A sensory axon reflex is the body's first response to needling, which elicits reflex responses at different levels from local spinal segment to cortex. To obtain specific results from nonspecific needling, selecting the best acu-reflex points for particular condition is the primary procedure.
Sensory axon reflex "points" are distributed all over the body (except for the nails, the hair, and part of the cornea; this is why pain is not felt when nails and hair are cut). Needling induces both mechanical and lesion-created stimuli in the body, which results in local and systemic reflex responses. Whenever health declines, some peripheral sensory nerves become sensitized. This sensitization can be caused by peripheral pathologic insults such as injury, or by visceral pathology, or by central sensi-tization such as pathologic changes in the anatomy and/or the functional and neurochemical profile of the central nervous system.
If this sensitization, especially when it is peripheral, is not neutralized, the sensitized reflex nerve will sensitize other peripheral nerves, possibly through both central sensitization and functional intercon-nectedness between different parts of the body. For example, when low back pain occurs at the L2-L5 level, it can be found that the superior cluneal, inferior gluteal, popliteal and sural nerves have already been sensitized. If the pain persists, the lateral and medial pectoral nerves also become sensitized. Why this happens in such an interconnected pattern is little understood, and what is currently known is just the tip of an iceberg. Nevertheless, the limited knowledge of this interconnectedness has already offered guidance in clinical practice: a systemic approach to restoring homeostasis. For instance, when pathologic conditions of the core system (e.g., low back pain) are treated, the interconnected peripheral nerves of the lower limbs will be treated at the same time. Or when knee pain is treated, the core systems, such as the lower back and even the neck, will not be ignored.
Thus a competent clinician should have both analytic and synthetic understanding of human anatomy, the pathologic condition that is currently being examined, and, particularly for sports medicine, the nature of human movement. This chapter provides the background for this understanding.
The ancient Chinese practitioners noticed this systemic functional interconnectedness between different parts of human body at least 3000 years ago, and they created "meridian theory" to explain it. With modern scientific knowledge of the human body and its pathology, clinicians are replacing empirical practice with evidence-based scientific practice. Modern Western medical professionals independently discovered similar techniques for treating soft tissue dysfunction and with a deeper analytic understanding, such as Janet Travell's trigger-point approach and C. Chan Gunn's intramuscular stimulation approach.
Needling therapy, presented as integrative systemic dry needling (ISDN) therapy in this book, is an integration of modern approaches to needling. It represents a synthesis of the theories and techniques of Janet Travell and C. Chan Gunn with other dry needling techniques and classical acupuncture. According to modern medical training, there is no conflict between these needling therapies, and each therapy has its advantages and limitations. This synthesis integrates the different clinical wisdoms and in this way enables clinicians to go beyond the limitations of each modality.
Each peripheral nerve, whether muscular or cutaneous, has a physiologic relationship with other distal peripheral nerves, as described previously. The sensitized tibial nerve on the leg, for example, can affect the greater occipital nerve from the posterior ramus of CII. Thus all the peripheral nerves form a physiologic network. This network is of great clinical importance, particularly in explaining the process and development pattern of chronic pathologic processes, especially chronic pain.
The origins of muscle pain can be categorized into five types: (1) trigger points, (2) muscle tension, (3) muscle spasms, (4) muscle deficiency (weakness), and (5) other soft tissue dysfunction, such as that of the fascia, tendon, or ligament. All these dysfunctions sensitize peripheral nerves, locally and even systemically.
The entire peripheral nerve network is a system that includes both modern trigger points and classic acu-reflex points. This system is the integrative neuromuscular acu-reflex point system (INMARPS). It is neuroanatomically defined and physiologically based. A basic understanding of the correspondence between the human nervous system (especially peripheral nerves) and these trigger points, or acu-reflex points, is crucial in the physiologic interpretation of the INMARPS. Many authors claim the discovery of "traditional meridians." However, in view of the relationship between the peripheral nervous system and acu-reflex points, this revelation actually concerns neither anatomic nor physiologic features of the human nervous system.
In this chapter, the physiology and anatomy of the INMARPS are described in detail. The purpose is to provide the anatomic and physiologic understanding of the acu-reflex point system that is necessary for clinical practice.
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