Trigger Point Therapy for Myofascial Pain (4 page)

During our first fifteen years in practice we studied and utilized both traditional Chinese medicine (TCM) and an ancient style of acupuncture that actually represents a group of methods collectively known as
meridian acupuncture
. Traditional Chinese medicine, primarily based upon an internal medical model, considers the practices of acupuncture and herbology to be inseparable. TCM emphasizes assessment through the evaluation of signs and symptoms, including the evaluation of pulse and tongue characteristics, in an effort to diagnose some internal condition.
²

All acupuncturists study the meridians. However, unlike the practitioner of TCM, the practitioner of meridian acupuncture utilizes needles first and foremost to open constrictions along the pathways of the meridians. He generally relies on palpation skills to locate constriction, sets needles related to areas of constriction, and often identifies distal constrictions related to local ones. In practice, however, we found that the use of acupuncture techniques, both those outlined in TCM as well as those employed by meridian acupuncturists, were limited in their ability to aid patients suffering from either chronic or acute myofascial pain, regardless of the location of that pain. Neither the TCM treatments utilizing the internal medical model nor the treatments utilizing techniques based on meridian acupuncture were sufficient to completely alleviate that pain. Something was missing. When we encountered the work of Dr. Janet Travell we discovered what was clearly needed. Since that first introduction we began evolving a practice that utilizes both the Eastern perspective of meridian therapeutics and the myofascial perspective outlined so extensively by Travell and Simons. In developing this practice we perceived and treated our patients through two “lenses,” and so began to see the real similarities between the patterns of pain resultant from myofascial trigger points as catalogued by Travell
and
the pathways of the meridians as they lie along the limbs and torso.
³
By directly treating the
source
of the pain—the specific muscle harboring trigger points as identified through palpation—and then supporting that with treatment along related meridian pathways, we found that we were able to greatly alter our patients' conditions, allowing them far greater freedom from pain. Employing this integration of Eastern and Western perspectives, the work we have developed is called
myofascial meridian therapy.
This merging of Eastern and Western points of view is useful: simply put, it works.

In observing the fields of acupuncture and Oriental medicine over the past decade, we have seen unprecedented growth in the numbers of people who wish to learn about its principles and practices. These numbers include physicians, dentists, chiropractors, osteopaths, physical therapists, and massage practitioners who are seeking out additional, and perhaps more effective, means of treating their patients; as well as people who have personally benefited from acupuncture and who wish to change their career, perhaps to help others as they have been helped. In so many (if not all) cases, these people are interested in caring for the whole person, no longer satisfied with the focused specialization within the medical community in which a patient is defined by his presenting condition. Health care practitioners of all types are embracing a newfound, but old-fashioned, respect for the individual, holding a view in which a physical condition represents dysfunction within the whole and is considered within the context of its effects on the whole.

Myofascial meridian therapy is a form of treatment in which addressing a patient's pain is done within the context of treating the whole person. Because myofascial meridian therapy utilizes aspects of both Eastern and Western approaches to patient care, it can provide the basis of treatment—the meeting point—for those whose orientation lies in either Oriental medicine or allopathic medicine. Those whose background is Oriental medicine can broaden their approach to patient care and the treatment of pain by delving more deeply into the study of the myofascia, increasing their understanding of the musculature and the fascia and the complex role those play in human health and well-being. Just so, those whose background is in the Western perspectives of health care can broaden their perspective of the human experience by embracing some basic concepts utilized in the practice of Oriental medicine.

One of the most basic of those Oriental medicine concepts is that of qi, popularly conceived of as “life force.” It is in the consideration of qi, redefined in Western terms, that we once again find a meeting place for both the Eastern and Western perspectives. However, in order for qi to be considered as a unifying principle for guiding treatment, its definition must be expanded and refined.

It is important to preface this discussion with the statement that Chinese philosophical concepts are extremely fluid: ideas change relative to their context and application. The point here is to provide a way in which the concept of qi may be particularly useful to the practitioner of myofascial meridian therapy, regardless of orientation. Hopefully the result will simultaneously elevate qi to a more complex concept while making its application in meridian therapies, and pain management specifically, far more pragmatic.

Perhaps the most intriguing and powerful aspect of Oriental medicine is its direct connection to universal principles. The Taoist application of cosmology to human health—the view of the human being as a part of a much broader universal system—is foundational to understanding the ancient Oriental approach to health care. Seeing the human being as a microsystem that is part of a macrosystem is intrinsic to understanding how to treat health problems. Indeed, the principles used by acupuncturists are not so much acupuncture principles as they are universal tenets applied to acupuncture.

Let us consider universal principles as described in Taoist cosmologies. Taoist cosmology begins with the idea of Wu Qi, sometimes described as Emptiness, the Void, or Nothingness. This is the universe a priori to existence. Think of what an extraordinary idea this is: it is the concept of some “thing” before anything exists. This is the idea of the unmanifest God, the Absolute, Unity, or Nirguna Brahman (in Hinduism), which refers to God without attributes. It is perhaps more accurately discussed as
a dynamic that is in perfect balance
. When there is a change in this delicate balance, some movement occurs. Movement is a relative concept—it only exists in relation to something else; therefore, movement implies duality. This is the beginning of existence, the Tai Qi, the Yin/ Yang, a concept similar to the big bang theory of creation. And so we have the Wu Qi, movement as potential only, giving rise to the Tai Qi, movement made manifest in the form of duality.

Now consider the idea that, following this first movement, everything that subsequently comes into existence can only function under this universal principle of duality, Yin/Yang. All that exists is a function of, and therefore reflects, this first principle, this first movement, the beginning of duality. Existence can be viewed as a continuum of energy, starting with the highest energetic level of the Tai Qi and moving outward, slowing down, and becoming more material. The Tai Qi pervades everything, including its ultimate manifestation as the “ten thousand things,” the Chinese euphemism for the material world.

Applying this idea to our work, we can therefore see that the concept of qi that is particularly useful to myofascial meridian therapists is this notion of impetus toward movement. Organic life exists as a particular vibration, or level of movement, on this universal continuum of energy; health is intimately connected with this movement. We are not referring here to the movement of qi but rather to movement itself, with qi being the source of such movement. Qi as impetus toward movement may be equated, then, with the Tao, the “way of all things.” As the Tao te Ching begins: “The Tao that can be named is not the eternal Tao.”
⁴
If we try to name qi we have begun to bring the concept down and, in some sense, make it more “material.”

Viewed from this perspective, qi is a metaphysical—rather than a physical—concept; it thus cannot be understood in physical terms or through customary language. Because language is generally developed in the context of physical reality, we are in a linguistic quandry when we enter the world of metaconcepts. Considered in this way, however, qi cannot be described or held to a specific definition, though it can be alluded to through metaphor, parable, or similar constructs. Unfortunately it is the history of such ideas to be reduced, brought down to the way we, as human beings, easily understand, and made into something physical rather than metaphysical. While the idea that qi is some sort of invisible “stuff” flowing through the meridians can have its uses, it should be understood that this is a materialized concept of qi.

The fundamental characteristic of energy is movement, and the quality and nature of this movement defines the continuum of energy and matter. This continuum can be observed by looking at water, that remarkable substance that is both the basis and the reflection of life. In its most energetic state water exists as steam; in its least energetic and most material state it exists as ice. The metaphors of qi applied in a number of Oriental medical contexts—such as immune, muscular, and soft-tissue functions
(wei qi);
nutritive functions
(ku qi);
or genetic predispositions
(yuan qi)
—are all about harmonious movement: life connected to balanced activity; open, flowing movement. It is no wonder that qi is often connected to water metaphors (sea, river, spring, and so forth).

Conceptualizing qi in terms of movement rather than substance marries it into a philosophy of life and health held by all medical systems. Consider the words of reknowned osteopath and educator John McMillan Mennel in his discussion of the musculoskeletal system:

The musculoskeletal system has two equally important functions. The first is movement, and the second is support (or containment). The most important part of its movement function is perhaps that
its absence is associated with death
(emphasis ours). As movement becomes more and more impaired, the functions of the systems that the musculoskeletal system is designed to contain cannot be maintained, and these other structures themselves become dysfunctional. This in itself contributes to and may hasten the final loss of function of the contained systems.
⁵

Health requires movement; when movement ceases, life ceases.
When the human organic system is functioning properly, things move well and in a coordinated, homeodynamic manner. Blood moves in a steady tidal flow, connected to such diverse and changing conditions as muscular contraction and release, digestion, and mentation. Nerves signal through electrochemical flows in a coordinated system of activity; endocrine glands provide well-timed secretions related to the requirements of the whole. Muscles, fascia, tendons, and ligaments direct lubricated joints through complex movements. The respiratory system moves gases in coordinated quantities, while cilia and mucus provide the first line of defense against pathogens. Digestive enzymes are secreted, and harmonious peristaltic action allows for the transformation of materials into energy. Lymph is pumped and circulated as the body moves. All of this is taking place in an interactive symphony that we call life, from the cellular level to the cosmological level.

A central principle of tai qi quan holds that the universe
is
this all-pervasive movement, or activity, and it is that movement which we experience as our human bodies. Human beings are loci of this activity; the more a person is capable of relaxing, both physically and psychologically, the more he becomes a locus through which more of this movement can take place. The more constricted a person is (both physically and psychologically—which are, in fact, interdependent), the more movement is impeded. Such impediments produce consequences that affect health and well-being. Consider the words of a great taijiquan master, Dr. Jwing-Ming Yang, as he discusses the fact that many qigong practitioners mistakenly take the feeling of heat that they experience as qi:

Actually, warmth is an indication of the existence of Qi, but it is not Qi itself. This is just like electricity in a wire. Without a meter, you cannot tell there is an electric current in a wire unless you sense some phenomenon such as heat or magnetic force. Neither heat nor magnetic force is electric current; rather they are indications of the existence of this current. In the same way,
you cannot feel Qi directly, but can sense the presence of Qi from the symptoms of your body's reaction to it, such as warmth or tingling
[emphasis ours].
⁶

Once again we see the struggle to deal with an experience that is both physical and metaphysical. The associated warmth to which Dr. Yang refers is connected to increased circulation of blood and lymph and increased nerve conduction that occur as a result of the release that takes place during the practice of tai qi quan; that is, to the
effects
of improved movement.

Giovanni Maciocia, author of
The Foundations of Chinese Medicine,
correctly identifies the enormous difficulty in defining qi, which he describes as something that is material and immaterial at the same time. One interpretation he offers is “moving power.”
⁷
He, like many others who have closely examined the idea, decides to leave the term
qi
untranslated.

A similar problem of definition occurs when we consider other metaconcepts, such as the idea of higher dimensions of space. Concepts such as a fourth- or fifth-dimensional space can be represented mathematically or can be discussed in metaphor (see Abbott's
Flatland
or Bragdon's
A Primer of Higher Space
⁸
), but they cannot be imaged or described. Try to picture a direction perpendicular to all three spatial dimensions (that is, image the fourth dimension), and you confront the difficulty. Qi, like other metaconcepts, is in the same category of definitional complexity. However, once we relate the concept of qi to movement, we hold a rather elegant idea that bridges Eastern and Western views of life and health.