The present article discusses a specific approach to treating microtrauma using distal needling. Microtrauma is defined as a musculoskeletal or joint pain pattern that does not involve severe structural damage.
Research supports the effectiveness of selecting the distal acupuncture points for the treatment of microtrauma and for relieving pain, particularly in cases of chronic shoulder pain.1 In my experience, however, this relief is often short-lived because the pain frequently shows a deeper functional problem: impaired ability of some muscles to produce a clean, reliable contraction when the movement demands it.2
To make the treatment results long-lasting, clinical experience and research suggest that instead of treating the most painful structure first, we identify the inhibited driver, restore reliable recruitment, confirm it with immediate re-testing, and only then address the painful area as a branch of a deeper pattern.
Distal needling, also known as yuǎn dào cì, 远道刺, has been recognized as a reliable acupuncture strategy for as long as acupuncture has been recorded. Chapter 9 of the Ling Shu says: “When the disease is on the upper part, the acupoints down be picked, when the disease is on the lower part, the acupoints on the upper can be pricked, when the disease is on the loins, the acupoints on the popliteal fossa can be pricked.”3
Some styles of acupuncture that specialize in distal needling focus entirely on identifying the acupuncture channels that traverse the area of pain and on selecting distal points to treat them. It is a powerful technique because anyone who has experienced it will attest that pain disappears, or at least reduces significantly, as soon as the needles are inserted.
However, symptom-guided treatment works, up to a point. Distal needling typically alleviates symptoms very effectively, sometimes even dramatically, which is one reason many practitioners use it as the default response for microtrauma. Yet the same clinical story repeats: The patient feels better on the table, but then the pain returns as soon as he/she loads the system in the same way that created the problem.
In my experience, recurrence is most common in the treatment of shoulder, elbow, foot, and wrist pain. This happens because the main issue is not the irritated tissue, but a motor pattern that the nervous system keeps protecting: guarding that limits a vulnerable plane, substitution that steals work from the intended prime mover or stabilizer, and load-shift that gradually overloads the wrong tissues.
This article proposes a functional sequence that fits that reality. Instead of chasing the most painful structure first, we identify the inhibited driver, restore reliable recruitment, confirm it with immediate re-testing, and only then address the painful area as a branch of a deeper pattern.
Microtrauma often unfolds as a self-protective loop that looks like an extremely obvious excess on the surface – pain and guarding, and a quiet deficiency underneath: inefficient muscular contractility.4 In biomedical terms, repeated strain, trauma, inflammation, and psychosomatic load can steadily degrade the reliability of muscle contraction on demand by desensitizing the muscle spindles, the tiny sensory receptors inside skeletal muscle that detect muscle length and how fast that length is changing, then signal the nervous system to regulate tone together with reflexive contraction.
Desensitization of muscle spindles leads to a lack of voluntary muscle contraction. When this happens, the nervous system limits access to the vulnerable range by inhibiting the prime mover or stabilizer, and increasing tone in synergists or antagonists, so the person feels ‘tightness’ and compensates, even though the limiting factor is impaired activation of the muscle that should own that position.
In this context, the restricted range of motion is not a pathology but a protective strategy that occurs when one or more muscles cannot produce an efficient contraction in the joint positions they are meant to control. However, this combination of inhibition and protective contraction causes imbalance in movement and inevitably leads to strain and wear elsewhere in the body.
Clinically, this phenomenon has three distinct aspects. First is the symptom: pain felt in a muscle, joint or connective tissue, the stressed tissue that has been overloaded by imbalance and overcompensation. Second is the compensation pattern, in which synergists or antagonists tighten to restrict joint movement and create stability through limitation. Third is the inhibited muscle or muscles, the true functional deficit, because they do not contract on demand.
Crucially, the area of pain is often not the same as the joint range that is restricted, and the inhibition may sit in a different region from the symptom. One of the most dramatic observations: Medial and lateral epicondylitis frequently trace back to inhibited recruitment of some shoulder muscles, even when the elbow is where the pain announces itself.
One current example from my clinic: A 45-year-old female, a dedicated marathon runner, presented with the chief complaint of gripping hamstring pain and tightness. The pain started some eight months ago. She experienced gripping hamstring pain that worsened with running and prolonged sitting. At the time of our initial interview, she had stopped running because of the pain. Instead, she was engaged in strength training and yoga, hoping to strengthen her core and stretch her tight hamstrings. She also regularly used deep-tissue massage to release hamstring tightness, but it only provided temporary relief.
The initial session revealed her pain traveled along the posterior thigh, the tai yang region. Additionally, she demonstrated a severe inhibition of hip flexion and external rotation on the affected side. Surprisingly, her gluteus maximus was inhibited as well despite the strength training. It has become apparent that she used the hamstrings as the main driver of hip extension and as a guard against active hip flexion. Of all the muscles, the hardest one was to restore the function of the m. iliacus.
In terms of acupuncture meridians, the m. iliacus is traversed by the Foot Yangming, Foot Taiyin Spleen, and Foot Jueyin Liver channels. Acupuncture point selection: LI 4, St 36, LI 11, Sp 6, GB 34, and especially Lv 3, all needled on the opposite side. Notice that none of these points corresponds to the Foot Tai Yang Bladder channel, the domain of the hamstrings.
The above-mentioned point selection proved to be very effective at activating the contractile abilities of m Iliacus. This method of needling was especially advantageous because it allowed re-testing of muscle tonicity with the needles in place.
Presently, this client has returned to running and is running for 30 minutes on the track per day with no apparent hamstring tightness. We continue our weekly acupuncture sessions during which I monitor for and restore muscle inhibition as this client continues to improve.
Editor’s Note: Part 2 of this web exclusive (June issue) presents a six-step assessment-to-treatment workflow.
References
- Zhang H, Sun J, Wang C, et al. Randomised controlled trial of contralateral manual acupuncture for the relief of chronic shoulder pain. Acupunct Med, 2016;34(3):164-170.
- Day JM, Bush H, Nitz AJ, Uhl TL. Scapular muscle performance in individuals with lateral epicondylalgia. J Orthop Sports Phys Ther, 2015;45(5):414-424.
- Yellow Emperor’s Canon of Internal Medicine: Ling Shu, Chapter 9. Beijing, China: Science & Technology Press, 1997: p. 552.
- Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol, 1991 May;69(5):683-94.
