Needling Restores Normal Energy Metabolism In Soft Tissue Dysfunction

Weinstein and Britchkov13 demonstrated that muscular contraction knots are the histopathologic characteristics of trigger points. Gunn18 also suggested a similar histologic structure of the shortened muscles with palpable sensitive or painful bands or points (Fig. 7-1).

Careful examination of pathologic activity in passive or active acu-reflex points and the muscles harboring them reveals that in addition to pronounced pain symptoms, at least two other abnormal phenomena are present:

• The surface temperature of most acu-reflex points is a little higher than that of normal tissues (0.3 ° to 0.5 ° C). This can be a sign of inflammation. Cooler temperatures in and around some acu-reflex points have also been reported, possibly attributable to vascular constriction in some cases.

• The affected muscles are tight and resist stretching.

In 1950, medical scientist Y. Nakatani, from Kyoto University in Japan, discovered that acu-reflex points on the skin have a high level of electrical conductivity. Moreover, the electrical conductivity of some acu-reflex points increased significantly during sickness. He found 370 such points, incorporated them into the classic meridian system, and called them ryodoraku points. Ryodoraku in both Japanese and Chinese languages means "meridian point with good electrical conductivity."

In 1977, Nakatani noticed that ryodoraku points were situated on areas containing sweat glands and inferred that the higher electrical conductivity of ryodoraku is caused by the high conductivity of the sweat glands. Modern ryodoraku theory focuses on interactions between the sympathetic nervous system and the somatic nervous system.6

In healthy skeletal muscle fibers (cells), calcium is stored in the sarcoplasmic reticulum. When a


tender/painful bands

Figure 7-1 Muscle contracture caused by radiculopathy or other muscle injuries.

tender/painful bands

Figure 7-1 Muscle contracture caused by radiculopathy or other muscle injuries.

motor nerve fiber sends impulses to the muscles, the impulses initiate an action potential in the membrane of the muscle fiber. This action potential spreads into the sarcoplasmic reticulum (whose membrane is continuous with the muscle membrane), which results in release of calcium into the cytoplasm. The high concentration of cytoplasmic calcium triggers the coupling between two linear proteins (actin and myosin). After coupling, these two linear proteins slide against each other, which leads to shortening of the muscle fiber. This coupling and sliding between the two protein molecules consumes a large amount of energy. If there are no further impulses from the motor fiber after the initial shortening, the sarcoplasmic reticulum takes back the calcium into storage, and the concentration of cytoplasmic calcium drops accordingly. The low level of cytoplasmic calcium causes a decoupling of the contractile proteins (actin and myosin), which relaxes the muscle fiber.

If a muscle fiber is damaged, the sarcoplasmic reticulum is unable to take back the cytoplasmic calcium into storage. The two contractile protein molecules cannot decouple because of the high concentration of cytoplasmic calcium. This results in persistent contraction of the muscle fiber, even without any further impulse from the motor nerve. If this energy-consuming process (the energy crisis) continues, sensitive muscle bands or acu-reflex points are formed. The sensitive bands, or trigger points, become a permanent contracture if the energy crisis persists for long enough.

Because acupuncture needling creates a tiny lesion, with bleeding, in the tissue, the contracting muscle immediately relaxes, and blood circulation improves. Thus acupuncture needling breaks the vicious circle of energy crises in trigger points inside the muscle.

The needle-created lesion disturbs the surrounding tissue and generates an electrical current of as much as 500 mA/cm,8 which is called the lesion current. In addition, small local bleeding caused by the lesion stimulates secretion of numerous growth factors such as platelet-derived growth factors and neurotrophic factors.9

The electrical current and the bleeding promote healing and regeneration of damaged tissues and induce DNA synthesis of new proteins and collagens that repair damaged cellular organelles and restore normal function. A lesion may last for at least 2 days before the body heals it, which means that the stimulation it causes may also last as long. During the healing period the cells with lesions are digested and replaced by fresh tissue cells of the same type. This explains why acupuncture needling can achieve long-lasting results. After the needles are removed the needle-induced lesions keep working for at least a few days.

Acu-reflex points are mainly composed of sensitized sensory nerve receptors. This sensitized condition is a dynamic process: Acu-reflex points appear and grow when health deteriorates, and they may disappear as health is restored. Normal physiologic homeostasis reduces the sensitivity of acu-reflex points, whereas acute injuries or chronic diseases sensitizes them.

Acute injuries and acute diseases create local sensitive points. These are called symptomatic acu-reflex points, and they appear in different locations in individual patients, depending on each patient's injury or disease.

Some latent or active acu-reflex points appear as a result of the vicious circle of the metabolic energy crisis. Such acu-reflex points maintain a temperature higher than that of surrounding tissues because of sustained muscle contraction. The muscle contraction is itself an energy-demanding process, but when it is sustained, an environment of low energy and low oxygen (hypoxia) is created as a result of reduced blood circulation. Needling is able to relax the muscle, which breaks the vicious circle and restores normal blood circulation (Fig. 7-2).19

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