Trigger point acupuncture and sports injuries-exciting new developments!

Townsend Letter for Doctors and Patients,  July, 2003  by Stephen J. Kaufman

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1) Where to place the needle! In TCM acupuncture this is determined by many factors, including the pulse and abdominal palpation, inspection of the local area of pain, time of day, season, patient's body type, diet, symptoms, etc. Traditional TCM theory is then applied to justify the selection of points. Most often, point selection and rationalization will vary among practitioners, sometimes widely. It is sometimes not obvious to one practitioner why certain points are chosen by another practitioner. In TCM, the points are selected based on the available data. It can be a very complex, abstruse process. The points themselves are often not even palpated. In contrast to that, trigger point acupuncturists first palpate the points to find them, by seeing if they are tender and radiate pain. (Of course trigger points are also recognized and used in Chinese medicine; they are called "ah shi" points. However, this technique has been much more extensively developed in the British methodology.)

In the British approach, point selection is extremely simple. The patient is examined for trigger points based on his pain syndrome, according to patterns originally discovered by Travell. For many forms of muscoloskeletal pain, the patient will have predictable exquisitely tender areas near the area of pain, which, when pressed, reproduce the patient's pain. In one of the greatest (and unknown) works of the last century on pain management, Travell has mapped out, in two 800-page volumes, scores of these pain patterns. Like all true science, these patterns are predictable, consistent, verifiable and reproducible. These trigger points are the points to needle. They are often not very near the point of pain that the patient complains of, but several inches away. These points will be consistent from one practitioner to another, providing they are adequately trained in trigger point palpation.

2) How deeply to insert the needle. TCM acupuncture usually inserts the needle from 1/2 inch to 2 inches or more. Japanese acupuncturists favor a much shallower insertion. In the British view, based on the neurophysiology involved, a depth of 5mm (1/5 inch) is all that is required. Most of the afferent fibers that produce the effect in acupuncture are near the surface of the skin. Deeper penetration is not necessary and may be counter-productive. In this regard, thin (36-40 gauge) needles are usually adequate, as against the thicker 32 gauge needles traditionally used by the older school. My patients often remark how much more comfortable it is to have acupuncture in this, almost painless, way. They often ask me if the needle has been inserted yet, or is it still in! They often can't feel the needle going in or being taken out.

3) How many needles to use. This can vary greatly among traditional acupuncturists. There is a feeling in TCM that fewer is better. Trigger point acupuncturists will use as many needles as there are active trigger points to treat, frequently a dozen or more. Sometimes they will use only one needle to sequentially treat several trigger points. Sometimes they will put two or more needles in per trigger point. I have developed an approach using 4-8 needles in key trigger points (Eight Needle acupuncture) which I feel has given me exponentially improved results.