| Question | Answer |
| What is myofascia? | Myo=muscles
Fascia= connective tissue
Surrounds, seperates and lies within muscles |
| What are some symptoms that might indicate myofascia problems? | Pain
Stiffnes
Muscle weakness
Muscle fatigue
Poor posture
headache
back pain
organ dysfunction
things that don't make sense |
| Myofascial point system | A clinical system of diagnosis and treatment that is based on locating points on the body. These points have an anatomical and physiological basis |
| Myofascial systems | Counterstrain tender point (Jones tender points)
Chapman reflex
Trigger point (aka Travell or Travell & Simons trigger points)
Acuptuncture point |
| True or False, Point based systems work therapeutically in different ways? | True |
| What should the systematic points relate to? | The patients symptom or suspected underlying process. |
| What five things are important to know about the points | They are flags, they are reliable, they reveal a pattern, they help you differentiate, they are targets |
| what can points be used for? | diagnosis and treatment |
| hyperirritable point on tissue that represents somatic dysfunction | Counterstrain Tender Points |
| Where are counterstrain tenderpoints located? | Located in muscle belly, origins, or insertions, as well as fascial raphe |
| What is the basis of a counterstrain tenderpoint? | focal muscle spasm or area of increased nociception. |
| Who discovered and mapped counterstrain tender points? | Lawrence Jones, DO |
| Why is the treatment of counterstrain tenderpoints beneficial to the patient? | quick relief
gentle and well tolerated
may use in appropriate acute situations |
| Why are counterstrain tenderpoints beneficial from a diagnostic and treatement perspective? | diagnosis easy
treat local point
positioning helped by patient feedback
can be time consuming (multiple points)
pulsatile release (may be palpable) |
| What are the three counterstrain principles? | Patient must relax
Communicate
Hold and Slow |
| reflex points that present as anterior and posterior fascial tissue texture abnormalities assumed to be visceral dysfunction or pathology | Chapman point |
| What are the characteristics of a Chapman point? | gangliform contractions”
plaque-like, stringiness, small, round, nodules
usually tender
usually lie near bony or cartilaginous sites |
| What is the basis for Chapman points? | represent viscero-somatic reflexes via visceral-sympathetic pathways |
| What will a recurrent type II somatic dysfunction indicate? | visceral component |
| What are three anatomic components of the viscero-somatic pathway | role of spinal interneurons, SNS dysfunction, and lymphatic blockage |
| Who first described Chapman's points? | Frank Chapman, DO |
| Who first published material on Chapman's points? | Charles Owen, DO |
| What are some views a patient may have about Chapman's points? | may not be symptomatic unless palpated
patient may not relate it to an organic condition |
| What are diagnostic benefits for the physician regarding Chapman's points? | anterior (relatively superficial), posterior (deeper)
lateralizing to side of organic condition
tenderness
should be palpable (not always as beginner)
should respond quickly to treatment
can monitor for recurrence and/or severity |
| What are the treatment principles for deciding Chapman's points? | innervation specific not necessarily organ specific; precise location; pain intensity (benign vs. pathologic); lack of finding ≠ no problem |
| What are the treatment principles for deciding Chapman's points? | innervation specific, but not necessarily organ specific;location is precise
pain intensity may not relate to nature (benign vs. pathologic)
lack of finding ≠ no problem |
| Who worked with myofascial trigger points? | Dr. Janet Travell |
| a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band | Trigger point |
| Trigger points are.. | active vs latent and have a
radiation pattern specific to that point |
| What is the basis of a trigger point? | a taut band of contracted and tender muscle fibers |
| What are physiological findings of a trigger point? | multiple causative factors
impaired circulation
implicated in somatic dysfunction*
research supports neuromuscular dysfunction |
| What is a patient perspective on trigger points? | symptoms can be perplexing
where it hurts may not be where the problem is
can have symptoms lasting years to life-long |
| What is the physician perspective on trigger points? | symptoms can be perplexing
a variety of symptoms aside from pain
often not sought after or recognized
look for reproduction of patient’s symptoms
snapping tenderness/muscle contraction
may be a twitch response to injection or dry-needling |
| In the order of importance, what are the principles regarding trigger points? | study
think
search (history, exam)
go after
stretch
treat somatic dysfunction |
| A trigger point in the buccinator might indicate what? | upper gum pain |
| A trigger point in the trapezius might indicate what? | Retro-orbital pain
Pain behind the ear |
| A trigger point in the sternocleidomastoid might indicate what? | ipsilateral hearing loss (clavicular branch)
tongue pain (sternal branch)
visual disturbances
chronic cough
TMJ pain (sternal) |
| What are the components and dimensions of an acupuncture needle? | Composed of stainless steel shaft and a spiraled handle of copper, bronze, or other alloy
Typical needle is 1 to 8 cm long, 0.3-0.4 mm in diameter or 26 to 28 gauge |
| How many microvolts and at what temperature should an acupuncture needle be? | 3 microvolts of electrical potential with tip at body temperature and handle at room temperature |
| How long does an acupuncture needle take to reach equilibrium? | This gradient reaches equilibrium in 10-15 minutes |
| Is acupuncture an experimental procedure? | No |
| How does the FDA have acupuncture classified? | Class B (surgical) medical device |
| based on concept of flow of Qi (energy) through meridians (channels) that are accessed by points as found on traditional acupuncture charts | Classical acupuncture |
| Utilizes anatomical trigger point, motor point, and tender point injections to decrease pain, muscle spasticity, and for dermatomal pain relief | neuroanatomical acupuncture |
| the use of electrical impulses to achieve effects on pain transmission via neurologic (primary sensory cortex, spinal cord, midbrain) and neuroendocrine effects | electroacupuncture |
| reflex somatotopic system (homunculus) organized on the surface of the external ear | auricular acupuncture |
| Describe the acupuncture energetics model. | electrical fields result from the sum of metabolic activity within organs
the paths of least resistance are interfascial planes between muscle groups or cleavage planes
Meridians (channels) are the surface representations of these paths |
| Name a physiological and histological description of acupuncture points. | occur in areas of decreased skin surface electrical resistance
histologic: loose bundles of connective tissue, often overlying neurovascular bundles |
| True or false. All of the acupuncture points have been found. | False new points are being discovered and used |
| True or False. There is a scientific basis to differentiate between real and sham points. | True. technetium 99 Studies in France: linear flow of 6 cm/min in real acupuncture points; No flow in sham points |
| What types of diagnosis can acupuncture help? | Addictions
Stroke rehabilitation
Headache
Menstrual cramps
Carpal tunnel
Low back pain
Asthma
Fibromyalgia
Tennis elbow |
| How do we diagnose? | After a thorough medical exam and considering multiple possibilities. |
