Tandem Point Tandem Point(SM) Therapy:
An integrated acupressure approach for myofascial pain

by Rena K. Margulis
Presented to Rehabilitation Medicine Grand Rounds
Institutes of Health
March 17, 2000

Simplified (muscle-only) Tandem Point approach

What muscle-only 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
  • holds a third point in the muscle
  • waits for the pulsations in the first and third points to converge in timing and amplitude (for the "points to balance")
  • asks the patient to actively stretch the muscle
  • waits for the points to balance again
  • asks for the patient to stretch further, until full range of motion is achieved

Example: Levator scapulae. The patient holds the C1 and C2 attachment trigger points; clinician holds central trigger point and scapular attachment trigger point. As the points release, the patient rotates her head contralaterally and then tucks her chin, to stretch the muscle. As noted above, in my practice, the levator is almost always overstrained as the result of one or more overcontracted antagonists, and those antagonists are addressed first.

Demonstration of the simplified approach: [A volunteer from the audience, a physical therapist, presented with pain near the lateral epicondyle of the humerus, which she called tendinitis. She identified the supinator referred pain pattern from Travell & Simons as resembling her pain pattern, although she had no referred pain to the thumb. During the demonstration I held the central trigger point of the supinator, she held one attachment trigger point, and I held another attachment trigger point. After her points balanced with her arm in a neutral position, she pronated her forearm to stretch the supinator. She felt heat release from her trigger point, and I felt heat release from the two points I was holding. After her points balanced with her supinator in maximum stretch, we stopped work, and she rubbed her forearm. She was unable to find any pain in her forearm. Her comment: "The tendinitis is not palpable."]

Everyone in this room should be able to use this approach today. All you need is a copy of Travell and Simons's book and good palpation skills.

When I explained this approach to massage therapists, they were able to implement it with their patients the next day. Anyone who practices physical therapy, neuromuscular therapy or any other pressure to trigger point approach could also implement this strategy immediately.

Important caution: This approach is effective in eradicating trigger points. If the clinician eradicates the trigger points in a muscle that is splinting against an overcontracted antagonist, it could make the problem worse. Because this approach is effective, it is extremely important that the clinician know where the problem is, as opposed to where the pain is. This caution will be repeated later. It is my greatest fear when I teach not that students will fail to release trigger points, but that they will succeed in releasing them in the wrong muscles. Especially, I tell students never to release trigger points in the quadratus lumborum.



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