Standard Tandem Point approach
While a muscle-only approach is easy to learn and
will provide faster results than single-point acupressure, the much
faster and more effective approach is to combine acupressure to
trigger points with acupressure to relatively distant acupuncture
points. Relative to a muscle-only approach, a standard approach
is much faster and "holds" longer, that is, the patient's problem
seems less likely to recur, and it takes longer for the problem
to recur.
What standard Tandem Point therapy looks like: Clinician
- identifies which muscle may be causing a myofascial pain syndrome
- finds a trigger point in the muscle
- waits to feel a pulsation in the trigger point
- locates a second trigger point in the taut band or in the muscle's
referral pattern
- holds that second point until a pulsation appears in the second
point
- asks the patient to hold that second point
- finds an acupuncture point that will help to release the primary
trigger point
- feels for a pulsation in the tandem point
- waits for the pulsations to converge in timing and amplitude
(for "the points to balance") in the primary trigger point and
the tandem point
- asks the patient to stretch through the trigger point
- waits for the points to balance in the two points again
- asks for the patient to stretch again
- waits for the points to balance again, until a full range of
motion is achieved in the target muscle
- balances points in the trigger point with points superior to
and inferior to the point, on energetic (channel) lines
The experience of the patient
- when a tandem point is held, pain starts to disappear from the
trigger point, sometimes rapidly
- when a patient presses a point, and then a tandem point is pressed,
the patient will feel the point he is pressing soften and the
pain go away
- often when the patient can no longer feel the pain in the point
he is pressing, he will start rubbing the area around the point,
looking for pain
- more than half of patients will feel a release of heat during
the work, especially in points they are pressing
- some patients feel other referred sensation during the work,
including
- referred pain
- tingling, especially in the hands and feet, not associated
with pressure on nerves
- energy movement
- itching, especially in the face
- twitching
- colors behind the eyes
[At this point in the lecture an audience member expressed concern
about patient responses to referred sensation, that patients might
find these experiences frightening. Answer: The response of the
clinician is very important. In my experience, the patient needs
to be told (a) that the referred sensation is a good thing, very
helpful, and (b) that the referred sensation will go away. Frequently
I tell patients to take notice of any non-painful referred sensation,
to enjoy it, because they may never feel it again.]
Demonstration of the standard approach: [A volunteer, a
doctor, presented with pain in the supraspinatus related to an automobile
accident she had suffered more than 20 years earlier. I palpated
the supraspinatus, which the volunteer found quite painful. In my
experience, the supraspinatus is usually an overstrained antagonist
of an overcontracted agonist. Important antagonists of the supraspinatus
include the serratus anterior, triceps brachii, and pectoralis minor.
In this case, palpation revealed the strongest contracture to be
in the coracobrachialis. In applying the standard approach, I held
the muscle origin, the volunteer held the insertion (both attachment
trigger points), and I held Lung 6 (the xi-cleft point of the Lung
channel, which is superficial to the coracobrachialis). When the
coracobrachialis origin and Lung 6 balanced, I laterally extended
the volunteer's shoulder, stretching the muscle. When the muscle
had achieved full length and the volunteer had no pain in her points,
I palpated the supraspinatus again. The volunteer's evaluation of
her supraspinatus pain: "feels better; feels much better."]
Advantages of Tandem Point therapy
- the clinician and the patient can tell immediately if a point
is effective
- dozens of points can be taken in one session, in a search for
those that are effective in causing a trigger point to release
- it is not necessary to wait until the end of the session to
determine whether the approach is effective
- it is possible, through the piezoelectric effect, to affect
trigger points in deep muscles, points that can't be reached with
needles [Question: Can you explain the piezoelectric effect? Answer:
the piezoelectric effect is the production of electricity through
pressure on a crystalline structure. As James Oschman discussed
with you, collagen is liquid crystalline in structure, and therefore
one can expect that applying pressure to collagen will generate
a weak electrical current.]
- the trigger point can be released with the muscle in a fully
stretched position, which always provides a much more effective
release than a release with the muscle in a neutral position.
As the muscle stretches, and the originally-restricting taut band
lengthens, other taut bands may appear. With Tandem Point therapy,
it is easy to move to the next taut band. For example, one patient's
psoas major may have the most contracted taut band in the L4 division.
However, as the trigger point in that division is released, that
division can stretch, and another taut band in the L5 division may
become the most contracted.
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