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12-degree patient classification method,

ABCD grouping, 16-point method,

135-137, 145t Abdominal muscles, 193, 196t, 197/

injuries of, 225 Acetylcholine release, at trigger points, 148 Achilles tendinitis, 230

in runners and cyclists, 236 Achilles tendon injuries, in basketball players, 238 Achilles tendon rupture, in football players, 243 Action potential, propagation of, 61-62, 62/

Active acu-reflex points, 75

Active phase, of exercise responses, 17

Acupuncture, 4

dry needling. See Dry needling acupuncture; Integrative systemic dry needling. electrical, 53 modern, 5

needle manipulation in, 59 Acu-reflex point system

16-point method of patient classification in, 135, 145t charting of, 134-135, 134t historical review of, 133-134 integrative, in clinical treatment, 133 patient classification in, 135 prediction of treatment outcome in, 146

trigger points in, 147-161. See also Trigger points. Acu-reflex points, 74-75, 86 active, 75

anatomic configurations of, 74-75, 79-85. See also Neuroanatomic features. cutaneous and muscular, 92-93 distribution of, 88-92 brachial plexus, 101-103 cervical plexus, 99-101 facial, 93-98 lower limb, 108-115 torso, 115

upper limb, 103-108 electrical conductivity of, 77 electrophysiology of, 77 homeostatic, 132-146. See also

Homeostatic acu-reflex points.

Acu-reflex points (Continued )

number of, as indicator of health status, 76-77 latent, 75

neural origins and segmentation of, 96t passive, 75

formation of, 76 pathophysiology of, 72-74 pattern of, in upper and lower extremities, 81 phases of, 75

physical properties of, 75-77 physiology of, 74-75 primary, 92-93, 96f, 134t, 135-137, 136/. See also Homeostatic acu-reflex points. sensitized, 75-76, 79, 84-85, 132. See also Acu-reflex point system.

physiologic parameters of, 74, 74t sequence in appearance of, 76-77 specificity of, 76 superficial, 81 symptomatic, 76, 79

identification of, 120-123 thickness of body wall at, 259 types of, 86 Acute inflammation, 53 Acute injury, and symptomatic acu-reflex points, 76 Acute stress, 2-3

Adaptive shortening, of muscles, 42 Adhesion, soft tissue, 54 atrophy and, 54

circulatory blockage and, 54, 55 external impact and, 54 internal insults and, 54 musculoskeletal imbalance and, 54 pathology of, 54 scarring and, 54 Adrenocortical response, 10 Adrenocorticotropin hormone

(ACTH), 10-11 Adrenomedullary response, 10, 15-16 Adverse effects, and prevention, 256-258, 257t acupuncture induced, case analyses nervous system injuries, 260, 261 peripheral nerve injuries, 261 pneumothorax, 259 syncope, 262-263 visceral injuries, 262 body position in, 258 disposable needles in, 258

Adverse effects, and prevention (Continued ) electrical percutaneous stimulation in, 258

needle manipulation in, 257 needle size in, 257 needling time duration in, 257-258 patient medical condition in,

258-259 patient physiologic condition in, 258

short-term physiologic reactions and, 256, 257t Afferent nerve fibers, 83 Allergy, and muscle pain, 74 Amygdala, 12

sensitization of, and physiologic responses, 15, 16 Analgesia, acupuncture, 64. See also Pain relief.

Ankle ligaments of, 183, 183/ muscles producing movement of, 182t and talotarsal joint, 188/ Ankle fracture, 232 Ankle injuries in basketball players, 238 in soccer players, 244 in swimmers, 249 in tennis players, 251 in volleyball players, 253 Ankle sprain, 231-232 Anterior compartment syndrome, 231 Antidromic neuronal activity, 57, 57/ Arches, of foot, 184-185, 186/ Arm, acu-reflex points for evaluation of, 145/. See also Upper limb.

Athletes brain-body interaction in, 20, 21-22 improved performance of, 3 Athlete's foot, 213 Athletic fatigue, 43 Athletic performance, 1-2

chronic and acute stress effects on, 2-3

integrative systemic dry needling for, 4 goals of, 2 limits of, 3-4 Atrophy, 54

Autoimmune disease, and muscle pain, 73 Autonomic nervous function, homeostatic, 8-9

Note: Page numbers followed by "f" refer to illustrations; page numbers followed by "t" refer to tables; page numbers followed by "b" refer to boxes.

Autonomic nervous responses, in overtraining stress, 18 Autonomic nervous system, 90-92 divisions of, 92

sensory and motor nerves of, 10 Avulsion fracture, 225-226 Axillary nerve, motor functions of, 104i

Back acu-reflex points of, 115-120, 117/ greater occipital (H7), 118 L2 posterior cutaneous (H15), 119-120

L5 posterior cutaneous (H22), 120 superior cluneal (H14), 120 T6 posterior cutaneous (H21), 119 T7 spinous process (H20), 118-119 muscles of, 193, 194/ average length, 194/, 194i long, 193 i, 194/ short, 195/; 195t Back and spinal injuries, 223-225 back ligament strain, 224 back muscle strain, 223-224 disc herniation, 224 in football players, 243 in swimmers, 249 in tennis players, 250-251 thoracic contusion, 224 vertebral stress fracture, 224-225 Baseball player's injuries, 240-241 other position-specific injuries, 241 throwing injuries, 240-241 Basketball player's injuries, 238-240 Bernard, Claude, 6 Beta (P)-endorphin, 10-11 Biceps brachii muscle strain and bruising, 217 Biceps brachii tendon rupture, 217 Biceps femoris tendinitis, in cyclists, 237 Biceps tendonitis, in baseball players, 240

Bicipital tendinitis, 218 Blisters, 213

Blood coagulation factor XII, 68 Blood vessels, and acu-reflex points, 81-83

Body position, for treatment, 258 Body structure, segmentation of, 123 Body weight, musculoskeletal support of, 31 Bolt, Usain, 3-4

Bone(s), responses to stress in, 33-35, 35/ Bone foramina, and acu-reflex points, 80/, 81

Bone spurs, and soft tissue dysfunction,

55-56

Brachial plexus, 88-90, 91/, 104t Brachial plexus acu-reflex points, 101-103, 102/

Brachial plexus injuries, in football players, 242-243 Bradykinin, 56, 67

vasoactivity of, 60 Brain atrophy, 24 Brain plasticity, 23 Brain-body interaction, 20-25 attention to activity in, 23 basic principles of, 21-22 brain plasticity and, 23 in motor skill learning, 20-21, 22 in physical training, 20-24 in skill training, 23 synaptic integration in, 22 Brain-derived nerve growth factor, 23 Brain-motor skill associations, 21-22, 22f, 23

Brainstem function, homeostatic, 8, 9,

12-14, 13f Brainstem needling reflexes, 65 Brainstem response subsystem, 12-14, 13f

Breaststroker's knee, 248-249

Calcitonin gene related peptide (CGRP), 56 in neurogenic inflammation, 60 Calf strain, 230 Cannon, Walter, 6 Carpal tunnel syndrome, 222 Central feedback loop subsystem,

12-14, 13f 15, 15f Central nervous system and integration of stress response,

11-17, 14f and pain sensation, 60 Cerebral cortex, sensory and motor nerves in, 9-10 Cerebral cortical function in homeostasis, 8-9 in integrative systemic dry needling, 49-50, 51f Cerebral cortical needling reflex, 66 Cervical joint, 29, 29f Cervical nerve stretch syndrome, 214 Cervical plexus, 88, 91f Cervical plexus acu-reflex points, 99-101, 100f great auricular, 99-100 other, 100-101 spinal accessory (H3), 101 Cervical radiculitis, 215 Cervical spine injuries in cyclists, 238 disc injury in, 215 in swimmers, 249 Cervical spondylosis, 215-216 Cholecystokinin octapeptide (CCK-8), 58-59

Chondromalacia patella, 229 in cyclists, 237

Chronic disease, and passive acu-reflex points, 76 Chronic inflammation, 53 Chronic pain, 71

Chronic soft tissue syndrome, 53, 55

Chronic stress, 2-3

Circulatory blockage, and soft tissue adhesion, 54, 55 Clavicle fracture, 216 Common fibular acu-reflex point

(H24), 113, 114/ Compartment syndrome anterior, 231 osteofascial, 55

in soccer players, 244-245 Concentric muscle contraction, 37-38 Concussion injury, in football players, 243

Contraction knots. See Muscle contraction knots. Contracture. See Muscle contracture. Corticotropin-releasing factor (CRF)

subsystem, 15, 15/ Cortisol, 10

and effects on target tissues, 10, 10t and enhancement of autonomic nervous function, 10 receptors activated by, 15 secretion of, and physiologic responses, 15 in stress response, 14 Cramps. See Muscle cramps. Cranial nerve V. See Trigeminal nerve. Cranial nerve VII. See Facial nerve. Cranial nerve IX. See Glossopharyngeal nerve.

Cranial nerve X. See Vagus nerve. Current of injury, 58-59 Cutaneous acu-reflex points, 92-93 of back, 115-120 of brachial plexus, 101-103 of cervical plexus, 99-101 facial, 93-98 of lower limb, 108-115 of torso, 115 of upper limb, 103-108 Cutaneous electromagnetic field, 58 Cutaneous innervation, segmental,

123-126, 124/ Cutaneous microcurrent reaction, 58-59 Cyclist's injuries, 236-238 Cytokines, role of, in overtraining syndrome, 19

de Quervain tenosynovitis, in cyclists, 237

Deep fascia, 81

Deep fascial penetration, and acu-reflex points, 81, 83/ Deep fibular acu-reflex point (H5), 83, 85/, 115, 116/

Deep fibular nerve, motor functions of, 111 i

Deep radial acu-reflex point (H1), 81-83,

82/ 84, 105-106, 107-108 Delayed-onset muscle soreness (DOMS), 43-44, 44/ and eccentric muscle contraction, 44 edema in, 44

inflammatory reaction in, 44 muscle pain and, 72 physiologic causes of, 44 Dermatomes, 123-126, 124/ Dermopoints, 61, 74-75 Diaphragm, 197/ DOMS. See Delayed-onset muscle soreness. Dorsal horn neurons, 121 Dorsal scapular acu-reflex point (H13),

105-106, 106/ Dorsal scapular nerve, 128i Drug-induced muscle pain, 74 Dry needling acupuncture, 1, 207-211.

See also Integrative systemic dry needling. safety issues in, 256-263. See also

Safety issues. for specific sport injuries, 234-255 baseball, 240-241 basketball, 238-240 cycling, 236-238 football, 242-243 golf, 241-242 ice hockey, 246-247 other sports, 253 running, 235-236 skiing, 246 soccer, 243-246 swimming, 247-249 tennis, 249-251 volleyball, 251-253 for treating soft tissue dysfunction, 212-233. See also Soft tissue dysfunction. of abdomen, 225

of back and spine, 223-225. See also under Back and spinal injuries. of head and neck, 213-216 of hips, pelvis and groin, 225-227 for injury prevention, 207-208,

234-255. See also Sports injuries; Sports injury prevention. of lower limb, 227-228 knee, 228-229 lower leg and foot, 229-233 thigh, 227-228 of skin, 212-213 of upper limb, 216-219

elbow, 219-221. See also Elbow injuries. hand and fingers, 222-223 shoulder and upper arm, 216. See also Shoulder and upper arm injuries. wrist and forearm, 221-222

and physiology of acu-reflex points, 134

Dynamic work, 37-38 force generated by, 38 types of, 37-38

Eccentric muscle contraction, 37-38

delayed-onset muscle soreness and, 44 Edema, in lesion formation, 60, 67 Efferent nerve fibers, 83 Elbow extensor muscles, 201/ 201 i Elbow flexor muscles, 200/ 200i Elbow injuries, 219-221 in baseball players, 240-241 bursitis, 221 dislocation, 220 fracture, 219 in golfers, 242 lateral epicondylitis, 220 medial epicondylitis, 220 sprain, 220 in swimmers, 248 in tennis players, 250 thrower's elbow, 220-221 triceps brachii tendon rupture, 220 Elbow joint, forces on, 28-29, 28/ Elbow supinator and pronator muscles, 202/

Elbow supinator muscle, 202i Electrical acupuncture, 53 Electrical percutaneous stimulation, safety issues in, 258 Electrogenic contraction, 41 Electrogenic spasm, 41 Endocrine physiology homeostatic, 8-9, 10 in overtraining, 18-19, 46, 47/ in stress, 14-16, 14/ Endogenous muscle contracture, 42 Endomysium, 36 Endorphins, 64

Energy crisis, in skeletal muscle, 77-79, 79/ Energy crisis hypothesis, 63, 63/ Epimysium, 36-37 Epinephrine, 10

and effects on target tissues, 10 in stress response, 14 Epinephrine secretion, central nervous regulation of, 15-16 Erector spinae, 193, 196i Evidence-based practice, of dry needling acupuncture, 2, 4, 49, 50, 52 Evidence-based research, supporting sport injury prevention, 210 Exercise, response to, 16-17 active phase of, 17 brain stimulation and activity in, 23 positive or negative stress in, 17 preparatory phase of, 16-17 Extravasation, 66-67

Facial acu-reflex points, 93-98, 98t facial nerve, 95-97 infraorbital (H19), 97-98 other, 98

supraorbital (H23), 98 trigeminal nerve, 94-95 Facial nerve, 88, 90/ 95-97, 98t Fascia, muscle, 36 Fasciculi, muscle, 36 Fast-twitch (type II) fibers, 39 characteristics of, 39-41, 39t developmental training for, 41 subclassification of, 39 Femoral nerve, motor functions of, 111t Femur fracture, 227 Fibrogenesis, 55 Fibular fracture, 229-230 Fibular (peroneal) tendinitis, 232 Finger dislocation, 223 Finger sprain, 223 Finger tendinitis, 223 Foot arches of, 184-185, 186/ ligaments of, 187/ muscles of, 177/, 184 musculomechanics of, 181-189, 184/ and subtalar neutral position, 185-189 Foot fracture, 232 Foot injuries in basketball players, 238 in swimmers, 249 Football player's injuries, 242-243 Force(s)

muscle generated, 38 and stress, in movement, 27-28 curved bones and, 28 injury causing, 27 transmission of, 28 Forearm injuries, 221-222 Forearm muscles, 201, 205/

in anterior fascial compartment, 203t in lateral fascial compartment, 203t in posterior fascial compartment, 204t Frostbite, 212-213 Frozen shoulder, 219

Gallbladder, visceral reflex zones of, 168/ Glenohumeral instability, in baseball players, 240 Glossopharyngeal nerve, 97 Glucocorticoid (type II) receptors, 15 Golfer's elbow, 220 Golfer's injuries, 241-242 Gravity, in facilitating movement, 27-28 Great auricular acu-reflex point (H2),

99-100, 100/ Great auricular nerve, 99 Greater occipital acu-reflex point (H7), 118, 118/

Groin injuries, in soccer players, 245 Groin strain, 226 Gunn, C. Chan, 71

Hageman factor, 68 Hamstring strains, 227

in basketball players, 239 Hand and finger injuries, 222-223 finger dislocation, 223 metacarpal fracture, 222-223 tendinitis, 223

thumb and finger sprain, 223 in volleyball players, 252 Head and facial injuries, in ice hockey players, 246 Head and neck, muscle pain in, and associated trigger points, 153t

Head and neck injuries, 213-216 acute torticollis, 214 cervical disc injury, 215 cervical nerve stretch syndrome, 214 cervical radiculitis, 215 cervical spondylosis, 215-216 neck strain, 214

strains, contusions, fractures, 213-216 whiplash, 214 Head-forward posture, and muscle pain, 72-73 Healing, stages of, 55 Health status, homeostatic acu-reflex points and, 76-77 Heart, visceral reflex zones of, 166/ Heat exhaustion in basketball players, 239-240 in football players, 243 Heel spur, 233 Hines, Jim, 3-4 Hip abductor muscles of, 172-174, 176t adductor muscles of, 174-177, 176t extensor muscles of, 176t flexor muscles of, 172, 176t ligaments of, 175/

musculomechanics of, 171-177, 176t Hip, pelvis, groin injuries, 225-227 avulsion fracture, 225-226 groin strain, 226 hip flexor strain, 225 hip pointer, 225 osteitis pubis, 226 piriformis syndrome, 226 stress fracture, 226 trochanteric bursitis, 226-227 Hippocampus, loss of volume of, 16 Histamine release, 58 Homeostasis musculoskeletal, 6-7 restoration of physiologic, 1 in sports and exercise, 6-19. See also Sport homeostasis.

Homeostatic acu-reflex points, 76-77, 86, 92-93 of back, 115-120 of brachial plexus, 101-103 of cervical plexus, 99-101 of face, 93-98, 98t of lower limb, 108-115 nonspecific, 142/, 143t in posterior rami of spinal nerves, 115-120

primary, 92-93, 135-137, 136/; 137t quantity of, and health status, 76-77 secondary, 138/ 139t sensitized, 132-133 tertiary, 140/ 1411 of torso, 115 of upper limb, 103-108 Hormonal responses. See also

Endocrine physiology. in overtraining stress, 18-19 Hormones, stress, 10

homeostatic functions of, 10 Human movement, 26 Humeral fracture, 216 Hyperalgesia, 122 Hyperesthesia, 122 Hypermobility, and muscle pain, 72 Hypothalamic integration, in homeostasis, 8-9, 12 Hypothalamic needling reflex, 65 Hypothalamic-pituitary-adrenocortical

(HPA) axis, 46, 47/ Hypothalamic-pituitary-adrenocortical

(HPAC) axis, 14-16, 14/ Hypothalamic-sympathetic-

adrenomedullary (HSAM) axis, 15-16

Ice hockey player's injuries, 246-247 Iliotibial acu-reflex point (H18), 111 Iliotibial band syndrome, 228 in runners and cyclists, 235 Imagination and behavior, in physical training, 24 Immune function dry needling-induced lesions and, 58 overtraining syndrome and, 19, 47 restoration of, 68 Impingement. See Shoulder impingement syndrome. Infectious disease, and muscle pain, 73-74

Inferior gluteal acu-reflex point (H16), 111, 112/ Inferior gluteal nerve, 128t Inflammatory response, 53

in delayed-onset muscle soreness, 44 in integrative systemic dry needling, 49 in soft tissue dysfunction, 53 Infraorbital acu-reflex point (H19), 97-98, 97/

Infraspinatus acu-reflex point (H8),

106-107, 107/ Injury(ies). See Soft tissue dysfunction;

Sports injuries. Integrative neuromuscular acu-reflex point system (INMARPS), 72, 84, 133

Integrative systemic dry needling

(ISDN), 6, 49, 1-5. See also Dry needling acupuncture. and acupuncture, 1, 4-5 analgesic effects of, 64, 66-67 and athletic performance, 1-2 basic techniques of, 1 biologic mechanisms of, 49, 51/ cutaneous microcurrent, 58-59 lesion induced, 49, 50/, 57-58 nociceptive stimulation in, 56-58, 66-67

segmental axon reflex in, 66-67 central cortical mechanisms of,

49-50, 51/ disciplines combined in, 5 efficacy and evidence-based practice of, 2, 4, 49, 50, 52 goals and purpose of, 1, 64 in immune function restoration, 68 needle manipulation in, 59 nonspecificity of, advantages of, 51 and pain relief, 2

for pathologic muscle contracture, 59-64

physiologic reactions to, 256. See also

Safety issues. self-healing potential and, 50-51 as soft tissue therapy, 51-53, 77-79.

See also Soft tissue dysfunction. and spinal segmental axon reflex, 66-67 summary of physiology of, 68-69 tenets of, 2

therapeutic synthesis in, 71 and trigger-point medicine, 4-5.

See also Trigger point therapy; Trigger points. Intervertebral disc herniation, 224 Intestine, visceral reflex zones of, 168/ Intrafusal fibers, 32 Intramuscular stimulation, 1 ISDN. See Integrative systemic dry needling. Isometric muscle contraction, 37-38

Joint dysfunction, and muscle pain, 60 Joint function, in musculoskeletal mechanics, 28-29 Joint-muscle dysfunction, and muscle pain, 73

Joints of class I skeletal levers, 28-29 of class III skeletal levers, 29 reaction forces within, 29-31

Kandel, Eric, 20 Knee, 177-181

muscles producing movement of,

179-181, 180i and thigh muscles, 177f, 178/ Knee extensor muscles, 179, 180i Knee flexor muscles, 179-181, 180i Knee injuries, 228-229 in basketball players, 239 bursitis, 228-229 chondromalacia patellae, 229 in football players, 243 ligament sprains, 228 meniscal tear, 228 patellar subluxation, 229 patellar tendinitis, 229 patellofemoral pain syndrome, 229 in skiers, 246 in soccer players, 245 in swimmers, 248-249 in tennis players, 251 in volleyball players, 252-253 Knee joint, ligaments of, 179/ Knee lateral rotators, 180i Knee medial rotators, 180i

L2 posterior cutaneous acu-reflex point

(H15), 119-120 L5 posterior cutaneous acu-reflex point

(H22), 120 Labral injuries, in baseball players, 240 Latent acu-reflex points, 75

transformation to passive points, 76 Lateral antebrachial acu-reflex point

(H9), 81-83, 83/, 105 Lateral epicondylitis, 220 Lateral horn neurons, 121

autonomic regulation by, 121 Lateral medial popliteal acu-reflex point

(H11), 111-112 Lateral pectoral acu-reflex point (H17),

104-105 Lateral pectoral nerve, 128i Lesion current, 78-79 Lesion mechanisms, biology of, 49, 50/, 64-66, 78-79 central nervous activity in, 60 immune function restoration in, 68 neurochemical analgesic, 64 neurogenic inflammation in, 60 noxious stimulation in, 59-60 reflex pathways in, 64-66, 65/ reflex points (contraction knots) in, 61

segmental axon reflex in, 66-67, 67/ summary of, 68-69 vasoactivity in, 60 Lesser occipital nerve, 99 Leukotrienes, 58

Lever(s), 26-27 classes of, 27/ skeletal class I, 28-29 class III, 28-29 Lifting mechanics, 191, 192/ Ligaments, and acu-reflex points, 83 Limbic needling reflex, 66 Limbic system components of, 12b, 13/ integration of stress response in, 12 Liver, visceral reflex zones of, 168/ Local acu-reflex points, 122 Local reflex loops, 8-9 Local twitch response, 160-161 Long-distance runners, case histories athlete with previous injuries, 209b athlete without previous injuries, 209b Long-term depression, 23-24 Long-term memory, 20-21 Long-term potentiation, 23-24 Lower back, forces on, 29, 30/ Lower back pain, musculoskeletal origins of, 190-191 Lower leg and foot, musculomechanics of, 181-189, 181/, 182t Lower leg and foot injuries, 229-233 Achilles tendinitis, 230 ankle fracture, 232 ankle sprain, 231-232 anterior compartment syndrome, 231 in basketball players, 238-239 calf strain, 230 in cyclists, 237-238 fibular (peroneal) tendinitis, 232 foot fracture, 232 foot stress fracture, 232-233 in football players, 242-243 heel spur, 233 in hockey players, 247 medial tibial pain syndrome, 230 plantar fasciitis, 233 posterior tibial tendinitis, 231 in runners, 235-236 in soccer players, 244-245 stress fracture, 230-231 in swimmers, 248-249 tibial and fibular fractures, 229-230 in volleyball players, 252-253 Lower limb. See also Lower limb acu-reflex points; Lower limb injuries major nerves of, 1111 muscle pain in, and associated myofascial trigger points, 156t musculoskeletal mechanics of, 171-189, 189t hip, 171-177, 176t knee, 177-181, 180t lower leg and foot, 181-189, 182t peripheral nerves, muscles, and nerve roots of, 128t summary of muscles of, 189t trigger point sites of, 159/

Lower limb acu-reflex points, 108-115, 110/

common fibular (H24), 113 deep fibular (H5), 115 iliotibial (H18), 111 inferior gluteal (H16), 111 lateral medial popliteal (H11), 111-112 lumbar plexus, 110 sacral plexus, 111 saphenous (H4), 112-113 sural (H10), 113 tibial (H6), 113-114 Lower limb injuries in basketball players, 238-239 in cyclists, 237-238 in football players, 242-243 hip, pelvis, and groin, 225-227 in ice hockey players, 247 knee, 228-229 lower leg and foot, 229-233 in runners, 235-236 in skiers, 246 in soccer players, 244-245 in swimmers, 248-249 in tennis players, 251 thigh, 227-228 in volleyball players, 252-253 Lumbar biomechanics, 189-190, 190/ Lumbar plexus acu-reflex points, 92/, 110

Lumbar spine, physical tension on, 191, 192/

Lumbar vertebrae, compression forces on, 190, 190/ Lumbosacral and coccygeal nerve plexus, 88, 89/, 92/ Lungs, visceral reflex zones of, 167/ Lyme disease, and muscle pain, 73-74

Mast cells, 58

Mechanical signal transduction, 59

Medial epicondylitis, 220

Medial patellofemoral ligament pain, in cyclists, 237-238 Medial tibial pain syndrome, 230 in basketball players, 238-239 in runners, 235-236 in soccer players, 244 Median nerve, motor functions of, 104i Median nerve neuropathy, in cyclists, 237 Medulla, 12-14

Membrane depolarization, and muscle contraction, 61-62, 62/ Membrane potentials, 61-62, 61/ Meniscal tear, 228

Meridian points, in Chinese practice, 133 Meridian theory, 4, 71 Metabolic energy crisis, muscle contracture in, 59-64, 77-79, 79/

Metacarpal fracture, 222-223 Microwhiplash injury, in cycling, 238 Midbrain needling reflex, 65 Mineralocorticoid (type I) receptors, 15 Motopoints, 61 Motor nerve fibers, 83 Motor reflexes, subconscious, 20-21, 22-23

Motor skills, learning, 20-21, 22. See also Brain-body interaction; Physical training. MTrPs. See Myofascial trigger points. Muscle(s), skeletal, 31, 171, 172/. See also Musculoskeletal mechanics. anatomy and structure of, 36-37, 37/ contraction of, 37-38. See also Muscle contraction. energy crisis in, 77-78 fatigued or overtrained, 33 shapes of, 36-37, 38/

and function, 37 stress responses in, 33-35, 35/ and tendons, 33 thixotropic property of, 41-42 Muscle contraction, 37-38, 41-42 in contracture, 42

dry needling and reflex restoration in, 9 and exercise-associated muscle cramps, 45 forms of, 41

homeostatic regulation of, 9 imbalanced, 42-43 membrane depolarization and, 61-62, 62/ and muscle fatigue, 43 and muscle fiber types, 39-41 and muscle soreness, 43-44 pathologic, 63, 63/ posture and, 42-43 in spasms, 42 Muscle contraction knots, 61, 77 Muscle contracture, 41, 42, 54, 59-64, 78/ endogenous, 42

metabolic energy crisis in, 59-64,

77-79, 79/ needle lesion in relief of, 78 reflex points in, 61. See also Acu-reflex points. soft tissue dysfunction in,

53-54. See also Soft tissue dysfunction. types of, 60, 61 Muscle cramps, 45

soft tissue dysfunction in, 53-54 Muscle fatigue, 43

and muscle cramps, 45 Muscle fiber tension, increased, in etiology of trigger points, 148-149 Muscle fibers, 36

microanatomy of, 36, 37/ type I (slow-twitch) fibers, 39 type II (fast-twitch) fibers, 39-41 types of, 39-41, 39t

Muscle fibers (Continued ) aging and effects on, 40 changing, according to training, 40 early determination of, 40 low- or high-intensity sports and, 40, 40t percentage of, in different muscles, 39, 40t Muscle pain, 72 allergy and, 74 autoimmune disease and, 73 delayed-onset muscle soreness and, 72

drug induced, 74

head-forward posture and, 72-73

hypermobility and, 72

imbalanced muscular action and, 73

infectious disease and, 73-74

joint dysfunction and, 60

local, four common sources of, 59-60

nerve root compression and, 73

nutritional deficiencies and, 74

origins of, 72

passive acu-reflex points and, 72 pelvic torsion and, 73 physiology of, 60 postural reflexes and, 61 sacroiliac joint dysfunction and, 73 somatic dysfunction and, 73 static overload and, 73 visceral disorders and, 74 and viscerosomatic reflex, 60 Muscle soreness, 43-44. See also

Delayed-onset muscle soreness. Muscle spasm(s), 42 protective, 42 segmental, 42 visceral disease and, 42 Muscle spindles, 32-33, 32/

protective sensory action of, 32 Muscle sprains, in football players, 242 Muscle tension. See also Electrogenic contraction. measurement of, 42 Muscle tone, 41

Muscle trauma, in overtraining syndrome, 46-47, 47/ Muscular acu-reflex points, 92-93 Muscular imbalance, and muscle pain, 73 Muscular innervation, segmental, 126, 126t

Musculocutaneous nerve, 128t motor functions of, 104t Musculoskeletal homeostasis, 6-7 Musculoskeletal imbalance, 42-43

and soft tissue adhesion, 54 Musculoskeletal mechanics, 26 of body weight support, 31 force and stress in, 27-28 joint function in, 28-29 joint reaction forces in, 29-31 levers and torque in, 26-27 of lower limb, 171-189

Musculoskeletal mechanics (Continued ) hip, 171-177, 176t knee, 177-181, 180t lower leg and foot, 181-189, 182t muscular contributions to, 31 protective reflexes in, 31-33 responses to stress in, 33-35, 35/ sensory organs in, 33 sensory reflexes in, 31-33 skeletal contributions to, 26-28 of trunk, 189-198, 190/

abdominal muscles, 193, 197/ back muscles, 193, 194/ respiratory muscles, 195-198, 197/ of upper limb, 172/; 198-202 elbow, 199-201 forearm, 201 shoulder, 198-199 wrist, 202

Musculoskeletal screening examination,

208-209, 208t Musculoskeletal system, 171 Myalgic headache, 72-73 Myofascial pain, 147 Myofascial pain syndrome, 147 Myofascial trigger points (MTrPs), 74-75, 147-161 discovery of, 133-134 etiology of, 148-149

acetylcholine release in, 148 fiber tension increase in, 148-149 sensitizing substances in, 149 interaction of, 149 locating, 160

and muscle contraction knots, 77 and muscular tension release, 160-161 needling therapy of, and prognosis, 161 nociceptors of, 149-150 pain patterns and associated,

150-160, 151/ palpation of, 160 sites of, 150 Myofibrils (muscle fibrils), 36 Myofilaments, 36 Myotomes, 126, 126t

Nakatani, Y, 77

Nasal visceral reflex zones, 170/ Neck. See also cervical entries. forces on, 29, 29/ muscle pain in, and associated myofascial trigger points, 153t, 154t pinched nerve in, 215 trigger point sites of, 158/ Neck injuries, in swimmers, 249 Neck sprain, 214 Neck strain, 214 Needle grasp, 59 Needle manipulation, 59 benefits of, 64

safety issues in, 257 Needle sizes, suggested, 257 Needles, used in dry needling, 56, 258 Needling reflex(es), 64-66, 65/ Needling sensation, 56-58 diversity of, 57

and related nerve fibers in muscles, 571 Needling time, duration of, 257-258 Nerve depth, and acu-reflex points, 80-81, 82/ Nerve fiber composition, and acu-reflex points, 83 Nerve growth factor, brain-derived, 23 Nerve plexus, 88, 89/ Nerve root compression, and muscle pain, 73

Nerve trunk size, and acu-reflex points, 80, 80/

Nervous system injuries, case analysis of safety issues, 260, 261b peripheral, 261 Neural bifurcation, and acu-reflex points, 83, 85/ Neuroanatomic features, of acu-reflex points, 79-85 bifurcation points in, 83, 85/ blood vessels in, 81-83 bone foramina in, 80/, 81 deep fascial penetration in, 81, 83/ ligaments in, 83 nerve depth in, 80-81, 82/ nerve fiber composition in, 83 nerve trunk size in, 80, 80/ neuromuscular attachments and, 81, 84/

and safety issues in dry needling acupuncture, 256-258 skull suture lines in, 83 Neurogenic inflammation, neuropeptides in, 60 Neuromuscular attachments, and acu-reflex points, 81, 84/ Neuropeptides, 56

in neurogenic inflammation, 60 Neuropoints, 74-75 Nociceptive stimulation, 56-58, 66-67 Nociceptor(s) definition of, 57

of myofascial trigger points, 149-150 physiology of stimulation of, 60, 67, 67/

Nodes, 61

Nonspecific homeostatic acu-reflex points, 142/; 143t Norepinephrine, 10 Nutritional deficiencies, and muscle pain, 74

Obturator nerve, motor functions of, 111t Optic visceral reflex zones, 169/ Oral visceral reflex zones, 170/

Organs, and local reflexes in homeostasis, 8-9 Osteitis pubis, 226 Osteoarthritis, in soccer players, 245 Osteofascial compartment syndrome, 55

in soccer players, 244-245 Otic visceral reflex zones, 169/ Overreaching training, 45 Overtraining stress, 7-8

autonomic nervous responses in, 18 hormonal responses in, 18-19 local muscle pain caused by, 60 Overtraining syndrome, 7-8, 17-18 autonomic nervous responses in, 18 emotional demands and role in, 45-46

endocrine responses in, 46, 47/ hormonal responses in, 18-19 immune function in, 19, 47 muscle physiology in, 45-47. See also

Muscle(s). muscle trauma associated with, 46-47 parasympathetic symptoms of, 46 prevention of, with dry needling therapy, 47 signs and symptoms of, 18, 45 in swimmers, 247 sympathetic symptoms of, 46 types of, 18 Overuse injuries, in swimmers, 247

Pacinian corpuscles, 33, 34/ Pain, referred, 147

visceral pathology and, 163 Pain inhibition system, 66 Pain patterns, and associated myofascial trigger points, 151/ head and neck muscle, 153t lower limb muscles, 156t neck, shoulder and upper limb muscles, 154t Pain perception, modulation of, 66 Pain quantification, and prognosis,

137, 145t Pain relief, integrative systemic dry needling in, 2, 161 Pain-sensitive nerves, 33, 34/ Pancreas, visceral reflex zones of, 168/ Parasympathetic division, autonomic nervous system, 92, 94/ Paravertebral acu-reflex points, 86 selection of, 123-127 thickness of body wall at, 259, 259t Passive acu-reflex points, 75

formation of, in chronic diseases, 76 pathophysiology of, 72-74 Patellar subluxation, 229 Patellar tendinitis, 229 in cyclists, 237

in volleyball players, 252-253

Patellofemoral pain syndrome, 229

in runners, 235 Patient classification, in acu-reflex point system, 135 Patient medical condition, in dry needling, 258 Pectoral muscle tendinitis, 219 Pelvic muscle injuries, 225-227 Pelvic torsion, and muscle pain, 73 Perimysium, 36

Peripheral nerve network(s), 71, 72 Peripheral nervous system injuries, case analysis of safety issues, 261 Phelps, Michael, 3-4 Phrenic nerve, 99 Physical activity active phase of, 17 brain-body interaction in, 20-25 musculoskeletal mechanics in, 26-35

positive or negative stress in, 17 preparatory phase of, 16-17 Physical stress, 16 Physical training, 7

brain-body interaction in,

20-25. See also Brain-body interaction.

imagination and behavior in, 24 learning and unlearning activities in, 23-24

musculoskeletal mechanics in, 26-35. See also Musculoskeletal mechanics. Piriformis syndrome, 226 Plantar fasciitis, 233

in runners, 236 Platelet activating factor, 58 Plexus, nerve, 88, 89/ Pneumomediastinum, spontaneous, in swimmers, 249 Pneumothorax case analyses of safety issues, 259,

259b, 260b signs of, 259 Pons, 12-14

Posterior tibial tendinitis, 231 Posttraumatic stress disorder (PTSD), 15

Postural pain, 43 Posture, 42-43

muscle pain and, 61 Preparatory phase, of exercise responses, 16-17 Primary homeostatic acu-reflex points, 92-93, 96/, 134t, 135-137, 136/. See also Homeostatic acu-reflex points. Primary hyperalgesia, 66-67, 67/ Primary motor cortex, organization of,

21-22, 21/ Prostaglandins, 56, 67 Psychologic stress, 16

appraisal model of, 11-14, 11/

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