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Acupuncture and Trigger Points

Discussion in 'General Issues and Discussion Forum' started by mahtay2000, Oct 18, 2006.

  1. mahtay2000

    mahtay2000 Banya Bagus Makan Man

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    Can anyone tell me if 'dry needling' and acupuncture are the same thing in treatment of trigger points?
    I find many incalcitrant pains are referred from trigger points and was wondering what methods other pods use to treat them and if anyone has experience in acupuncture as a modality for them?
  2. Pod2B

    Pod2B Welcome New Poster

    Dear Mahtay 2000,
    Acupuncture really refers to treatment of acupuncture points but mechanically is similar to dry needling. Dry needling is effective in treatment of trigger points and appears to have the same effectiveness as wet needling, ie the injection of either normal saline or xylocaine. I personally prefer the use of Traumeel as an injectable. It is a homeopathic anti-inflammatory, and if you don't believe in homeopathy, it's just saline.
    I hope this is helpful.
  3. Ian Linane

    Ian Linane Well-Known Member

    Hi Mahtay2000

    I have used dry needling on a number of occassions, both directly into trigger points and the area of direct tenderness that some call the acupuncture treatment area (ATA), whether it lies in a TP or Ap or not. Certainly used it in the case of M. Neuroma and neuritis on the medial heel (after exhausting my own conservative approaches).

    I have also used it on myself for various soft tissue things. The least successful self application was lateral "tennis elbow" although it did bring pain relief. Muscular pain around my medial knee responded with one treatment.

  4. Anne McLean

    Anne McLean Active Member

    Hi Mahtay,

    Some people refer to dry needling rather than acupuncture and yes, they would consider 'dry needling' and acupuncture are the same thing in treatment of trigger points.


  5. chinaword

    chinaword Welcome New Poster

    acupuncture methods

    Acupuncture therapy includes using a needle or injection to stimulate "acupuncture points". You can also use ultrasound or TENS to stimulate these points. These points might be found in books and charts but any area of limb that is painful on palpation becomes an "acupuncture point" even if it is not a standard point. Texts will call these "Ah Shi" points, meaning "Ah, yes!" in Mandarin Chinese.

    Treatment can be stimulation of points in the area of the disorder or on selected points along "channels" or "meridians". So,proper acupuncture therapy can be local or systemic in approach.Local acupuncture therapy is probably similar to "trigger point therapy"or "dry needling". Musculoskeletal conditions in the limb often respond to local therapy but not always. In many cases using points away from the area of pain is the best way to treat conditions. To do this one must have a good understanding of acupuncture points all over the body. When you use points to stimulate "meridians" that is probably really "acupuncture" by definition.

    It is all very interesting and a useful modality in podiatry.
  6. Shane Toohey

    Shane Toohey Active Member

    Dear Mahtay,

    I'd just like to add a bit to the responses you have had. I've been treating trigger points routinely for 15 years, using a variety of techniques, but mostly dry needling. I also have acupuncture qualifications sufficient to be registered when it comes through in Australia in the next year or so. Orthotic therapy is often only a factor in the resolution of the problems we see each day and other powerful interventions which are often used in my practice include release of trigger points and joint mobilisation.

    Dry needling is a technique used to release 'myofascial trigger points' generally in muscles. Active trigger points refer pain in distinctive patterns for each muscle (myotomes) and so for example lateral ankle pain may be caused by an active trigger point in peroneus longus, so you don't just put needles into where it hurts. The patient would generally not be aware of the point in PL until found it. The bible is "Myofascial Pain and Dysfunction The trigger point Manual" Vol 2, is 'The Lower Extremity' , Janet Travell and David Simons. You can also get quite good pain chart books through Amazon.
    The bible is based on injection techniques, but using acupuncture needles seems to be equally effective. I have used both methods and find that dry needling is accepted more readily by patients. I think that the more relaxed they are does help. As well trigger points may be released using manual methods such as the 'ischaemic compression' technique.

    I also use acupuncture in my pain relief armament but not so much to treat trigger points per se. I often use acupuncture points as well as the dry needling points at the same time as I usually leave my patients with the needles in for 20 to 30 minutes. So, some general pain points such as stomach 44 can be used as well. I also use acupuncture points for joint pain and neuroma symptoms. It's always case by case.

    If you can locate an active trigger point, by firstly it's referral pattern, then it's twitch response and tenderness, then it can be effectively treated by dry needling, often very quickly. Follow this up with a spray and stretch and a home heating and stretching programme. This is the quickest way I've found to treat a trigger point.

  7. Shane Toohey

    Shane Toohey Active Member

    I also don't hesitate sticking needles into myself and have had a good response to a painful golfer's elbow just using one acupuncture point.
  8. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    Thank you all for your time in responding.
    I look forward to learning the techniques and putting them into practice one day.
  9. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    Course done, Mahtay impressed!

    Well I've done the course and WOW!!!!!
    The western acupuncture is great, the dry needling is the most effective treatment for trigger points I have ever seen. The guy who did the course dry needled my psoas (100mm needle to the hilt!) and my traps-I thoroughly recommend this to all pods with the usual back pain!
    And Shane, do you have a list of 'big points' such as GB 34? That was really the only one they specifically talked about but they alluded to many others.
  10. Peter

    Peter Well-Known Member


    Just a word of caution. You might find that your SOCAP insurance for acupuncture, would only cover you for Rx from the knee down. Mine is. Having said that, the lecturer who needled your Psoas is highly likely to be totally insured, unlike ourselves.

    Enjoy your acupuncture. Great for medial compartment knee OA.
  11. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    knee down insurance

    Yes I definitely am only doing knee down but this fellow-Trevor form Golfworks in Auckland-is the bomb my man, the bomb I tell you!!! He's a physio so ok for up there and abouts.
  12. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    PS Peter, what points do you use for medial knee OA?
  13. musmed

    musmed Active Member

    Dear Mahtay

    I like Shane Toohey have been dry needling tender points for 20 years. I also teach it.

    In my wildest dreams I cannot see how anyone could dry needle the psoas (and actually honestly say that is what they are doing) let alone put their hand up for the same process unless it was performed under radiological control.

    I would never teach the psoas. Have a look at your anatomy book, there are plenty of things that are in the way.

    Paul Conneely

  14. Shane Toohey

    Shane Toohey Active Member

    Dear Mahtay,

    I'm glad that you are excited about the 'acupuncture' course that you did and hope that it will spur you on to find out more!

    I have been disappointed to hear, not only from you, but also podiatrists in the UK who have supposedly learnt 'western acupuncture' - that they learn very few acupuncture points and really get told to put needles in 'where it hurts'.

    There are 6 'meridians' passing through the lower limbs, each with numerous points which have unique characteristics. For me 'western acupuncture' was about using acupuncture points more according to the symptoms and locations - a bit like a cookbook compared to traditional chinese medicine where the points are detirmined by "pulse and tongue diagnosis". Those folk teaching these courses should be honest and admit that they have no qualifications in acupuncture and that they do dry needling and that their acupuncture knowledge comes from reading some literature.

    Recently, I have had success treating a patient with peripheral neuropathy.
    This woman, was experincing numbness during the day in her toes which had spread over 6 months from the great toes to include up to the 4th toes but not the 5th. At night the toes were extremely painful and she required medication to sleep.

    After the first acupuncture treatment she slept unmedicated for 4 nights and for 6 after the second session. We shall see how she went after the third session. The points used were on one foot only, as acupuncture points can be used on either side and were repeated on subsequent treatments. Used were the "extra" Bafeng points (which include St44) and Liv 3 and Spleen 6.
    Points were selected for their characteristics, for being local and Spleen 6 to balance the area. It's not as esoteric as it sounds.

    An interesting, aside, is that the patient could only feel one of the foot needles (Bafeng 4/5), on the first treatment, then 2 on the second and all on the third.

    This result could be placebo. Certianly no trigger points were treated and coinincidence is too implausible.

    I think there are a few physios teaching acupuncture. I don't think they've been around for long.It has been outside their Act to penetrate the skin and I don't know that it has been universally changed. I have heard them saying that their Act is going to be changed! It's about time that pods took some of this ground for themselves. We've got the training in skin penetration.

    Anyway, if they are going to call it acupuncture, they should teach acupuncture! Part of the training is about dangerous points, which as has been rightly been pointed out does not apply to pods who needling below the knee. There are significanht dangerous points in the torso, head and neck.
    As Dr Conneely pointed out, have a look at psoas and where the needly would be going. Sounds reckless to me.

    Very happy to discuss this further.

  15. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    Yes I have looked at the psoas and assorted structures. The 'chi' shot straight to my lesser trochanter both sides x3 twitches each.
    This guy is a physio who specialises in golfers, he does these kinds of muscles all day-I can promise you that I won't be going anywhere near it!!!!

    The course had two teachers, this fellow for dry needling-he uses it in 98% of his pts as an adjunct to stretching/strengthening etc.

    The other teacher does the 'western acupuncture' side of it, I found her very enlightening and knowledgable, just the course was very short, two weeks watching with real patients might just start me off on the right track!

    I already use dry needling and am having great success (Below knee!) but am a bit reticent to charge money for acupuncture treatment. I really would only be using 'big' points and 'surrounding the dragon,' not really offering a solidly thought-out treatment.

    Any suggestions as to a 'beginner' treatment regime, Shane?

  16. Shane Toohey

    Shane Toohey Active Member


    Mahtay you wrote
    "Any suggestions as to a 'beginner' treatment regime, Shane?"

    Sorry, if what follows sounds a bit techy, as I'd love to encourage more interest and use of acupuncture but see it being overall poorly taught, as in not being comprehensive nor practical. You wrote "The other teacher does the 'western acupuncture' side of it, I found her very enlightening and knowledgable, just the course was very short" What's the point of saying that you are teaching acupuncture if you do it the way you describe. So, I really am answering your question, but not to gloss over real issues and not to give an acupuncture course in a paragraph which seems to be widespread.

    Obviously, only a general outline, but a context needs to be set, and the training is either adequate or not as I still get the feeling that it wasn't very practical on the acupuncture front.

    So do you have a good text outlining the meridians, the point locations and characteristics? If you only know a few "big" points then it's difficult if I mention others and you don't know where they are etc. Also, I'd suggest that a really watered down version of acupuncture will not give a true reflection on the art and lead to those poor studies which are equivocal about the treatment.

    In my experience, the effect of acupuncture is often accumulative and gains more power over a course of treatment. I usually book a series of 3, and then decide if another series is warranted. Generally, a succesful programme takes between 3 & 6 treatments and I'll stop sooner if no result is happening (certainhly no more than 3 and I would have tried out some variations by that stage). You have to accept in the western system that acupunture will not cure everything!

    Points are used depending on their specificity for the problem, for being local,for being tender points, for being on that meridian, to surround the dragon, etc etc. Often over a series, some of the points will change depending on the response. Choice of points is case by case and so for example some different points will be used from one subject to another.

    Hopefully, I've been of some help and feel free to get more specific with your questions. I'd expect there a few others with grounding in acupuncture out there.

  17. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    Longing for Honging

    Thanks again Shane,
    Yes we were given a manual with meridians and points.
    The 'western' style taught was basically traditional but with neurophysiology discussed instead of 'ah shi' etc.
    We were shown the points and meridians, but the time frame was short, especially as we had dry needling interspersed and that hit home to me much more easily. (Ah Shi!)
    I am finding that intractable heel pain is going in a lot of pts after needling soleus and sometimes gastroc1, but there is a small amount of residual pain. Do you have a suggestion for treating, with acupuncture, this generalised, not too intense heel pain?
    cheers again
  18. Shane Toohey

    Shane Toohey Active Member

    Acupuncture and heel pain

    Hi again Mahtay,

    You wrote: "I am finding that intractable heel pain is going in a lot of pts after needling soleus and sometimes gastroc1, but there is a small amount of residual pain. Do you have a suggestion for treating, with acupuncture, this generalised, not too intense heel pain?"

    Firstly, how do you follow up on your dry needling?
    I use the spray and stretch, followed up later with heat packs and more stretching.
    Secondly, there are foot muscles which may also refer into the heel.
    Abductor hallucis and quadratus plantae - these can be the primary cause of the pain. QP can be needled from the medial side of the foot if you are good at visualising or directly plantarly into the tender area, for which I do a cold spray before penetrating the skin,
    I'd also check for tender points in FHL and FDB and FHB, even though they don't refer primarily into the heel but may be associated with the dysfunction causing the heel pain. I'd also check for any joint 'blockages', primarily the intermediate cuneiform and others in that area.
    When needling the calf trigger points I'd include UB57 as a general or local point. There may also be a case for using spleen 6.

    As mentioned previously, each case by itself, and mustn't generalise too much.

  19. Peter

    Peter Well-Known Member


    I needle the periosteum medial to the tibial tuberosity. Also, occasionally, I superficially needle over the POMT over the joint line.
  20. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    Thanks Peter and Shane,
    To continue on my line of questioning/harassment Shane, what was your thought process to treat the lady with peripheral neuropathy that you discussed earlier?
  21. Shane Toohey

    Shane Toohey Active Member


    You wrote: "what was your thought process to treat the lady with peripheral neuropathy that you discussed earlier?"

    I had a go at treating this problem because she was an old patient of mine having treated her for heel pain in the past and other members of her family. So treatment was on the basis of let's do something because you are here now and it may help but no promises.

    The patient's symptoms were gradually worsening over about 6 months. She had been a good girl and followed instructions and lost weight and had regained good blood sugar levels although it was a struggle.
    I'm at home, so please forgive some generalisations.
    The symptoms started as numbness on medial hallux right foot. This slowly spread across 2nd, then 3&4, but not to 5. Also started in other foot following the same lines.
    Despite numbness, she started getting severe pain in toes, worse in halluces, which kept her awake at night, and she had been on medication of some sort to sleep for a few months. The level of pain increased if she had had a big day at work.

    Points were not very hard to select and hopefully you have them in your book.
    The first are collectively known as Bafeng (Extra 36), which are on the dorsum of the foot, 0.5 cun proximal to the webbing between the toes ( 4 points on each foot).
    You will note that St44 is one of the Bafeng points. These points are used for:
    "arthritis in the toes, numbness of the foot and toes and polyneuropathy"
    Acupuncture The 14 Channels by Anton Jayasuriya.
    I also used Liv3, as a local point, about the line of the proximal extent of the neuropathy and Sp6 as a general point because it is used for "general tonification", which seemed appropriate for neuropathy and also it is a meeting point of 3 channels which all originate in the toes.
    I actually saw this patient today. She has had no pain since the last treatment, so the first treatment helped for a few days, the second for a few more and the third for a full week. Also, the extent of the numbness is decreasing and some feeling is returning to some of the toes and she felt the needle at Bafeng 1/2 today for the first time.
    We are going to continue for a few more treatments as we are still making progress and as a generalisation I find that acupuncture has an accumulating effect not at all like a good trigger point which can be turned completely off in one treatment.
    My point selection could have been different and there is no way of knowing at our level. I don't know if all of my points were important and I've just continued with the same points for each treatment. Often I will change points along the way with some treatments as the symptoms alter.
    I'm confident this was no coincidence say for example due to blood sugar levels dropping as the condition changed overnight with treatment. I could not rule out placebo, but hopefully I can bring it on regularly!
    Hope this explains how this pricker thinks.
  22. gold

    gold Member

    Thanks for your insights Shane. Very interesting! As a podiatrist who has also recently started using acupuncture and DN techniques I was wondering if you have concerns about needling the extremeties of these high risk diabetic patients,from an infection control point of view?
  23. Shane Toohey

    Shane Toohey Active Member

    Hi Luke,

    You wrote: "I was wondering if you have concerns about needling the extremeties of these high risk diabetic patients,from an infection control point of view?"

    In the outlined case, I didn't regard her as "high risk", she had very peripheral neuropathy and her vascular assesment ( a written report from her vascular surgeon) was sound. She had lost the requested weight and and blood sugar was stable and normal. She was not on insulin. Otherwise, I'm simply doing an alcohol wipe in the area and, of course, all needles are single use, sterilised and the penetrating portion is not handled. In 15 years of needling I've never seen an infection develop at the needling site. Infections are not mentioned in the literature as having any incidence. Most common is minor bleeding (3%), which is usually controlled by short term pressure at the site, and bruising (2%). Next is dizziness (1%), Lying down solves this. If you google, wikipedia, and search for acupuncture you can get a lot more detail.

    Otherwise, us pods are not needling near any dangerous or forbidden points, but need to be gentle in some parts of the foot. Personally, I don't often see high risk patients. I don't do surgery any more, nor routine foot care and give possible complications a wide berth.

  24. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    Thanks Shane,
    I have a candidate with neuropathic night pain begging me to try this acupuncture, so I will report later how it goes.
    Feel free to keep the case studies posted!
  25. Shane Toohey

    Shane Toohey Active Member

    Hi Mahtay,

    You wrote "I have a candidate with neuropathic night pain begging me to try this acupuncture, so I will report later how it goes.
    Feel free to keep the case studies posted!

    Just thought that I'd report on my case of peripheral neuropathy as I saw her last night. She continuous to sleep pain free and unmedicated and can now feel some sensation in all toes. Sharp is felt as blunt. One of our diabetic podiatrists would be able to describe this much better!
    My physio associate who specialises in nerve pain has suggested that the acupuncture is having a local effect on the small blood vessels supplying the nerves and thereby causing our result.

    Let us know how you go with your case and what points you use.

  26. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    I have a patient who has had a very longstanding deltoid ligament rupture, and acquired STJ coalition with peroneal spasm.

    I have made him quite aggressive UCBL style orthoses, however he will need some ?dry needling to reduce his peroneus brevis spasm, and allow the hindfoot to get out of valgus.

    Anybody with experience in reducing peroneal spasm using dry needling approaches? Any advice appreciated.

  27. Shane Toohey

    Shane Toohey Active Member

    Hi Lucky,

    Well, I'll have a go at a quick reply.Just on the information given so far.

    Other areas of pain would influence selection, for eg. is there still any medial ankle pain?

    Apart from any palpable triggers in p.brevis, I'd check also in p.longus. I'd also check gastroc and soleus, as they'd be dysfunctional with a valgus rearfoot for any length of time.

    I'd also use Ac points Gb34 and 41.

    I would have also worked on mobilising every joint in the foot.
  28. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    Hey Shane,
    I was wondering if you, or anyone else for that matter, has a nice way of telling people that dry needling is going to be less than pleasant? Because I'm a wuss and have a love/hate relationship with the needling I receive, I find it hard to sell to the apprehensive people who would probably benefit the most.
    Any ideas would be appreciated.
  29. Shane Toohey

    Shane Toohey Active Member

    Hi Mahtay,

    You wrote: "I was wondering if you, or anyone else for that matter, has a nice way of telling people that dry needling is going to be less than pleasant? Because I'm a wuss and have a love/hate relationship with the needling I receive, I find it hard to sell to the apprehensive people who would probably benefit the most"

    Well, you can't force anyone, and some will never have it and tha's that.
    Otherwise, I find that many folk are quite interested in the experience!!

    I always advise firstly that it may hurt, but not as much as having injections or deep tissue massage and that generally most discomfort settles fairly quickly.
    I warn them about the twitch response that can be quite unexpected and more of a fright than painful.
    I'm telling them that this is the quickest way of resolving their problem.

    Surprised about you being a wuss after psoas needling on yourself (still not convinced about that - illiacus?)

    Also have recently trolled back through all of the old threads on acupuncture and see that there are a few very well trained pod acupuncturists lurking out there.

  30. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    psoas wuss

    Hi Shane,
    The psoas was the psoas, I have done a lot of research lately on it, and physio and myo therapists with much experience do it.
    It is the same as tib post with pods i spose-the more experienced and confident you are, the more likely you will do it. (I don't!)
    On the wuss factor-I was a needling pup then and didn't have half an idea what I was getting into, but trusted the guy that did it.
    I recently had a myo therapist do my piriformis' etc and she does the travell and simons method-leaving the needle in after the twitch. Whereas I use the hong method.
    Which do you use and/or advocate.
  31. Shane Toohey

    Shane Toohey Active Member

    Hi Mahtay,

    You wrote: "I recently had a myo therapist do my piriformis' etc and she does the travell and simons method-leaving the needle in after the twitch. Whereas I use the hong method.
    Which do you use and/or advocate.

    I presume that the "hong" method is to not leave the needles in and withdraw them straight away. Honestly, sometimes I leave them and sometimes I don't. It seems to me that the needles also have an 'area of influence' that spreads over the time that they are left in and in some cases and with certain responses I'll choose one or the other method.

    So, firstly, with myofascial trigger points I'll leave them in longer if I think that the area is 'generally' tight and tender and insert a few needles in the muscle and leave them in situ for 20 odd minutes, often including some acupuncture points in support of what I'm trying to achieve. If, I'm after what seems a discrete trigger I'll often just go for the twitch and remove.
    With "pecking" periosteum I tend to do that for only a few seconds! For straight acupuncture points I usually leave the needles in for 20 mins.
    20 mins could be 15 or 30 mins depending on circumstances and includes some stimulation and obvious "durchi" (however it is spelt) at the points.

    I've just spent a day in clinic with Dr Paul Conneely in Sydney who would be the most experienced dry needler in Australia. He usually leaves the needles in for a 5-10 mins and uses laser on the triggers while the needles are still in situ. He only uses techniques that work (and quickly). Results were outstanding, including complex, widespread chronic pain. He still mobilises the feet before starting on problem areas in other parts of the body!

    Again, just a bit of concern re myotherapists. Some do a year long course in dry needling in Melbourne, others do very short workshops of a few days and do not necessarily have a comprhensive anatomy training. You're doing well for a wuss!

    By the way, Simons and Travell do not advocate leaving the needles in after the "twitch' response. Their method is to inject LA into the trigger and withdraw. Often traditional acupuncture leaves the needles in for more extended periods.

  32. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    Thanks oncea gain for your widespread experience Shane.
    The myotherapy course that my myotherapist did is three years as RMIT and is covered by health funds.
    She massaged and searched for the trigger points then kaboomed them!
    very good results, but cos I'm a wuss I pulled out of Glut med so now have to go back to get it done.
    She also did my right forearm, and while I was fighting huge mahi mahi, kingfish and snapper on the weekend (cobia too) only the left started to cramp.
    (That was irrelevant but I needed to tell someone about my fishing exploit!)
    Cheers once again
  33. NewsBot

    NewsBot The Admin that posts the news.

    ScienceDaily are reporting:
    Acupuncture And Myofascial Trigger Therapy Treat Same Pain Areas
    Full story
  34. musmed

    musmed Active Member

    Dear All

    In my 20m years experience I totally disagree that most TP's are where acupuponits are.
    secondly the nervous system does not transmit pain. It can only transmit pressure of temperature and the thalamus decides what it is you are experiencing
    Paul Conneely.
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