SECTION I
Needle manipulation: After insertion of the needle through the skin, the needle can be move in certain ways to elicit specific physiological and mechanical response.
4 types of needle manipulation
- Pistoning
- Fishing
- Needle rotation
- Periosteal pecking
Pistoning
Back and forth movement of the needle after insertion. Promotes healing, provides A delta stimulation.
The ECF is full of ions and the needle insertion creates ionic redistribution. The insertion of the needle causes a minute injury to the epithelium.
Injury potentials are generated and can persist and provide electrical stimulation for days until the miniature wound heals1.
The injury potentials are known to accelerate healing by creating galvanotaxis (polarity directed cell migration) along with a host of other biochemical events.
Fishing
Changing directions to reach different dysfunctional motor end plates. Care must be taken to avoid using the needle direction abruptly or the needle will bend.
When the needle is inserted directly to the trigger point, in the vicinity of dysfunctional motor end plate, a small muscle contraction is obtained, which is called Local Twitch Response (LTR). With fishing the chances of obtaining local twitch response increases. LTRs normalize the chemical environment of active MTrPs and diminish endplate noise associated with trigger point instantaneously5.
Needle rotation
Once the needle is inserted through the skin to the target tissue, the needle can be rotated clockwise and anticlockwise. It has been found that needle manipulation produces winding and gathering of collagen around the needle.
Within minutes of needle rotation pulling of collagen toward the needle induces an active cellular response in connective tissue fibroblasts up to several centimeters away from the needle2. This transduction of the mechanical signal into fibroblasts can lead to a wide variety of cellular and extracellular events leading to neuromodulation and healing3.
Periosteal pecking
In case of chronic inflammatory condition especially in the junction of periosteum and ligament/tendon, to accelerate the healing response an acute inflammation is created by ‘Pecking’ that is, tapping the needle on the bony area multiple times after insertion. The resulting acute inflammation brings forth healing.
References
1.Gunn C. Chan, Acupuncture and the Peripheral Nervous System A Radiculopathy Model
2.Helene M et al, Connective Tissue Fibroblast Response to Acupuncture: Dose Dependent Effect of Bidirectional Needle Rotation, J Altern Complement Med. 2007 April ; 13(3): 355–360.
3.Langevin HM et al. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: Evidence for a mechanotransduction-based mechanism. J Cell Physiol 2006;207:767-774
4.Simons DG, Hong CZ, Simons LS. Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil 2002;81(3):212-22.
5.Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 2005;99:1980-1987.
SECTION II
SECTION III
SECTION III
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