscles - this triggers the release of substances which improve blood flow to the area, reduces pain and inflammation and promotes healing.

Needling also has effects within the CNS which further reduces pain, eases muscle tension and can promote a sense of wellbeing.

2 Hz EA - Adding gentle low frequency electrical stimulation enhances the segmental and central analgesic effects of needling by activating the central nervous system in a way similar to exercise

I’ve written on this topic before and given more recent evidence in support of a mechanisms based approach, I thought it time to revisit. Furthermore, as a sinus pain and congestion sufferer the role of Acupuncture in providing relief is definitely of interest to me!

First a quick review of the condition:

Acute sinusitis is defined as inflammation with swelling and engorgement of the nasal cavity and sinuses characterised by the existence, for 12 weeks or less, of two or more of the following symptoms (Fokkens, 2005).

• Blockage/congestion and discharge (anterior or posterior nasal drip which may result in a cough)
• Facial pain or pressure
• Reduced or loss of smell

Other associated symptoms may include toothache (involving the upper teeth), tenderness, swelling, malaise and fever (Ah-See 2007). Clinically neck pain and stiffness and headache may also occur.

This course ran on the 24th and 25th of January at Mount Merrion Chartered Physiotherapy, 105 Trees Road, Co Dublin, Ireland. The course tutor was Dr. Hugo Pinto from Portugal who was assisted by myself.

Given the interest in the course and great feedback, we have decided to run the course again on the 10th and 11th of May 2015. Please email This email address is being protected from spambots. You need JavaScript enabled to view it. for further information.

Here are some comments from the course attendees:

What follows is a variation on a mechanisms based approach to the use of Medical Acupuncture with particular emphasis on the role of the spinal segments.

1. According to this approach, we may start by using local points such as myofascial trigger points (MTrP) and taut bands related to the patients presenting complaint. This would take into account referred pain patterns, altered muscle length and function. Manual needling as well as point stimulation using the Pointer Excel II or EA at 2 Hz may be used to augment the sensory neuro-modulatory and mechanical needling effects.

2. If too sensitive to treat locally or for enhanced modulatory effects use somatic segmental points to suppress nociceptive transmission and influence muscle tone through the related segments.

For example: