Trigger point acupuncture and sports injuries-exciting new developments!

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

4) How long to leave the needles in. Almost all of the patients that I see that have been to TCM acupuncturists have been surprised that I leave the needles in for such a short time. In TCM the needles are usually left in place for 10-20 minutes, or even longer. As far as I can tell this is a traditional recommendation ("that's what my teacher did"), and has no objective basis. In trigger point acupuncture as practiced by the British physicians, the needles are usually left in for 5 seconds to less than 3 minutes. Most often it is less than a minute. It has been hypothesized that there is actually a diminishing return longer than five minutes: at 10-20 minutes the therapeutic effect is less, not more!

I believe this relates to the accommodation process of the nervous system. If you walk into a room and smell something, within a few minutes your nervous system will accommodate to the stimulus of the smell, and you will not smell it anymore. Similarly, we get used to background noise. In the same way, the stimulus of the needle penetration in acupuncture may cause its strongest effect in the first 60 seconds of treatment. After that it then has a greatly diminished or even counter-productive effect. To my patients who ask if leaving it in such a short time works as well, I ask them "How long does it take to turn on a light switch?" That may be what acupuncture does, by throwing a switch in the nervous system to allow neural pathways to fully initiate a healing response (the "current of injury").

Here I would like to introduce the experimental observation that I have verified many times, and that each practitioner can verify for himself. To me, this proves the case for trigger point acupuncture. Since in TCM, the acupuncture point itself is rarely palpated, this observation was not emphasized until recently Are you ready? Here is the essential trigger point acupuncture protocol:

Simply find the active trigger point by palpation. Note how tender the patient feels it is, and the radiation pattern. Needle the point using a 32-38 gauge, 1 inch needle. Insert the needle 5mm only. Withdraw the needle after 30 seconds. Repalpate the point. (I glove my palpating hand so as not to contact the patient's blood.) If the point is still tender, re-insert the needle for 30 more seconds. Withdraw it again and repalpate. Repeat this for a maximum of 2-3 minutes per point. In the large majority of patients, the point will no longer radiate pain after this short treatment time. The point may still have some local tenderness, but it's usually much less. It's more important to resolve the radiating pattern. This immediate elimination of trigger point tenderness is an extremely important phenomenon. Peter Baldry mentions this in his book. In my experience it is very predictive of success. In 25 years of practice, this is by far the most effective technique I have seen to eliminate these pesky trigger poi nts, which produce an enormous amount of suffering.

Acupuncture of scar tissue is an accepted, effective technique, but the usual protocols are vague. Scar tissue often has very tender areas that may or may not radiate. Using this technique on them often gives remarkable results, even in long standing visceral complaints.