Acupuncture related techniques such as cupping, gua sha, tui na, moxibustion and qi gong are important components of traditional Asian medical practice and home treatment. Medical acupuncture also uses “hybrid” techniques that employ acupuncture needles in ways informed more by Western medicine than by traditional acupuncture theory. What follows is a description of some of these terms and procedures.
Cupping is an ancient technique used extensively around the world in both traditional and modern medicine. In this procedure, suction cups are placed over strategic areas of the body, and a vacuum is created, either with a suction pump or by heating the air inside the cup and allowing it to cool. This negative pressure stretches the tissues, improves blood circulation to the area, and creates a mild inflammation that stimulates healing. Cupping relieves muscle tightness and restricted motion, but can also treat other medical conditions and energy imbalances.
Dry Needling (see Fine Needle Trigger Point Deactivation)
Fine Needle Trigger Point Deactivation
Trigger points are tender areas of constriction that develop in muscles, causing the muscle as a whole to be shortened and referred pain to be experienced at sites distinct from the trigger point itself. Based on the work of Travell and Simon, who developed a comprehensive atlas of the body’s trigger points, physicians will sometimes inject lidocaine, corticosteroids, or saline into these points to relax the affected muscles. There is a strong overlap between the locations of trigger points and acupuncture points.
In fine needle trigger point deactivation (also known as trigger point acupuncture or dry needling), acupuncturists, and in some areas physical therapists, use delicate acupuncture needles to treat myofascial pain instead of using hypodermic needles, with less discomfort and risk to the patient. Gently needling trigger points and tight bands of muscle fibers can relieve pain and spasm, while increasing range of motion and blood flow to the areas involved. I utilize fine needle deactivation of trigger points and tight bands extensively in the treatment of pelvic, neck, shoulder and back pain.
Gua sha is physical medicine treatment used throughout Asia for centuries for treatment of stiffness, pain and spasm, among other conditions. “Sha” is a term for congestion of blood and toxins that accumulates in areas where tight muscles or other tissues prevent normal circulation. After lubricating the skin, pressure is applied with repeated strokes of a tool until red spots (petechiae) appear under the skin. This usually coincides with relief of symptoms. The skin itself is undamaged, and all signs resolve in a few days. As with cupping, the stronger the initial discoloration, the better the treatment! Because gua sha stretches the muscles and fascia, it is a very good complement to trigger point deactivation.
Intralesional injection (scar deactivation or neural therapy)
Long after a wound from trauma or surgery has healed, the resulting scar can sometimes remain active, which that can be a factor in chronic pain. “Deactivating” the scar by injecting small amounts of local anesthetic quiets the abnormal nerve activity that may be keeping pain going when it no longer serves a purpose. Also called “Neural therapy,” this technique is widely used in Europe, and has been shown to be helpful in numerous conditions.
Moxibustion is a traditional technique of heating acupuncture points with preparations made from Artemesia vulgaris (common mugwort), an important herb in both Eastern and Western herbal medicine. This warms and relaxes muscles, and strengthens the energies of the body. During acupuncture, needles may be heated with moxa for added benefit.
Moxibustion for Breech Pregnancy
In recent years, several studies have been published showing that moxibustion in pregnancy on specific acupuncture points can help turn around a baby in breech position. Obstetricians and midwives commonly recommend this to help avoid the need for cesarean section. Moxibustion is most effective for this purpose when done prior to 35 weeks of gestational age
A collection of acupuncture procedures in which the selection of points to needle is based, not on theories of Chinese Medicine, but rather on the basis of their anatomical and neurological attributes. Used primarily for musculoskeletal problems, the points relating to specific tendons, muscles, nerves, etc, are needled with the intent of influencing these structures.
Percutaneous Electrical Nerve Stimulation (PENS)
Percutaneous electrical nerve stimulation is an acupuncture-like treatment for chronic pain developed by William Craig, MD in the 1970’s, that has been shown to be effective for low back pain, sciatica, trigeminal neuralgia and diabetic neuropathy, among other conditions. It involves placement of needles at appropriate levels on either side of the spine to stimulate a change in the nerves that carry pain and other signals from an affected area of the body (neuromodulation). Needle placement is determined by position of the nerves (rather than by traditional acupuncture points), and needles are connected in specific circuits and stimulated at a series of frequencies over a course of treatment. Many medical acupuncturists use variations on the Craig PENS procedure in conjunction with other techniques to create a multilayered electro-acupuncture treatment. It should be pointed out that though this procedure bears obvious similarity to acupuncture, the developers of PENS themselves do not actually consider this procedure to be acupunctures
Trigger Point Injection
Small amounts of a local anesthetic, such as lidocaine, or an anti-inflammatory corticosteroid can be injected into relevant trigger points to provide a stronger input than would be attained with trigger point deactivation alone.