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

Techniques for deactivating trigger points

Recall that a major cause of myofascial pain is one or more trigger points in the muscle. A trigger point can (a) shorten and or (b) weaken the muscle. A trigger point usually lies within a taut band of a muscle, which prevents the muscle from achieving full length. Achieving full muscle length is key to the release of a trigger point.

How would you measure the success of any technique in deactivating a trigger point? The patient should have

  • full range of motion
  • no pain

There are many approaches to deactivating, or eliminating, trigger points and their associated taut bands. These include:

Needle techniques

  • injection (Travell recommended 0.5% procaine in physiological saline)
  • dry needling (inserting an acupuncture needle into a trigger point)

Cooling techniques

  • spray and stretch (now often ice and stretch)

Pressure techniques

  • myotherapy, also called trigger point therapy (seven-second acupressure to the trigger point, followed by stretching, popularized by Bonnie Prudden)
  • neuromuscular therapy (repeated acupressure to the trigger point, followed by stretching)
  • myofascial release (acupressure to one point in a taut band or one end of a taut band plus stretching)
  • soft tissue release (acupressure to a series of points in a taut band plus stretching)
  • trigger point pressure release (gentle acupressure along the taut band and the trigger point, recommended in the most recent volume of Myofascial Pain and Dysfunction)
  • deep tissue massage, including cross-fiber friction
  • percussion and stretch (tap the trigger point slowly with a mallet, 10 times, then stretch).
  • Tandem Point therapy (acupressure to a trigger point, plus acupressure to another trigger point in the taut band or to a point in a pain referral pattern, plus acupressure to an acupuncture point, plus stretching)

Contraction and Release techniques

  • postisometric relaxation (contracting the tense muscle isometrically against resistance and then encouraging it to lengthen during a period of relaxation)
  • reciprocal inhibition (the muscles that oppose the muscle being stretched are voluntarily contracted; this technique is frequently incorporated in Tandem Point therapy)
  • muscle energy techniques (voluntary muscle contractions by the patient against a specific counterforce provided by the clinician)
  • strain-counterstrain (holding a muscle in a position of greatest comfort for a period of 90 seconds; one Tandem Point student combines strain-counterstrain with Tandem Point therapy)



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