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

Standard Tandem Point approach

While a muscle-only approach is easy to learn and will provide faster results than single-point acupressure, the much faster and more effective approach is to combine acupressure to trigger points with acupressure to relatively distant acupuncture points. Relative to a muscle-only approach, a standard approach is much faster and "holds" longer, that is, the patient's problem seems less likely to recur, and it takes longer for the problem to recur.

What standard 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
  • finds an acupuncture point that will help to release the primary trigger point
  • feels for a pulsation in the tandem point
  • waits for the pulsations to converge in timing and amplitude (for "the points to balance") in the primary trigger point and the tandem point
  • asks the patient to stretch through the trigger point
  • waits for the points to balance in the two points again
  • asks for the patient to stretch again
  • waits for the points to balance again, until a full range of motion is achieved in the target muscle
  • balances points in the trigger point with points superior to and inferior to the point, on energetic (channel) lines

The experience of the patient

  • when a tandem point is held, pain starts to disappear from the trigger point, sometimes rapidly
  • when a patient presses a point, and then a tandem point is pressed, the patient will feel the point he is pressing soften and the pain go away
  • often when the patient can no longer feel the pain in the point he is pressing, he will start rubbing the area around the point, looking for pain
  • more than half of patients will feel a release of heat during the work, especially in points they are pressing
  • some patients feel other referred sensation during the work, including
    • referred pain
    • tingling, especially in the hands and feet, not associated with pressure on nerves
    • energy movement
    • itching, especially in the face
    • twitching
    • colors behind the eyes

[At this point in the lecture an audience member expressed concern about patient responses to referred sensation, that patients might find these experiences frightening. Answer: The response of the clinician is very important. In my experience, the patient needs to be told (a) that the referred sensation is a good thing, very helpful, and (b) that the referred sensation will go away. Frequently I tell patients to take notice of any non-painful referred sensation, to enjoy it, because they may never feel it again.]

Demonstration of the standard approach: [A volunteer, a doctor, presented with pain in the supraspinatus related to an automobile accident she had suffered more than 20 years earlier. I palpated the supraspinatus, which the volunteer found quite painful. In my experience, the supraspinatus is usually an overstrained antagonist of an overcontracted agonist. Important antagonists of the supraspinatus include the serratus anterior, triceps brachii, and pectoralis minor. In this case, palpation revealed the strongest contracture to be in the coracobrachialis. In applying the standard approach, I held the muscle origin, the volunteer held the insertion (both attachment trigger points), and I held Lung 6 (the xi-cleft point of the Lung channel, which is superficial to the coracobrachialis). When the coracobrachialis origin and Lung 6 balanced, I laterally extended the volunteer's shoulder, stretching the muscle. When the muscle had achieved full length and the volunteer had no pain in her points, I palpated the supraspinatus again. The volunteer's evaluation of her supraspinatus pain: "feels better; feels much better."]

Advantages of Tandem Point therapy

  • the clinician and the patient can tell immediately if a point is effective
  • dozens of points can be taken in one session, in a search for those that are effective in causing a trigger point to release
  • it is not necessary to wait until the end of the session to determine whether the approach is effective
  • it is possible, through the piezoelectric effect, to affect trigger points in deep muscles, points that can't be reached with needles [Question: Can you explain the piezoelectric effect? Answer: the piezoelectric effect is the production of electricity through pressure on a crystalline structure. As James Oschman discussed with you, collagen is liquid crystalline in structure, and therefore one can expect that applying pressure to collagen will generate a weak electrical current.]
  • the trigger point can be released with the muscle in a fully stretched position, which always provides a much more effective release than a release with the muscle in a neutral position.

As the muscle stretches, and the originally-restricting taut band lengthens, other taut bands may appear. With Tandem Point therapy, it is easy to move to the next taut band. For example, one patient's psoas major may have the most contracted taut band in the L4 division. However, as the trigger point in that division is released, that division can stretch, and another taut band in the L5 division may become the most contracted.



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