Tri - Medical Acupuncture, Dry Needling & Trigger Points
Tri - Medical Acupuncture is an integrative approach that considers three primary physiological mechanisms for acupuncture therapy. These include the neurological, biochemical, and myofascial systems.
Neurological studies on acupuncture are extensive and much has been discovered about how acupuncture works on the nervous system. Many studies have revealed the role of sensory and afferent nerves, spinal reflexes, ANS and CNS responses resulting from acupuncture.
Similarly, biochemical mechanisms involving inflammation, the immune system, and other changes that occur with acupuncture have been researched and are well understood.
Research on fascia and connective tissues provide a modern anatomical basis for traditional theories about the meridians. Myofascial chains can be categorized according to structural and functional groups, and point to a possible anatomical basis for many of acupunctures therapeutic effects.
Medical Acupuncture &
Anatomical Foundations First
This image is based on the anatomical research of Tom Myers and shows what he calls the Superficial Back Line (SBL). According to his research the muscles on the SBL are interconnected through the fasciae and share structural and functional relationships. The SBL mirrors what is also known as the urinary bladder meridian and provides a myofascial basis for this channel.
The SBL and fascial line model also explains many of the clinical responses observed with acupuncture. For instance, there are a special group of points on the achilles tendon used to treat cervical spine disorders, whiplash, hydrocephalus, and other conditions of the neck, head and brain.
According to traditional concepts and modern findings involving tensegrity and force transmission, we can begin to understand the non-local effects of acupuncture.
77.01 - 77.04
This image reveals an anatomical basis for understanding how points on the legs and ankles can benefit the back, neck and occipital region.
Non - Local Effects, Force Transmission and Tensegrity
Non-Local Effects & Myofascial Chains
Force transmission and tension moves through the musculoskeletal system and myofascial chains. In the myofascial chain model tension produced through contractile elements can move through local and non-local regions. (Bordoni, B., and Myers, Thomas, 2020)
Muscles which are agonists and synergists are part of a myofascial chain, as are complimentary non-local muscle groups located in more distant regions. Myofascial lines and chains are used in physiotherapy, osteopathic medicine, sports training and yoga. Additionally, they explain many features of traditional acupuncture point indications.
The point small intestine 3 located at the distal end of the fifth metacarpal bone is indicated for neck, thoracic and spinal pain. This region is innervated by the ulnar nerve and is within the C8 - T1 myotome. From a neurological perspective we can understand how nerve transmission from needling this point could effect the cervical and upper thoracic regions.
Small intestine 3 is also beneficial for pain in the scapula and rhomboids, as well as for low back pain. While a neurological perspective allows us to understand the benefits on the cervical region, it does not adequately explain the other effects of this point. Adopting a myofascial perspective, and considering how tension and force transmission move through the myofascial chains, allows us to understand how SI 3 can be effective for thoracic and lumbar.
SI 3 - A Traditional Distal Point for Neck and Thoracic Pain
local and non-local needling methods
Non-Local Responses and the Nervous System
Acupuncture and dry needling produce local and non-local responses in the circulatory and nervous systems, as well as through the myofascial network. Sensory and afferent nerves send signals to the spinal cord and dorsal root ganglion (DRG). At the level of the spinal cord signals are processed in spinal reflexes, and these reflexes are involved in some of acupunctures effects. Other impulses from dry needling will be sent to higher levels in the brain.
Dry needling produces peripheral and central neurological changes.
Davidparmenter, Trigger Point Complex, Wikimedia Commons
Medical acupuncture may be categorized into two major categories
including direct and indirect approaches.
Direct methods needle into trigger points, tender points and directly into symptomatic areas.
Indirect or non-local needling occurs in regions distant from the disorder.
There are advantages and disadvantages to each style, and it is important to understand when to use one method over the other. For instance, local needling can aggravate certain conditions and even lead to an increase in pain for up to several days. Neuropathic pain syndromes are one category of pain in which local needling will irritate the conditions. Acute sprains and other conditions with acute inflammation may also respond negatively to local needling.
For these reasons it is important to have strategies for using both local and non-local needling.
Advantages of Non-local Needling
The patient can move and exercise the painful area with needles in distant locations.
The doctor can perform manual therapies and adjustments on the painful area.
Non-local needling is often less invasive and requires less disrobing.
Distal acupuncture reduces the risk of side-effects.
Non-local needling decreases adverse pain reactions.
Indirect dry needling increases office and patient flow efficiency.
I want to discuss each of these topics in greater detail, but first let's look at some of the disadvantages of local dry needling.
Conditions That May Be Aggravated by Local Needling
There are a variety of disorders that may respond adversely to local needling. Additionally, local needling is contraindicated for conditions like cancer, skin infections, post-herpetic neuralgia, lympohedema, and other neuropathic pain disorders. Here is a list of conditions which may be aggravated by local needling, but it should be kept in mind that other factors such as needling depth and intensity will contribute to the overall response. For instance, local needling of painful areas in fibromyalgia can increase pain with deep and high intensity needling. However, shallow needling with low intensity mitigates adverse reactions.
Neuropathic Pain Disorders
Post Herpetic / Post Shingles Neuralgia
Reflex Sympathetic Dystrophy / causalgia (nerve trauma)
Carpal Tunnel Syndrome, Cubital Tunnel Syndrome
Radial Nerve Compression
Allodynia - Pain resulting from non-painful stimulus
*** Radiculopathy of the spinal nerves tend to respond well with local needling unless a large area of muscles are hypertonic.
While many neuropathic pain disorders are susceptible to adverse reactions, spinal nerve compressions respond favorably to local needling in most cases. Adverse reactions are more common in spinal nerve disorders when they are acute injuries or when the surrounding muscles are extremely taut over a long distance.
Other Disorders Susceptible to Negative Responses from Local Needling
Acute Sprains and Inflammation
Myotonic Muscular Dystrophy
Hypertonicity and Spasticity
Joint Pain and Disorders
Individual patient response is also a significant factor to consider with local and non-local needling. Clients with hypersensitive trigger points, or who are otherwise hypersensitive to needling, may react more negatively to some styles and techniques. Similarly, clients with low reactivity to needles may respond better to local needling and stronger needling techniques.
A Simple and Effective Strategy - From non-local to Local
Key points for treating headaches, neck, back and spinal pain are located around the ankles, feet, wrists and hands.
This results from the high concentration of nerves in the hands and feet, and the convergence of tendons in the ankles and wrists.
One strategy to avoid the contraindications and adverse reactions common with local needling is to begin with points distal to the elbows and knees. These are primary points to use for most kinds of conditions and invoke strong neurological and myofascial responses. The higher concentration of nerve endings in the hands and feet results in fast therapeutic outcomes, and is especially effective for headaches and other disorders of the head and face.
Similarly, as the myofascial chains converge in tendons around the ankles, feet, wrist and hands, points in these areas work quickly for releasing myofascial pain located in proximal regions and the trunk. Through the principles of tensegrity we can understand how muscular tension can get transmitted to distal regions that follow the myofascial chains.
Additional Advantages of Non - Local Needling
Earlier we spoke of some of the advantages of non-local needling and I want to expand upon them here.
Non-Local Needling with Local Manual Therapies, Adjustments and ROM Exercises - When needles are inserted in distal locations various manual therapies and movements can be applied directly to the symptomatic areas. For instance, there are powerful points located on the hands and feet that produce quick results for neck and shoulder pain. When needles are inserted into the limbs then adjustments, osteopathic manipulations, myofascial release, and physical therapies can be done locally on the neck. Often non - local needling is enough to stop the pain, but when combined with other specialized techniques the results and benefits are compounded.
Non-Local Needling is Less Invasive - Needling into the cervical and occipital regions has risks, and needling traditional points like GB 20, GB 21, UB 10, UB 13 and others can be dangerous to the patients. When needling in the chest and abdomen there is also the risk of pneumothorax and puncture of the peritoneum. Even with the utmost care, patients will sometimes move too much or even adjust the needles themselves. I've also had a patient get off the treatment table to answer her cell phone, even though she had 10 needles in her body!
Less Chance of Adverse Reactions - We have already spoke of various conditions that are more likely to respond adversely to local needling, these include neuropathic pain disorders, carpal tunnel syndrome, lateral epicondylitis, fibromyalgia, hypertonicity, sprains and other acute conditions.
Improved Office and Patient Flow Efficiency - As most non-local needling is done distal to the elbows and knees patients do not need to disrobe. This can save a tremendous amount of time. Expert needling techniques also require the use of less needles. Often 3 - 6 needles in one or two limbs can be enough to stop pain and get patients their desired results. By avoiding disrobing and using distal points a significant amount of time can be saved on each client. Busy practices can even see 35 - 87% more patients by increasing office flow efficiency.
Myofascial Lines, Non-Local needling & the Tung System
Superficial Back Line - SBL
The Lateral Line - LL
The Back Arm Lines
A highly effective system of non-local needling exists which originated in Taiwan from the late Dr. Ching Chang Tung.
One thing that makes this system unique is that it uses its own method of categorizing and using points. For instance, many points are located in connective tissues and tendons. We mentioned the achilles tendon points earlier, which are used for treating occipital headaches, neck pain and brain disorders.
Similarly, points in the connective tissue dense tensor fascia latae, are used for treating migraines, back pain and a variety of neurological disorders. As the diagram shows, the tensor fascia latae is located on the lateral myofascial line (LL). Additionally, many points on the LL on the thighs and legs are used in this system for treating lung disorders and other conditions related to the ribcage. As we can see the intercostal muscles are also part of the LL.
The myofascial line model allows us to better understand many of the
traditional indications of acupuncture points.
The Myofascial lines of the Arm and Hand points
The diagram of the hand shows many acupuncture points that can be used for treating neck and back pain. The points in blue are on the superficial back arm line (SBAL) while the points in red are on the deep back arm line (DBAL).
While the points in blue and red both treat neck, back and spinal conditions, there are subtle differences that are recognized in the Tung system. For instance, the points in blue are very effective for more acute patterns, while the points in red can treat more chronic disorders and problems in the occipital and sacral regions. Additionally, there are a group of points along the ulnar ridge on the DBAL that are very effective for thoracic pain and pain in the scapula.
While the traditional Tung system has its own methods for choosing groups of points with similar functions, the myofascial line model provides many insights into the subtle differences between point groups. For treating neck pain there are three distinct groups of points on the hands, and each of them work differently. When we understand the myofascial line model we can better appreciate how these different groups of points work.
Tri - Medical Acupuncture: Mechanics, Neurology & Biochem
The SFL, Chest Fascia and Quadricep Points
While much is known about the neurological effects of acupuncture, as well as biochemical changes that occur with needling, much less is known about the mechanical and structural role of the myofascial lines in acupuncture therapy.
By combining the Tung system with myofascial anatomy, we can begin to better comprehend the mechanics of how these points work. This has major implications for treating migraines, spinal conditions, pain, structural problems, as well as internal disorders.
A myofascial model combined with a highly effective system of using non-local points, can greatly assist you in increasing your clinical efficiency. While many therapists and doctors know about the ability of dry needling trigger points in treating pain, fewer know how effective non-local points can be. Non-local points also have many advantages over local needling, such as already discussed.
A 10 Hour course in Acupuncture & Myofascial lines
The course Acupuncture, Myofascial Lines & Tung's Points will give you many insights into the locations, actions, and indications of over 50 vital non-local points as taught in the Master Tung system.
This course is specifically written for doctors, osteopaths, chiropractors, and physical therapists. The concepts presented will solidify a biomedical approach to acupuncture. In it I present a working model for understanding how to get fast and effective clinical results for many common clinical disorders.
If you are currently doing dry needling and looking to improve your clinical efficacy, take the next step and learn what non-local needling of myofascial lines can do for you and your patients.
The course includes :
In depth coverage of over 50 points
Over 60 high quality illustrations
107 pages & 6 PDF files on each of the fascial planes
7.5 hours of audio recordings
Immediate access to files
Get the Course Today!
Bordoni B., Myers T., 2020. A Review of Theoretical Fascial Models: Biotensegrity, Fascintegrity, and Myofascial Chains, Cureus; https://dx.doi.org/10.7759%2Fcureus.7092
Brady, et al., Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists; Journal of Manual Manipulative Therapy, 2014
Filshie, White, Cummings, Longhurst; Medical Acupuncture, A Western Scientific Approach; 2016, Elsevier Publishings
Langevin, Helen, et al., “Biomechanical response to acupuncture needling in humans,” J Appl Physiol, 91:2471-78, 2001.
Langevin, Helene, et al., “Mechanical signaling through connective tissue: A mechanism for the therapeutic effect of acupuncture,” FASEB J, 15:2275-82, 2001.
Read more about how these systems can contribute to Acupuncture Research.