Trigger Point Therapy for Myofascial Pain (38 page)

APPENDIX 2

O
N
C
UTANEOUS
Z
ONES

The concept of zones as developed by Mark Seem, Ph.D., is an intelligent view of the meridian system useful in the treatment of myofascial pain syndromes. The concept of cutaneous zones is part of Dr. Seem's treatment protocol, which is fully described in his book
A New American Acupuncture
(Blue Poppy Press, 1993).

Zones as defined by Dr. Seem are composite representations of associated meridian pathways; a given zone is comprised of the regular meridians, divergent luo, tendinomuscular meridians, and any extraordinary vessels passing through the region. Using the framework of the cutaneous zones one can therefore treat, directly or indirectly, the complex meridian systems contained within a given region.

Dr. Seem has defined three zones through which he treats. The combined hand and foot aspects of Tai Yang (that is, Small Intestine and Bladder meridians, respectively) is named the
dorsal zone
due to their posterior placement in the body. The combined hand and foot aspects of Yang Ming (Colon and Stomach meridians, respectively) is named the
ventral zone
due to their frontal positioning in the body. The combined hand and foot aspects of Shao Yang, Triple Warmer, and Gall Bladder, respectively, is named the
lateral zone
in accordance with their positioning in the body.

Since constrictions both within the musculature and along meridian pathways both reflect and affect movement within the given region—both on a gross level, as in the ability of the myofascia to produce complete, pain-free movement, as well as on the level of movement of blood and lymphatic fluid, nervous innervation, and so forth—it is essential to release constrictions on every level to ensure healing on all levels. Cutaneous zones, as described by Dr. Seem, provide a guide to the exploration and treatment of related areas as defined from the Oriental perspective.

It is also interesting to note that muscles that are part of a particular zone often develop satellite trigger points in response to the presence of active trigger points in other muscles in that zone. Zones also most commonly contain the referred pain pattern for a muscle lying within a given zone.

APPENDIX 3

C
OMMONLY
U
SED
A
CUPOINTS

There are many useful texts delineating the use of acupuncture points (also known as
acupoints
). The interested reader is encouraged to investigate these points and study their applications. The following texts are recommended as sources of acupoint information:

The Foundations of Chinese Medicine
by Giovanni Maciocia (London: Churchill Livingstone, 1989)

Chinese Acupuncture and Moxibustion
edited by Cheng Xinnong (Beijing: Foreign Language Press, 1987)

The Manual of Acupuncture
by Peter Deadman and Maxin Al-Khafaji with Kevin Baker (East Sussex, England: Journal of Chinese Medicine Publications, 1998)

The points listed here are those we have found to be particularly effective in the treatment of patients in whom myofascial constriction is a reflection of organ or system dysfunction. Once a point is selected it should be treated through needling or direct pressure, in conjunction with the treatment of the myofascia.

Additionally, the treatment of local points—acupuncture points located within the affected region—used in conjunction with trigger point release methods can be quite useful to the overall healing of a patient suffering with pain due to myofascial dysfunction.

S
OURCE
P
OINTS/
O
RGAN
P
OINTS

The acupoints listed here directly treat the given organ. Sensitivity in these points is often a reflection of dysfunction within the organ.

LU 9 for the lungs

CO 4 for the colon

ST 42 for the stomach

SP 3 for the spleen

HE 7 for the heart

SI 4 for the small intestine

BL 64 for the bladder

KI 3 for the kidneys

PC 7 for cardiovascular function

TW 4 for digestive function

GB 40 for the gallbladder

LIV 3 for the liver

H
E/
S
EA
P
OINTS

These acupoints support the relationship between the given organ and the superficial meridian.

LU 5 for the lungs

CO 11 for the colon

ST 36 for the stomach

SP 9 for the spleen

HE 3 for the heart

SI 8 for the small intestine

BL 40 for the bladder

KI 10 for the kidneys

PC 3 for cardiovascular function

TW 10 for digestive function

GB 34 for the gallbladder

LIV 8 for the liver

S
UPPORT
P
OINTS

We have found that certain local points, or acupoints located within the region of an organ or system, are useful to the healing of that organ.

LU 1 and 2 support respiration

ST 25 supports the abdomen and treats associated conditions such as those related to digestion and elimination

KI 16 supports the abdomen, kidneys, and pelvis and treats conditions and dysfunctions associated with these organs and regions

KI 21 through 27 support respiration

GB 26 and 27 support and open the pelvis and might be used to treat gynecological and eliminative dysfunctions

BL 23 supports the lower back and kidneys and treats associated conditions

CV 13 and 17 support the upper warmer

CV 12 supports the middle warmer

CV 6 and 10 support the lower warmer

CV 3 and 4 support the lower abdomen, including urinary function, and are used to treat gynecological dysfunction

Distal points, or acupoints located away from the region of an organ or system, are related to that region through the meridian and can be useful in the treatment of that organ or system.

LU 7 supports the head and neck

CO 4 calms and supports the system in general

ST 36 promotes general health and is used to treat abdominal constrictions

SP 6 supports the abdomen and pelvis and treats conditions associated with that region

SP 10 supports gynecological function

SP 21 is the universal luo, or balancing point, of all meridians and is used to support overall health

BL 57 supports and treats the lower back and urinary function

BL 62 supports circulation throughout the back

GB 41 supports the pelvis and treats conditions associated with constrictions within the pelvis

F
OOTNOTES

Introduction: A Gathering of Forces

1
.  Janet Travell, M.D., and David Simons, M.D.,
Myofascial Pain and Dysfunction: The Trigger Point Manual,
2 vols. (Baltimore: Williams and Wilkins, 1982–92); Peter E. Baldry,
Acupuncture Trigger Points and Musculoskeletal Pain
(Edinburgh/ London: Churchill Livingstone, 1989).

Chapter 1: The Nature of Muscles and Trigger Points

1
.  Travell and Simons,
Myofascial Pain and Dysfunction,
1:12.

2
.  Travell and Simons,
Myofascial Pain and Dysfunction,
1:16.

3
.  Ibid.

Chapter 2: QI, Movement, and Health

1
.  Travell and Simons,
Myofascial Pain and Dysfunction
(2 vols.).

2
.  During the Cultural Revolution in China, in the midtwentieth century, acupuncture and herbal medicine were standardized, resulting in the schools of Oriental medicine all generally teaching the same curricula. That curricula was at the time named “traditional Chinese medicine.” The first major translated texts on Oriental medicine came from these Chinese programs; they served as the foundation for the vast majority of acupuncture curricula taught in the United States. Within this perspective the actions of acupuncture points and the influences of herbs upon the body are generally viewed in the same way: just as certain herbs are used to reduce “intestinal heat” or alleviate “spleen dampness,” certain acupuncture points are needled to assist in accomplishing the same purpose. In this approach to acupuncture, needling is practiced in order to support the effects produced by herbs; the acupuncture points are generally located by measurement or by light surface palpation.

3
.  This relationship was supported by a study performed by A. J. R. Macdonald, in which he correlated the relationship between acupuncture pathways and patterns of pain experienced by his patients suffering with myofascial constrictions. See A. J. R. Macdonald in Peter E. Baldry,
Acupuncture
, 44–45.

4
.  Lao Tsu,
Tao te Ching
, trans. Gia-Fu Feng and Jane English (New York: Vintage, 1972), 1.

5
.  John McMillan Mennel,
The Musculoskeletal System: Differential Diagnosis from Symptoms and Physical Signs
(Gaithersburg, Md.: Aspen, 1992), 5.

6
.  Jwing-Ming Yang,
Tai Chi Theory and Martial Power
(Jamaica Plain: YMAA, 1987), 27.

7
.  Giovanni Maciocia,
The Foundations of Chinese Medicine
(Edinburgh/London: Churchill Livingstone, 1989), 36.

8
.  Edwin A. Abbott,
Flatland: A Romance of Many Dimensions
(New York: HarperCollins, 1983); Claude Bradgon,
A Primer of Higher Space
(London: Kessinger, 1999). Originally published 1939.

9
.  David B. Jenkins,
Hollinshead's Functional Anatomy of the Limbs and Back,
6th ed. (Philadelphia: Saunders, 1991), 12.

10
.  John Upledger and Jon Vredevoogd,
Craniosacral Therapy
(Seattle: Eastland, 1983), 239.

11
.  See Paula D. Scariati, “Myofascial Release Concepts,” in
An Osteopathic Approach to Diagnosis and Treatment,
eds. Eileen L. DiGiovanna, D.O., and Stanley Schiowitz, D.O. (Philadelphia: Lippincott, 1991), 365.

Chapter 4: Diagnosis and Treatment

1
.  Travell and Simons identify potential effects related to syndromes of the abdominals, pectoralis minor, scalenes, serratus anterior and posterior, and sternocleidomastoid muscles.

2
.  Upledger and Vredevoogd,
Craniosacral Therapy
, 237–38.

Chapter 5: How to Use This Manual

1
.  Following in the work of Dr. Janet Travell, attachments of the musculature have been described in terms of proximal attachment and distal attachment rather than origin and insertion. We have opted for this description due to the effect of many muscles on both locations of attachment, making the terms
origin
and
insertion
inaccurate descriptors.

Hand and Finger Extensors

1
.  Moving lateral to medial on the dorsal (posterior) surface of the forearm

Hand and Finger Flexors

1
.  Moving lateral to medial on the dorsal (posterior) surface of the forearm

B
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