Acupuncture Physical Medicine [APM] is a comprehensive style of acupuncture developed by Mark Seem, PhD, that combines classical meridian acupuncture with the treatment of Trigger Points. Trigger Point therapy is actually a tool of western medicine extensively developed by the late Dr. Janet Travell and Dr. David Simons. Myofascial trigger points are extremely common and become a painful part of nearly everyone’s life at one time or another.  Inactive trigger points can cause stiffness and decreased range of motion, while active trigger points add pain into the mix.  In a study at a medical center pain clinic, a neurologist examining 96 patients found that 93% had at least part of their pain caused by myofascial trigger points, and in 74% of the patients trigger points were considered to be the primary cause of pain.  There are over 400 muscles in the human body and any one of them can develop trigger points that refer pain and dysfunction.  Yet, ironically, muscles and trigger points receive little attention as a major source of pain in most medical school training and in most acupuncture training programs as well. 

What are Trigger Points? 

Trigger Points are hyper-irritable loci palpable in a taut band of muscle that cause referred or local pain, or other symptoms of dysfunction.  In laymen’s terms - trigger points are small tender areas in a tight, rigid muscle that can be felt.  Applying pressure to active trigger points can reproduce pain symptoms that may radiate out from the point or other symptoms such as dizziness or nausea. 

How do Trigger Points get Activated?

Trigger points can be activated by overuse or overloading a muscle, i.e. shoveling snow or repetitive motions (repetitive strain injuries often have a trigger point component).  Leaving a muscle in a shortened position as sometimes occurs while sleeping in an awkward position or habitually holding a phone between your neck and shoulder can activate trigger points.  There is evidence that viral illness can activate trigger points.  Nerve compression (sciatica, etc.) and organic disease can also contribute to the activation of trigger points, as can emotional distress and sports injuries.

How are Trigger Points Treated?

There are 2 steps to treating trigger points with acupuncture.  The first step, like the first rule of real estate, is location, location, location.  The acupuncturist palpates the body (examines the body by touch) to feel for trigger points in tight muscles that are causing symptoms of pain or distress.  Using ‘informed touch’ and with confirmation of the patient (“oh, that’s it”) the trigger point is located and trapped with the non-needling hand. The second step involves a specific acupuncture needle technique.  The acupuncturist trained in APM technique stimulates the point to deactivate, elicits a twitch response and the muscle lets go.  Doctors that practice trigger point work, usually osteopaths or physical medicine specialists, typically treat by inserting a hypodermic needle into the trigger point and injecting it with lidocaine after eliciting a twitch response.  The disadvantage to this method is that it involves thick hollow hypodermic needles, and very few points can be treated in one session at a relatively high cost.  Body workers trained in trigger point work locate trigger points and apply pressure with their fingers to try to soften the tissue in that area.  The disadvantage of this method is that it takes a very long time to do less effectively what acupuncture can do in just seconds.

What Kinds of Symptoms do Trigger Points Cause? 

Trigger points can be responsible for a wide variety of symptoms.  They can cause local or referred pain in muscles that can mimic migraine pain in the temple or behind the eye, chronic abdominal wall pain, dysmenorrhea & pms, frozen shoulder, myofascial pain & dysfunction, radiculopathy, TMJ, tension headache, occipital headache, repetitive strain disorder and others.  There are also instances where trigger points can cause other symptoms of dysfunction such as limited range of motion, dizziness and weakness during certain movements such as pouring milk or turning a doorknob.  While trigger points can cause many symptoms, it is always recommended that a patient see a physician first to rule out the presence of serious organic or other disease.  Trigger points can occur in the presence of organic disease and patients should always investigate that possibility with their physician. 

How does APM Differ from Other Styles of Acupuncture?

Acupuncture Physical Medicine [APM] utilizes classical meridian acupuncture and trigger point - myofascial release acupuncture as a part of a treatment strategy aimed at treating the whole person and their particular ‘holding pattern’.  A holding pattern is roughly equivalent to a patient’s unique pattern of myofascial constriction or blocked energy.  The APM exam and treatment is based on a patient’s actual, physical, lived experience of distress, rather than a theoretical textbook diagnosis.

Acupuncture Physical Medicine focuses on palpation of the body to determine a patient’s holding pattern.  Acupuncture points are chosen based on classical meridian theory and the practitioners skill at navigating the meridians (acupuncture points are located along meridians).  Local points, including trigger points are selected by touch.  What makes acupuncture acupuncture is the use of fine needles to unblock stuck energy, correct imbalances and to encourage free flow.  Key questions:  Where does one put the needles for best effect?  How are the points best located?  What needle technique is used to get the desired response?

A strength of the APM style is its emphasis on informed touch, advanced needling technique and the ensuing rapport with the patient as their unique holding pattern becomes evident and is subsequently addressed quickly and effectively.

SOURCES:  The Trigger Point Manual by Travell & Simons;   A New American Acupuncture (& other writings) by Mark Seem, PhD.