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

Possible scientific basis for Tandem Point therapy and acupuncture for pain relief

Robert Becker, the orthopedic surgeon and researcher who developed the technique for healing broken bones with electricity, has theorized that acupuncture meridians are electrical conductors that carry messages to the brain.

He writes in The Body Electric: "Any current grows weaker with distance, due to resistance along the transmission cable. The smaller the amperage and voltage, the faster the current dies out. Electrical engineers solve this problem by building booster amplifiers ever so often along a power line to get the signal back up to strength. For currents measured in nanoamperes and microvolts [like the current in the human body], the amplifiers would have to be no more than a few inches apart, just like acupuncture points! I envisioned hundreds of little DC generators like dark stars sending their electricity along the meridians, an interior galaxy that the Chinese had somehow found and explored by trial and error over two thousand years ago."

To develop a test for his theory, he realized that "if the lines and points really were conductors and amplifiers, the skin above them would show specific electrical differences compared to the surrounding skin. Resistance would be less and electrical conductivity correspondingly great, and a DC power source should be detectable right at the point."

Using grant funds raised by Becker, biophysicist Maria Reichmanis tested the Large Intestine and Pericardium channels on the arm, and "found the predicted electrical characteristics at half of the points. Most important, the same points showed up on all the people tested. . . . Our readings also indicated that the meridians were conducting current, and its polarity . . . showed a flow into the central nervous system [similar to the polarity in the sinew channels: toward the head]. Each point was positive compared to its environs, and each one had a field surrounding it with its own characteristic field. We even found a fifteen-minute rhythm in the current strength at the points, superimposed on the circadian ('about a day') rhythm we'd found a decade earlier in the overall DC system."(10) Chinese medicine texts also teach that the body's native energy circulates in a 24-hour cycle.(11)

Adding Becker's findings to other key research on trigger points, collagen and acupuncture, we know that

  • trigger points are electrically different from the surrounding tissue(2)
  • there is a 71% correspondence between published locations of trigger points and classical acupuncture points for the relief of pain(12)
  • acupuncture points typically represent local maxima in conductance, elevated by a factor of 10 to 100(13)
  • acupuncture meridians have the characteristics of electrical transmission lines(10)
  • collagen in connective tissue, which reaches every cell in the body, can act as a semi-conductor(13)
  • collagen is liquid crystalline in structure(13)
  • in response to pressure, collagen will produce electricity through the piezoelectric effect(15)
  • collagen in dilute solution "melts" at 40 degrees C; melting may enable the collagen fibers to better realign and hence increase conductivity(13)
  • bound water surrounding collagen fibers can serve as a vehicle for proton-jump conduction(13)
  • proton-jump conduction is much faster than conduction of electrical signals by the nerves(13)
  • the conductivity of collagen increases strongly with the amount of water absorbed(13)

From the experience of Tandem Point therapy, we know that

  • patient hydration is critical: patients will not get a good result if they are dehydrated or if they have just finished a long plane flight
  • patients need to drink water throughout a session, or trigger point release will slow down and stop
  • patients who drink water while trigger and tandem points are being held experience a much faster release of the trigger point [this phenomenon has reproducibly occurred during my experience of Rolfing(TM) and microcurrent therapy as well]
  • electrolyte-deficient patients obtain suboptimal results
  • points will not release when patients hold their breath
  • immediately after an effective tandem point is pressed, there will be jump in the amplitude of the pulsation in the trigger point
  • heat is frequently generated in trigger points and tandem points as trigger points release

The common experience of heat is particularly intriguing. Especially when a release involves a muscle in severe contracture, the clinician will feel heat in the trigger point and the tandem points. Some patients will notice the heat release when a trigger point releases quickly. Patients describe heat releases as a "hot flash," a "flush," a "flow of heat." Sometimes patients will report that a heat release will be felt all over the body, sometimes in the face, sometimes on one-half of the body, sometimes in "rivers" flowing up and down from the trigger point. This quantity of heat seems in excess of what might be expected from just the piezoelectric effect. The often-reproduced experience of heat during Tandem Point therapy suggests that there is excess energy in a trigger point and frequently that energy is released as heat when a trigger point is released.

[Question: That is consistent with the qi model, right? Answer: Yes.]

Also, Travell and Simons write about factors that perpetuate myofascial trigger points: "In patients with chronic myofascial pain, attention to perpetuating factors often spells the difference between successful and failed therapy." Perpetuating factors include mechanical stresses, nutritional inadequacies, and metabolic and endocrine inadequacies.(14)

The experience of Tandem Point therapy has shown me that the 5000-year-old Chinese medical description of energy circulation has clinical validity. The research of Becker and others convinces me that this energy is electrical in nature. I have come to believe that a blockage in an acupuncture channel containing a myofascial trigger point is a perpetuating factor for the trigger point. Where a blockage exists, it is much more difficult to release the trigger point, and the referred pain seems to recur more quickly. In practice, when a trigger point is not releasing quickly, I seek out the blockage in the acupuncture channel, and when that blockage has been released, the trigger point will release. You will observe next week that Mark Seem also releases blockages in the relevant channels, even those distant from the trigger point in question.

It appears that some of the body's electrical energy circulates along connective tissue, along fascia, and that more energy circulates where fascia is thickest, along lines of strain in the human body. Tom Myers, a Rolfing educator and author, writes and teaches about what he calls "anatomy trains" or "myofascial meridians," which are lines of strain in the body following chains of muscle and fascia, and therefore collagen.(16) What immediately jumped out of his entirely western analysis was that his three most superficial lines of strain correspond quite closely with the three major external channels of Chinese medicine, the Stomach, Gall Bladder, and Bladder, which Tandem Point therapy uses most frequently. His analysis provides some additional justification for looking at the routes of meridians along collagen fibers.

I theorize that the critical factor in the perpetuation of a trigger point is its storage of excess electrical energy, and unless that energy is dispersed, the trigger point will not release. I theorize that this electrical disturbance prevents the entrance of water, ions, and oxygen into the trigger point. Perhaps muscle filaments require water, electrolytes, and oxygen to achieve full length and smooth function, and without the water, electrolytes, and oxygen, the filaments maintain a contraction knot, and the surrounding collagen fibers remain "kinked."

Insertion of a single needle may serve to disperse electrical energy along the needle. Simultaneous insertion of multiple needles may additionally serve to stimulate energy circulation. Acupressure to a single point may stress the point via the piezoelectric effect and lead to some slow, local dispersal of energy.

But multiple-point acupressure has great advantages. With acupressure to two points, a clinician can use the piezoelectric effect to stimulate energy movement along a circuit, to disperse or balance electrical energy between the two points. Recall that like trigger points, acupuncture points are electrically different from their surrounding tissue. If there is an electrical potential between a trigger point and an acupuncture point and an unblocked pathway between those points, then pressure to the two points seems to allow the electrical energy in the two points to equalize.

Based on the importance of hydration to Tandem Point therapy, it appears that the pathway of the circuit is bound water surrounding collagen molecules and that the electrical potential between two points is eliminated by the flow of protons along that bound water. Recall that proton flow along bound water is extremely fast, faster than electrical flow along neurons. This speed seems to coincide with the virtually immediate jump in the pulsation of a trigger point when a tandem point is stimulated. But the full release of the trigger point usually takes at least ten seconds longer, sometimes more than a minute, suggesting that some particles much larger than protons are more slowly migrating into the trigger point, namely water molecules and electrolytes (my thanks to James Oschman for this suggestion).

Recall that patient breathing is also critical to the success of Tandem Point therapy and that Simons found an oxygen deficiency in trigger points. Again, it appears that the resolution of a trigger point requires water, electrolytes, and oxygen.

Acupressure may be a better approach than needle treatments because the heat created by the pressure and the heat released during in trigger point release, combined with the patient stretching through the trigger point, allow collagen to melt and then lengthen at the precise location of a myofascial restriction. An acupressure approach allows a clinician to work on a muscle while it is in a stretched position, therefore the clinician can locate and address muscle restrictions that are not apparent when the muscle is shortened. Acupressure allows a clinician to address a dozen restrictions in one muscle in five minutes. And acupressure allows a clinician to release trigger points in a dozen muscles, agonists and antagonists, all in one session.

Acupressure has disadvantages, too. It is stressful to the hands of the clinician. It requires more direct attention on the part of the clinician, so that the clinician can treat fewer patients in a set time period with acupressure than acupuncture, for example. It requires outstanding palpation skills. It is inappropriate for the weak or ill patient.

If the theory above is correct, then it is likely that what improves patient results in acupressure therapy also would improve patient results for other muscle therapy modalities. Practitioners of acupuncture, physical therapy, massage, or Rolfing(TM), or even orthopedic surgeons, might encourage their patients to breathe deeply, to drink more water and consume more electrolytes before treatment and discourage them from scheduling appointments after an airplane flight.



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