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Understanding of Myofascial Trigger Points (2): Acupuncture Vs Dry Needling

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Understanding of Myofascial Trigger Points (2): Acupuncture Vs Dry Needling Open Access Physical Medicine and Rehabilitation - International Special Article - Acupuncture and Rehabilitation Understanding of Myofascial Trigger Points (2): Acupuncture vs Dry Needling Huang QM1,2*, Xu AL1, Ji LJ1 and Pang B1 1School of Kinesiology, Shanghai University of Sport, Abstract Shanghai, China The use of acupuncture and dry needling has been widely debated, and 2Department of rehabilitation, Hudong Hospital, the main point of contention is whether dry needling has been derived from Shanghai, China acupuncture. This paper comprehensively discusses the two aspects of basic *Corresponding author: Huang QM, School of theory, diagnosis and treatment of traditional acupuncture, meridian, acupoints, Kinesiology, Shanghai University of Sport, 188 Henreng and myofascial trigger points (MTrPs). Except the difference between two Road, Yangpu Area, Shanghai, China theories, many aspects are related in terms of clinical practice and basic laboratory studies. Nevertheless, two aspects are highly similar in terms of Received: March 28, 2018; Accepted: May 04, 2018; treatment action, applicable disease, and physiological experiments. Therefore, Published: May 11, 2018 MTrP theory is considered a basis for modern acupuncture, which is different from traditional acupuncture theory. MTrP is also easily accepted and learned by individuals with a background in modern medicine and those with knowledge in traditional acupuncture. Hence, MTrPs may be the precise acupoints in traditional Chinese medicine under modern scientific research, and meridian involves the synthesis of referred pain, nerves, vessels, and fascia mechanics. The scientific basis of Chinese and Western medicines should be coherent, although the origin of these two theories varies because of the distinctiveness of the identity between ancient and modern knowledge. The final goals of the two theories are the same, and their results are highly similar. Therefore, one theory should not belong to the other one. Meanwhile, as human behavior or thinking is essential for acupuncture development, a person often attempts either to experience nostalgia based on ancient knowledge or to develop new appropriate theory along with modern experiment technology. Keywords: Myofascial Trigger Points; Acuponits; Acupuncture; Dry Needling; Meridian; Referred Pain; Local Twitch Response Abbreviations be obtained because they are too abstract without real anatomical, physiological, and pathological bases. Needling acupoints should TCM: Traditional Chinese Medicine; TCA: Traditional Chinese achieve Qi, such as feeling of soreness, swelling, and numbness Acupuncture; MTrP: Myofascial Trigger Point; DN: Dry Needling; with pain [6]. As such, these acupoints are not easily understood WN: Wet Needling by beginners or ordinary individuals who have earned education The Difference between Traditional in modern medicine. In clinical treatment, most patients have Acupuncture and Dry Needling benefitted from traditional acupuncture at beginning, but such effects have subsequently become invalid. When experiences in acupuncture Acupuncture is based on traditional Chinese medicine (TCM) practices have accumulated for acupoint positioning without the theory and Yellow Emperor’s Inner Classic, which is one of the main use of traditional textbooks as references, acupuncture skills of most textbooks [1] with records of over 3000 years of clinical experience. doctors with a background in traditional acupuncture have been A total of 361 acupoints distributed in 12 meridians with dialectical improved. This accumulated skill is unrelated to textbooks of TCA. diagnosis have been described, and needling and heat treatments have focused on unclear structures or any structures to address MTrPs are pathological structures that undergo morphological health problems, dysfunctions, and disorders. Therefore, a unique changes in muscle fibers with spontaneous electromyographic traditional Chinese acupuncture (TCA) and moxibustion have been discharges [7-9]. Needling MTrPs should cause some alterations, such formed in China [2]. By contrast, dry needling (DN) derived from as a local twitch response (local muscle jump), a puncture referred wet needling (WN) is based on modern medicine and myofascial pain, or a strong feeling of soreness, swelling, and numbness [10- trigger point (MTrP) theory. In DN, symptoms, signs, and palpation 12]. Therefore, this procedure can be easily understood by beginners are diagnosed, and physical examination is performed. However, with a medical background, especially human anatomy, physiology, needle and heat treatments have focused on all skeletal muscles to and pathology. The effect of needling treatment is stable and quick alleviate health conditions, dysfunctions, and disorders in humans. because of the precise positioning of MTrPs. When their experiences Hence, DN belongs to modern clinical medicine and physiotherapy have accumulated, the effects will be enhanced and long lasting. [3-5]. However, we have to define acupoints and meridians and to Two systems have different theoretical sources, and diagnostic locate their precise positions in the body. Actual results have yet to methods and point localizations vary. In TCA, the general positioning Phys Med Rehabil Int - Volume 5 Issue 3 - 2018 Citation: Huang QM, Xu AL, Ji LJ and Pang B. Understanding of Myofascial Trigger Points (2): Acupuncture vs ISSN : 2471-0377 | www.austinpublishinggroup.com Dry Needling. Phys Med Rehabil Int. 2018; 5(3): 1146. Huang et al. © All rights are reserved Huang QM Austin Publishing Group Table 1: Local ACh, AChR, AChE concentrations at two weeks after acupuncture eight treatment measures (burning mountain fire, cooling through treatment (double control with upper two lines), n = 16. the sky, hiding yin within yan or hiding yan within yin, pounding Groups Ach (uM/ml) AChR (pg/ml) AChE (u/ml) mortar in the meridian, fighting between dragon and tiger, taking Normal muscle fiber 101.98±25.67 125.97±19.57 173.91±102.53 in, retaining, and extracting Qi) [2,6]. Different auxiliary techniques MTrPs model 141.49±32.41* 254.3±112.89* 204.67±66.01 called the eight other ways with hand include speculating, clawing, rubbing, plucking, shaking, palpating, following, and twisting [2,6]. Needling MTrPs 107.04±36.82 133.88±37.11 446.6±175.11** Acupuncture stimulation is an alternative to the “strong in draining, Needling out MTrPs 119.65±25.14 234.5±108.21* 188.39±64.82 the weak in making-up” because general health conditions in a Note: *p <0.05, **p <0.01, variance analysis between groups. From Liu GG, Liu human body vary between strong and weak individuals. Regardless of L, Huang Q-M et al., [13]. its achievements and how the myth of the noun is, any acupuncture of acupoints consists of three methods: “self-body surface”, “self-bone method is to obtain Qi in fact. In ancient acupuncture, achieving Qi degree” and “self-finger inch”, simplified for positioning acupoints in in various puncturing methods has been widely explored to address strict arrangement on 12 meridian lines. By contrast, other acupoints the lack of data on experimental condition and knowledge gap rather outside the 12 meridians have their independent and specific body than to determine the structure and function that can create “Qi.” surface positions, so each point has a unique location in the human DN and WN are simpler and more practical than CTA in terms body [2,6]. Some doctors suggest “to speculate points,” although of puncturing because the positioning of MTrPs should be accurate others promote “rather lose its point, do not lose it in meridian” to achieve Qi, but the “obtained Qi” is to induce a local muscle jump [1,6]. Therefore, the positioning of acupoints should be accurately with soreness and swelling sensations or puncturing referred pain. determined for an effective treatment. However, all of these acupoint Therefore, Qi can be achieved in MTrP acupuncture by employing positioning methods cannot accurately locate points because the “turtle exploring tomb” to look for local muscle jumps sequentially definition and location of an acupoint are unknown, except that one through puncturing back and forth and thus trigger more “jumps.” can give up traditional theory and earn more clinical experience. It Weak patients require few jumps, whereas strong patients need is said that Yi Jin Jing Classics can help precisely locate acupoints numerous jumps, which correspond to “draining and. making up”. [10], but a vague description in this Classics lacks experimental data For example, the number of jumps (stimuli) depends on how healthy has been presented. Therefore, it always has a debate with meridian a patient is. Deep and shallow punctures rely on the depth of MTrPs, theory. and straight and oblique punctures are determined by the shape and Positioning MTrPs generally needs clinical symptoms, physical thickness of a muscle and the anatomical locations of local risks. For signs, and dysfunctions as a diagnostic basis to determine affected DN and WN, the success of acupuncture is generally attributed to muscles, and MTrPs can be accurately palpated as a painful taut whether a muscle jump can be induced and how many jumps can be band through a finger [5,11-13]. Palpation should be employed achieved. The more jumps are, the higher the efficacy is. If a trigger to accurately identify the location of MTrPs because their location point is on a tendon, a needling sensation is characterized by soreness, varies from person to person [11-13]. Therefore,
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