The Fascinating History of Trigger Points and Their Relationship to Acupuncture
Taiji Yin Yang Symbol Made of Tools
Exploring the Origins and Evolution of Trigger Points and Their Role in Acupuncture
Trigger points are hyperirritable nodules or points in skeletal muscle and surrounding connective tissue that can produce referred pain, tenderness, and other symptoms. The concept of trigger points has been recognized for centuries, and the modern understanding of myofascial pain syndrome (MPS) as a distinct clinical entity developed in the mid-twentieth century. However, the roots of trigger point therapy can be traced back to ancient Chinese medical texts that describe the use of acupuncture and other techniques for the treatment of pain and dysfunction.
The Ling Shu, part of the Huangdi Nei Jing or Yellow Emperor's Classic of Internal Medicine, is one of the earliest known texts on acupuncture and discusses the use of acupuncture points for the treatment of various diseases, including pain syndromes.
The Nei Jing also describes the use of acupuncture points and their effects on the body's energy flow or "qi." At the root of Traditional Chinese Medicine (TCM) style acupuncture, is the concept of Qi, which is the body's vital energy that flows through it via energy channels or meridians.
Acupuncture points are believed to be located along these meridians and stimulating them with acupuncture needles is thought to promote the free flow of Qi and restore balance to the body. With current research, we now understand that these are metaphors for functions that our nervous system, muskuloskeletal system, fascial network, and nerves carry out in our bodies.
When it comes to acupuncture for pain, the traditional Chinese concept of "ashi" or "tender points" is similar to the Western concept of trigger points. In traditional Chinese medicine, ashi points are considered to be areas of the body where the flow of Qi is blocked or stagnant, leading to pain and dysfunction. Stimulating these points with acupuncture needles or other techniques is believed to help restore the free flow of Qi and promote healing. Not all ashi points are trigger points, but all trigger points are ashi points.
Acupuncture Points and Trigger Points Overlap
Acupuncture points and trigger points share anatomical locations and can overlap in the treatment of musculoskeletal pain. Trigger points are often found in the same areas as acupuncture points, and needling these points can elicit a therapeutic response. One 2016 study found that there was a high degree of overlap between acupuncture points and myofascial trigger points (MTPs). The study suggested that the overlap of acupuncture points and MTPs may explain the efficacy of acupuncture for musculoskeletal pain and that needling MTPs using the dry needling technique may be a useful adjunct to traditional acupuncture therapy.
The History and Evolution of Trigger Points in Western Medicine: From John Hilton to Janet Travell and David Simons
In Western medicine, physicians such as John Hilton, J. M. Charcot, and Sir James Paget described tender nodules in muscle tissue that could produce referred pain. However, it was not until the mid-twentieth century that the modern understanding of trigger points and their role in chronic pain and dysfunction was established. Drs. Janet Travell and David Simons published a landmark two-volume textbook on myofascial pain in 1983, which established the modern understanding of trigger points and their role in chronic pain and dysfunction. In their research, Travell and Simons identified trigger points as key players in a variety of musculoskeletal disorders, and developed new techniques for the diagnosis and treatment of MPS.
In the mid-1800s, John Hilton described the concept of referred pain from muscles to other parts of the body, and identified specific muscles that were associated with this phenomenon.
In the late 1800s, J. M. Charcot described the phenomenon of "myotomes," which were bands of muscle fibers that could cause pain and other symptoms when they became contracted.
In the late 1800s, Sir James Paget described the concept of "muscular rheumatism," which he believed was caused by inflammation of the muscles.
In the late 1800s, Sir William Gowers described "muscle headache" and "tender spots" in the muscles, which he believed were related to neuralgia.
In the early 1900s, J. Henry Gowers and James Mackenzie described tender points in the muscles that could be palpated and were associated with pain.
These early descriptions and observations laid the groundwork for the later development of the concept of myofascial pain syndrome and trigger points.
In the 1920s, Kellgren and Lewis described the phenomenon of "referred pain" from muscles to other parts of the body, and proposed that it was caused by trigger points.
In the 1930s, Henry Head and W.H.R. Rivers described "tender points" in muscles that were associated with pain and could be relieved by injections of saline solution.
In the 1940s and 1950s, Janet Travell began studying the phenomenon of "myofascial pain" and identified trigger points as a key component. She developed the concept of referred pain from trigger points and developed injection techniques to treat them.
Myofascial trigger points (MTrPs) were first described by Dr. Janet Travell and Dr. David Simons in 1942.
In the 1950s and 1960s, David Simons worked with Travell and continued to develop the concept of trigger points and their role in myofascial pain. They published their seminal work, "Myofascial Pain and Dysfunction: The Trigger Point Manual," in 1983.
About Travell and Simons
Dr. Travell was a cardiologist and White House physician for President John F. Kennedy. Dr. Simons was a research scientist. Both interested in understanding the nature of muscle pain and its relationship to other health conditions.
Travell and Simons observed that some patients with chronic pain conditions had areas of tenderness and tension in their muscles that seemed to be distinct from other types of pain. They coined the term "myofascial trigger point" to describe these areas of muscle tension and tenderness that could refer pain to other parts of the body. Travell and Simons developed a system of mapping out trigger points in different muscles and identifying common patterns of referred pain associated with different trigger points.
Acupuncture is safe and effective for myofascial pain
The integration of traditional Chinese medicine concepts with modern medical knowledge has led to the development of new approaches to the diagnosis and treatment of myofascial pain and other musculoskeletal disorders. These approaches often involve the use of acupuncture, as well as other techniques such as acupressure, dry needling, trigger point injection, and other manual therapies.
Acupuncture has been shown to be effective in reducing pain and improving function in patients with MPS. In one study, researchers found that acupuncture was as effective as trigger point injection for the treatment of MPS in the upper trapezius muscle. Acupuncture has also been found to be effective in treating other musculoskeletal disorders, such as low back pain.
One of the key advantages of acupuncture is that it is a minimally invasive treatment that does not require medication. Acupuncture needles are very thin and cause minimal discomfort, and the risk of adverse effects is low. Acupuncture is also relatively affordable compared to other treatments, and it can be performed by a licensed acupuncturist or other qualified healthcare professional.
Other Therapies for Myofascial Pain
In addition to traditional style acupuncture, other manual therapies such as trigger point injection and dry needling have been developed to treat MPS and other musculoskeletal disorders. Trigger point injection involves injecting a local anesthetic or other medication directly into the trigger point to relieve pain and reduce inflammation. Dry needling is a technique involves inserting an acupuncture needle directly into the trigger point and stimulating the needle to deactivate them without injecting any medication, which can help release tension and promote healing. Both trigger point injection and dry needling can be effective in treating myofascial pain, although they are more invasive than traditional acupuncture and may carry a higher risk of adverse effects.
Myofascial Release for Trigger Points
Another manual therapy that has been found to be effective in treating MPS is myofascial release. Myofascial release involves applying gentle pressure to the affected muscle and connective tissue to release tension and improve blood flow. Dry needling is a form of myofascial release that uses an acupuncture needle to fully release trigger points and reach areas that cannot be reached with manual release alnoe. Myofascial release can be performed by a healthcare professional, or patients can learn to perform non-needling versions themselves with the help of a qualified instructor.
Acupuncture and Dry Needling are related
Overall, the history of trigger points is intertwined with the history of acupuncture and other manual therapies. While the concept of trigger points has been recognized for centuries, it was not until the mid-twentieth century that the modern understanding of myofascial pain syndrome and trigger points was established. Today, a variety of manual therapies, including acupuncture, trigger point injection, dry needling, and myofascial release, are used to treat myofascial pain and other musculoskeletal disorders. These therapies are often used in combination with other treatments, such as physical therapy, exercise, and medication, to provide the most effective and comprehensive care for patients with chronic pain and dysfunction.
While dry needling is a modern technique, it is has some link to the ancient principles of traditional acupuncture. In fact, many dry needling practitioners use acupuncture needles, which are extremely thin and designed to minimize pain and tissue damage during insertion. However, the use of acupuncture needles for dry needling is controversial, as some acupuncturists argue that it is a form of medical appropriation that fails to acknowledge the holistic principles of traditional Chinese medicine.
Despite these debates, dry needling has become a popular needling technique for the treatment of myofascial pain syndrome and other musculoskeletal disorders. Its popularity is due in part to its minimally invasive nature, as well as its ability to target specific trigger points that may be difficult to reach with other manual therapies.
As the use of dry needling continues to evolve, it is important for practitioners to be mindful of its historical and cultural roots in acupuncture. By acknowledging the connection between dry needling and acupuncture, practitioners can better understand the principles that underlie this powerful manual therapy and provide more effective care for patients with chronic pain and dysfunction. If you are suffering from chronic pain, it is important to work with a qualified healthcare professional to determine the best course of treatment for your specific needs.
Over to you
If you liked this article, please share with friends and family who may be suffering with acute or chronic pain.
Sources:
Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual (Vol. 2). London: Lippincott Williams & Wilkins.
Maciocia, G. (2015). The Foundations of Chinese Medicine E-Book: A Comprehensive Text. Elsevier Health Sciences.
Liu L, Skinner MA, McDonough SM, Baxter GD. Traditional Chinese Medicine acupuncture and myofascial trigger needling: The same stimulation points? Complement Ther Med. 2016 Jun;26:28-32. doi: 10.1016/j.ctim.2016.02.013. Epub 2016 Feb 22. PMID: 27261978.
Hilton, J. (1863). On rest and pain: A course of lectures on the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain. John Churchill.
Charcot, J. M. (1883). Lectures on diseases of the nervous system, delivered at La Salpêtrière (Vol. 2). New Sydenham Society.
Paget, J. (1877). On rheumatism. John Churchill.
Gowers, W. R. (1888). Lumbago: Its lessons and analogues. British Medical Journal, 2(1463), 117-121.
Gowers, J. H. (1904). Lumbago: its treatment and prevention. British Medical Journal, 2(2248), 117-120.
Mackenzie, J. (1908). The back: Its aches and pains. William Heinemann.
Kellgren, J. H., & Lewis, T. (1928). Observations on referred pain arising from muscle. Clinical Science, 3(2), 175-190.
Head, H., & Rivers, W. H. R. (1930). The effect of saline injections upon the sensitivity of muscle. Brain, 53(4), 489-503.
Travell, J. G. (1942). Observations on the distribution of pain arising from trigger points. The Journal of the American Medical Association, 119(6), 474-478.
Travell, J. G. (1952). Myofascial pain syndromes. Medical Clinics of North America, 36(1), 149-165.
Gerber LH, Shah J, Rosenberger W, Armstrong K, Turo D, Otto P, Heimur J, Thaker N, Sikdar S. Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects With Chronic Myofascial Pain. PM R. 2015 Jul;7(7):711-718. doi: 10.1016/j.pmrj.2015.01.020. Epub 2015 Feb 4. PMID: 25661462; PMCID: PMC4508220.
Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K; Acupuncture Trialists' Collaboration. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018 May;19(5):455-474. doi: 10.1016/j.jpain.2017.11.005. Epub 2017 Dec 2. PMID: 29198932; PMCID: PMC5927830.
Lee MS, Ernst E. Acupuncture for pain: an overview of Cochrane reviews. Chin J Integr Med. 2011 Mar;17(3):187-9. doi: 10.1007/s11655-011-0665-7. Epub 2011 Feb 27. PMID: 21359919.
Disclaimer: This web site is intended for educational and informational purposes only. Reading this website does not constitute providing medical advice or any professional services. This information should not be used for diagnosing or treating any health issue or disease. Those seeking medical advice should consult with a licensed physician. Seek the advice of a medical doctor or other qualified health professional for any medical condition. If you think you have a medical emergency, call 911 or go to the emergency room. No acupuncturist-patient relationship is created by reading this website or using the information. Morningside Acupuncture PLLC and its employees and contributors do not make any express or implied representations with respect to the information on this site or its use.