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Truthaches, Trigger Point Therapy, and AcupunctureGregory T. Lawton, D.N., D.C., M.Ac. (Diplomate) This article originally appeared in a revised version that was written for the massage therapy profession. This version has been rewritten and modified for the medical acupuncture profession. Trigger point therapy theory and techniques are currently used in various ways by both professions. 
No, this is not an article about dentistry and acupuncture, but it is an article about trigger point therapy that was triggered in part by an article that appeared in a recent health magazine that attempted to inaccurately explain the physiological basis of trigger points. It is also an article about all of the past articles that have been written on the subject, those being written at this very moment, and those yet to be written. The point of the title is that truth hurts. If you are in a hurry and want to save yourself the trouble of reading the rest of this article on trigger point therapy you can save yourself some time if you just read and agree with the following:
The theory of trigger points has gone through several changes over the recent years from the original theory of Janet and Dave. Janet's original theory was that a trigger point was (you know this already) a palpable nodule or taut band of fibro-connective tissue in muscle. The problem with the original theory is that fifty five years later researchers and proponents of this concept are still attempting to find those pesty little nodules and taut bands. There is, unfortunately, a lack of histological evidence that they actually exist which led most rational members of the research community to abandon that idea all together. Even Janet and Dave dropped the idea of applying ischemic compression on the trigger point and opted for cortisone and other "exciting" chemotherapeutic drug injections. Of course knowledgeable members of the acupuncture community know that the idea that Travell and Simon "discovered" trigger points is absurd, since the idea of and treatment for localized areas of pain has been common practice in the Asian therapies for many centuries. Over the years there have been numerous studies that have either attempted to prove or disprove trigger point theory. The Prover's have failed to prove their point (there is that pun again) and the Disprover's have made some significant discoveries that have turned the entire idea of trigger points on its head. One of the best rebuttals of trigger point theory and citations of the current literature in the field is the article by John L. Quinter and Milton L. Cohen entitled, "Referred Pain of Peripheral Nerve Origin, An Alternative to the "Myofascial Pain" Construct." This is an excellent review of the historical development of trigger point theory and concepts and a step by step refutation of the theory along with some outstanding ideas about what this painful condition really is. The supporters of trigger point theory and trigger point therapists cite research that has been discredited as either inaccurate, having technical procedural flaws, or that contains artifacts that have been caused by false positive readings in equipment such as electromyographic instruments (EMG). Needle biopsy of supposed trigger points identified by trigger point "experts" has consistently failed to show any difference between the muscle tissue within the borders of an "identified" trigger point and any other normal muscle tissue, so much for the idea of ischemic alternations in trigger point tissue. So what is all this leading to? No one argues that there are areas "points" that generate pain. For example, the Ah Shi point. The question remains that if this is not muscle tissue pain, what kind of pain is it? Well this question led to the discovery that what had been erroneously labeled as trigger point pain and attributed to pathological changes in muscle tissue, is most likely (new theory) peripheral nerve pain at the motor end plate. This bears repeating so that this idea can replace all of the wrong information that you have been previously taught in school and in seminars, and keeping reading about in various books and magazines. This is where the story gets interesting for the acupuncturist, TuiNa therapists, or acupressurist. As a medical acupuncture instructor I believe that it is important that the acupuncturists and massage therapists know the truth about the conditions they treat and the techniques that they use. Consider this. If trigger points are not a fibrotic alteration in muscle tissue then what is with all of this ischemic compression, deep tissue break down of adhesions, forceful and painful acupressure techniques, Knobbles, knuckles, rigid fingers, elbows and knees all about? If, as the current research strongly suggests, these pain sites are inflamed and abnormal nerve endings then what in the world are we doing poking things into excited painful nerves? Imagine that you have a painful tooth, do you want me to poke a fork into it? Does that sound therapeutic to you? Of course there are oriental massage, acupressure and acupuncture students standing at treatment tables at this very moment being taught to push their elbows and knuckles into that "trigger point." As an acupuncture and massage educator I have taught and written about the non physiological methods of acupuncture and massage therapy that are currently being taught to new students with wide open minds and expectations. What does non physiological mean? Simply that you are being taught something about a condition or the effects of acupuncture, acupressure or oriental massage technique that is simply not true. This is also why there is a difference between instructors who teach non physiological theories and techniques and those that teach valid technique from the current research and scientific literature. As one of my teachers said to me years ago, "You teach what you are, you cannot give a gift that you do not possess and you cannot teach what you do not know." It does not matter what a treatment system is called, there are dozens and dozens of kinds and types of acupuncture, acupressure, and oriental massage therapy and techniques. What matters is our understanding of body function based upon universal physiological principles and can our techniques effectively affect the body's natural corrective and restorative processes? From the example provided in this article it does not when our original theory is incorrect and that leads to unnecessarily causing increased pain and suffering in our patients. Many acupuncture, acupressure and oriental massage schools that purport to teach effective techniques, the various groups and organizations that claim to follow the research literature are more interested in the number of course hours in a training program, than the quality of course content and have not even begun to address the task of validating acupuncture, acupressure and massage techniques and procedures to assure their safety and efficacy for patients. Don't bother to write and tell me about all of the clinical studies that are out there, they are poorly made attempts to create the illusion of solid research. If the truth hurts, that means that there was a problem to begin with. About the author: Gregory T. Lawton, D.N., D.C., M.Ac (Diplomate) is the founder of and an instructor at the Blue Heron Academy of Healing Arts and Sciences located throughout Michigan and parts of Indiana. References: Referred Pain of Peripheral Nerve Origin, An Alternative to the "Myofascial Pain" Construct, John L. Quinter and Milton L. Cohen, Medical Pain Education www.pain-education.com Looking Beyond Myofascial Pain Syndrome, Myofascial trigger points, myogenic or peripheral nerve pathology?, Gregory T. Lawton, American Health Source Publishing, Grand Rapids, Michigan Medical Acupuncture, A Rational and Scientific Approach, Gregory T. Lawton, American Health Source Publishing, Grand Rapids, Michigan
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