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:

The simple answer is yes we should be treating latent myofascial trigger points (L-MTrP), but why?

Studies have shown the following:

L-MTrP may be responsible for less specific but highly disabling symptoms of muscle fatigue (Ge et al, 2013)

L-MTrP result in weakness and general dysfunction with EMG studies showing abnormal and inappropriate muscle co-activation where there are MTrP present in the prime acting muscle. This may result in the inability to perform smooth con-ordinated movements involving the synchrony of agonist and antagonist muscle groups.

We are very pleased to be hosting the BMAS who once again will be be running Foundation Course at Mount Merrion Chartered Physiotherapy. This is an excellent opportunity for regulated medical and allied medical healtcare professional to learn how to use Medical Acupuncture safely and effectively in clinical practice.

Dates:

Friday 12th - Monday 15th June 2015

Location:

Mount Merrion Chartered Physiotherapy
105 Trees Road
Mount Merrion
Co Dublin
Ireland

Learning highlights:

The Foundation Course is a mixture of lectures and practical group sessions. Group sizes are kept to a maximum of 12. In the initial stages of training the emphasis is on safety and all attendees will be observed by an experienced demonstrator to ensure a safe needling technique.

On Saturday November 1st, I was very pleased to run the second in a series of Medical Acupuncture (with the integration of Dry Needling) courses in the management of a variety of regional conditions. This course focussed on the use of needling techniques in managing knee pain and dysfunction.

The aim of the course was once again to provide attendees with a range of needling techniques which can be effectively and safely applied in practice the following week. To allow for a practical emphasis, pre - course theory modules were completed online by the participants. These included a safety review, mechanism review, principles of point selection as well as conditions and patient suitable for medical acupuncture treatment.

We started the day with a review of the pre-course material and then went on to a clinical overview of the knee, followed by a rapid assessment relevant to the medical acupuncture practitioner.

It must be reiterated that pain referral is the cardinal feature of the myofascial trigger point (MTrP). As such simply trying to identify a MTrP by the presence of a taut band and tender point is insufficient. The referred pain patterns generated by the MTrP usually, but not always, occur within a predictable distribution as described by Travell and Simon’s. If the referred pain is familiar to the patient, i.e reminds them of the symptoms for which the patient may have sought treatment, the MTrP may be considered active. If the referred pain is unfamiliar is may be considered latent, but arguably the MTrP may still be worth treating.

Is the referred pain phenomenon a peripheral or central effect?

Evidence has concluded that referred pain is most certainly a central effect. My understanding of this has mostly centred at the dorsal horn where a ‘wind up’ may occur in response the afferent nociceptive barrage arising from the MTrP. This results in a progressive pain referral mostly within the associated segment. This effect has been supported by studies which have shown MTrP’s in rats capable of sensitising the dorsal horn with the development of new neurons.