What is Acupuncture?
Acupuncture is the insertion of needles into specific sites. This action creates a mechanical response, which results in the stimulation of tissue. Tissue stimulation leads to physical and psychological responses that promote balance or healing within the body.
Traditional Chinese medicine (TCM) has the first recorded evidence of acupuncture points being used to treat disease. The location of these points is found upon what is commonly known as meridians. Meridians are described as lines of energy through which the fundamental forces of life flow. The selection of these points is based upon fundamental aspects of Traditional Chines Medicine theory – Yin and Yang and Qi and blood. The aim of TCM is to promote or restore harmony to the body via the flow of energy.
In its traditional form, acupuncture is used to treat both Musculosketal and system disease. Prior to the Cultural Revaluation, acupuncture was based around meridian therapy. That is, locating a series of painful points along a meridian that were considered to be the cause of dysfunction. Following the Cultural Revolution in China during the 1960’s and 1970’s, acupuncture followed in a tradition of herbal prescription model, using a prescription of points with specific functions, to treat disease.
MTrP and Acupuncture. (Musculoskeletal Trigger points)
MTrPs are based around a Western medical diagnosis of signs, symptoms, referral pattern and palpation. They are used to treat conditions of the musculoskeletal system. The mechanism of understanding how these trigger points occur us based around physiological mechanisms.
Acupuncture is based around Traditional diagnosis which involves questioning, palpation and observation. Points are selected according to a TCM diagnosis and used not only for musculoskeletal conditions, but also systemic conditions. Musculoskeletal acupuncture is a combination of these two modalities. It provides the specificity of acupuncture points found around arrears of musculoskeletal pain and dysfunction, and applies a Western explanation into the effects of needling.
Mapping of these points via neuroimaging has found many of the points to where nerves bifurcate into superficial and deep, around free nerve endings and dorsal horns creating segmental innervations. Points can be located within myofascial trigger points, hypertonic muscle bands, associated paraspinal muscle, classical acupuncture points, and periosteum around joints.
Acupuncture (or needle insertion via Dry Needling) from a Western medical perspective involves needle penetration at specific sites. Stimulation of these sites results in mechanical stimulation of the surrounding tissues. This creates both a Physical and Psychological response in the body. It is both the physical and psychological response that the Western medical practitioner seeks to stimulate.
Needling is essentially a safe therapeutic intervention in the hands of a skilled and conscious practitioner.
Common reactions to needling include aggravation of symptoms, drowsiness, bleeding, and bruising. These common reactions can all be controlled with the correct treatment protocol and intervention if a reaction to treatment is suspected.
Other not so common events include peripheral nerve injury, vasovagal response and skin infection, such as hepatitis B, HIV and meningitis. Responsible treatment protocol will go a long way to observing these events are recorded.
Serious risk usually involves pneumothorax. A pneumothorax can be produced by needling anywhere within the thorax or where the anatomical position of the Lungs can be located.
How many treatments
Many factors will determine how many treatments. Research has shown that more than one treatment per week will not enhance treatment. If no response has been achieved in 3-4 treatments then continued treatments may not be effective.
When applying needles in the classical acupuncture, the practitioner is seeking to elicit a sensation known as de qi, which can be described by the patient as a dull ache, heaviness, numbness, tingling, or a spreading sensation. Dry needling seeks to stimulate or create a nerve twitch that will actively release an area of tight muscle tissue.
Needle insertion creates two distinct and related responses. Wherever a needle is inserted, it stimulates afferent sensory receptors in the skin and muscle.
The impulse travel from the insertion to the spinal cord to activate spinal neurons and to secrete enkephalin and dynorphin to inhibit the pain messages. Needle impulses are relayed through spinal cells to the cells to the midbrain and pituitary gland. This midbrain uses enkephalin to activate the pain inhibition system. This pain inhibition system secretes monoamines, serotonin and norepinephrine to inhibit pain by inhibiting ascending pain signals. The pituitary and hypothalamus release endorphin into the blood to promote analgesia of the injured site.
Secondly, insertion of needles into tissue results in cell damage, which stimulates the inflammatory response to damage of tissue. At a peripheral level, substance P and CGRP (calcitonin gene-related peptide) are released targeting muscle around the peripheral vessels and histamine cells, which results in vasodilation. The inflammatory response and consequent vote the tissue healing process. This occurs as damaged connective collagen and elastic fibres begin the re-laying of fibres and recreation of tissue (via gene transcription) in response to the initial inflammatory process.