Trigger point

From Wikipedia, the free encyclopedia

Jump to: navigation, search

Not to be confused with the "Tender points", used for fibromyalgia diagnosis..

This article may require cleanup to meet Wikipedia's quality standards. Please improve this article if you can. The talk page may contain suggestions. (August 2009)

Trigger points or trigger sites are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. [1] Trigger point practitioners believe that palpable nodules are small contraction knots[ambiguous] and a common cause of pain. Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response. The local twitch response is not the same as a muscle spasm. This is because a muscle spasm refers to the entire muscle contracting whereas the local twitch response also refers to the entire muscle but only involves a small twitch, no contraction.

The trigger point model states that unexplained pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from the trigger point itself. Practitioners claim to have identified reliable referred pain patterns, allowing practitioners to associate pain in one location with trigger points elsewhere. Many practitioners of chiropractic and massage therapy find the model useful, but the medical community at large has not embraced trigger point therapy. There is no consistent methodology for diagnosis of trigger points and a dearth of theory to explain how they arise and why they produce specific patterns of referred pain.[2]

Contents

[hide]

1 Definition

2 Myofascial pain syndrome

3 Qualities of trigger points

o 3.1 Diagnosis of trigger points

o 3.2 Misdiagnosis of pain

o 3.3 Demonstration and identification of myofascial trigger points

4 Treatment

o 4.1 Injection

o 4.2 Self-treatment

o 4.3 Risks

5 History

o 5.1 Janet G. Travell, MD

6 See also

7 References

8 External links

[edit] Definition

The term "trigger point" was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:

Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.

The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.

Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.

The pain cannot be explained by findings on neurological examination.

Practitioners do not necessarily agree on what constitutes a trigger point.

A study by Gerwin et al. found that independent examiners were generally able to identify myofascial trigger points (MTrP), but only with sufficient training and agreement on the definition and features of MTrP's. They said:

Three previous studies (Nice et al., 1992; Wolfe et al., 1992; Njoo and Van der Does, 1994) have examined this problem, and none of them could establish the reliability of MTrP examination in all of its major manifestations. ... The present study shows that four examiners can achieve statistically significant agreement, at times almost perfect agreement, about the presence or absence of five major features of the MTrP and on the presence or absence of the TrP, whether it be latent or active. This establishes the MTrP as a reliable clinical sign. The present study also shows that these features are identified with greater or lesser reliability depending on the specific feature and the specific muscle being examined. ... A training period was found to be essential in order to achieve these results.[3]

A 2007 review of diagnostic criteria used in studies of trigger points concluded that

there is as yet limited consensus on case definition in respect of MTrP pain syndrome. Further research is needed to test the reliability and validity of diagnostic criteria. Until reliable diagnostic criteria have been established, there is a need for greater transparency in research papers on how a case of MTrP pain syndrome is defined, and claims for effective interventions in treating the condition should be viewed with caution.[2]

[edit] Myofascial pain syndrome

The main innovation of Travell's work was the introduction of the myofascial pain syndrome concept (myofascial referring to the combination of muscle and fascia). This is described as a focal hyperirritability in muscle that can strongly modulate central nervous system functions. Travell and followers distinguish this from fibromyalgia, which is characterized by widespread pain and tenderness and is described as a central augmentation of nociception giving rise to deep tissue tenderness that includes muscles. Studies estimate that in 75–95 percent of cases, myofascial pain is a primary cause of regional pain. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimeters in diameter, found at multiple sites in a muscle and the fascia of muscle tissue. Biopsy tests found that trigger points were hyperirritable and electrically active muscle spindles in general muscle tissue.[4]

[edit] Qualities of trigger points

Trigger points have a number of qualities. They may be classified as potential, active/latent and also as key/satellites and primary/secondary.

There are a few more than 620 potential trigger points possible in human muscles. These trigger points, when they become active or latent, show up in the same places in muscles in every person. That is, trigger point maps can be made that are accurate for everyone.

An active trigger point is one that actively refers pain either locally or to another location (most trigger points refer pain elsewhere in the body along nerve pathways). A latent trigger point is one that exists, but does not yet refer pain actively, but may do so when pressure or strain is applied to the myoskeletal structure containing the trigger point. Latent trigger points can influence muscle activation patterns, which can result in poorer muscle coordination and balance. Active and latent trigger points are also known as "Yipe" points, for obvious reasons.

A key trigger point is one that has a pain referral pattern along a nerve pathway that activates a latent trigger point on the pathway, or creates it. A satellite trigger point is one which is activated by a key trigger point. Successfully treating the key trigger point often will resolve the satellite and return it from being active to latent, or completely treating it too.

In contrast, a primary trigger point in many cases will biomechanically activate a secondary trigger point in another structure. Treating the primary trigger point does not treat the secondary trigger point.

Activation of trigger points may be caused by a number of factors, including acute or chronic muscle overload, activation by other trigger points (key/satellite, primary/secondary), disease, psychological

distress (via systemic inflammation), homeostatic imbalances, direct trauma to the region, accident trauma (such as a car accident which stresses many muscles and causes instant trigger points) radiculopathy, infections and health issues such as smoking.

Trigger points form only in muscles. They form as a local contraction in a small number of muscle fibers in a larger muscle or muscle bundle. These in turn can pull on tendons and ligaments associated with the muscle and can cause pain deep within a joint where there are no muscles. When muscle fibers contract, they use biochemical energy, and these depleted biochemicals become fatigue toxins such as lactic acid. The tightened muscle fibers constrict capillaries and prevent them from carrying off the fatigue toxins to the body's recycling system (liver and kidneys)[citation needed] . The buildup of these toxins in a muscle bundle or muscle feels like a tight muscle -- a slippery elongate bundle.

When trigger points are present in muscles there is often pain and weakness in the associated structures. These pain patterns in muscles follow specific nerve pathways and have been readily mapped to allow for identification of the causative pain factor. Many trigger points have pain patterns that overlap, and some create reciprocal cyclic relationships that need to be treated extensively to remove them.

[edit] Diagnosis of trigger points

Trigger points are diagnosed by examining signs, symptoms, pain patterns and manual palpation. A 2009 review of nine studies examining the reliability of trigger point diagnosis found that physical examination could not be recommended as reliable for the diagnosis of trigger points.[5]

Usually there is a taut band in muscles containing trigger points, and a hard nodule can be felt. Often a twitch response can be felt in the muscle by running your finger perpendicular to the muscle's direction; this twitch response often activates the "all or nothing" response in a muscle that causes it to contract. Pressing on an affected muscle can often refer pain. Clusters of trigger points are not uncommon in some of the larger muscles, such as the gluteus group (gluteus maximus, gluteus medius, and gluteus minimus). Often there is a heat differential in the local area of a trigger point, and many practitioners can sense that. In 2007, a paper was presented describing images of trigger points taken by modified MRI.[6]

[edit] Misdiagnosis of pain

The misdiagnosis of pain is the most important issue taken up by Travell and Simons. Referred pain from trigger points mimics the symptoms of a very long list of common maladies, but physicians, in weighing all the possible causes for a given condition, rarely consider a myofascial source. The study of trigger points has not historically been part of medical education. Travell and Simons hold that most of the common everyday pain is caused by myofascial trigger points and that ignorance of that basic concept could inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain.[7]

[edit] Demonstration and identification of myofascial trigger points

A 2008 review in Archives of Physical Medicine and Rehabilitation of two recent studies concludes they present groundbreaking findings that can reduce some of the controversy surrounding the cause and identification of myofascial trigger points (MTPs). The study by Chen on the use of magnetic resonance elastography (MRE) imaging of the taut band of an MTP in an upper trapezius muscle may present a convincing demonstration of the cause of MTP symptoms. MRE is a modification of existing magnetic resonance imaging equipment to image stress produced by adjacent tissues with different degrees of tension. This report presents an MRE image of the taut band that shows the V-shaped signature of the increased tension compared with surrounding tissues. [8] Results were all consistent with the concept that taut bands are detectable and quantifiable with MRE imaging. The findings in the subjects suggest that the stiffness of the taut bands in patients with myofascial pain may be 50% greater than that of the surrounding muscle tissue. The findings suggest that MRE can quantitate asymmetries in muscle tone that could previously only be identified subjectively by examination.[6]

In the study by Shah and associates, they have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. With this technique, they have been able to investigate the biochemical milieu of muscle in subjects with active, latent, or absent myofascial trigger points (MTrPs) and to contrast this with that of the noninvolved muscle. [9]

In a June 2000 review, Chang-Zern Hong correlates the MTrP "tender points" to accupunctural "ah shi" ("Oh Yes!") points, and the "local twitch response" to acupuncture's "de qi" ("needle sensation"),[10] based on a 1977 paper by Melzack et al.[11] Peter Dorsher comments on a strong correlation between the locations of trigger points and classical acupuncture points, finding that 92% of the 255 trigger points correspond to acupuncture points, including 79.5% with similar pain indications.[12][13]

[edit] Treatment

Myofascial Trigger Point therapists may use myotherapy (deep pressure as in Bonnie Prudden's approach, massage or tapotement as in Dr. Griner's approach), mechanical vibration, pulsed ultrasound, electrostimulation [14] , ischemic compression, injection (see below), dry-needling, "spray-and-stretch" using a cooling (vapocoolant) spray, Low Level Laser Therapy and stretching techniques that invoke reciprocal inhibition within the musculoskeletal system. Practitioners use elbows, feet or various tools to direct pressure directly upon the trigger point, to save their hands.

A successful treatment protocol relies on identifying trigger points, resolving them and, if all trigger points have been deactivated, elongating the structures affected along their natural range of motion and length. In the case of muscles, which is where most treatment occurs, this involves stretching the muscle using combinations of passive, active, active isolated (AIS), muscle energy techniques (MET), and proprioceptive neuromuscular facilitation (PNF) stretching to be effective. Fascia surrounding muscles should also be treated, possibly with myofascial release, to elongate and resolve strain patterns, otherwise muscles will simply be returned to positions where trigger points are likely to re-develop.

The results of manual therapy are related to the skill level of the therapist. If trigger points are pressed too short a time, they may activate or remain active; if pressed too long or hard, they may be irritated or the muscle may be bruised, resulting in pain in the area treated. This bruising may last for a 1–3 days

after treatment, and may feel like, but is not similar to, delayed onset muscle soreness (DOMS), the pain felt days after overexerting muscles. Pain is also common after a massage if the practitioner uses pressure on unnoticed latent or active trigger points, or is not skilled in myofascial trigger point therapy.

Evidence based medicine researchers concluded as of 2001 that evidence for the usefulness of trigger points in the diagnosis of fibromyalgia is thin.[15] More recently, an association has been made between fibromyalgia tender points and active trigger points.[16][17]

[edit] Injection

Injections, including saline, local anesthetics such as procaine hydrochloride (Novocain), steroids, and botulinum toxin provide more immediate relief and can be effective when other methods fail. A low concentration, short acting local anesthetic such as procaine 0.5% without steroids or adrenalin is recommended. High concentrations or long acting local anesthetics as well as epinephrine can cause muscle necrosis, while use of steroids can cause tissue damage. Dry needling can be just as effective but causes more post-injection soreness. Botulinum toxin is rarely indicated.[1]

Despite the concerns about long acting agents[1], a mixture of lidocaine and marcaine is often used.[18] A mixture of 1 part 2% lidocaine with 3 parts 0.5% bupivacaine (trade name:Marcaine) provides 0.5% lidocaine and 0.375% bupivacaine. This has the advantages of immediate anesthesia with lidocaine during injection to minimize injection pain while providing a longer duration of action with a lowered concentration of bupivacaine.

Health insurance companies in the US such as Blue Cross, Medica, and HealthPartners began covering trigger point injections in 2005.

[edit] Self-treatment

There are a number of ways to self-treat trigger points and these methods are described in numerous texts. Underlying any attempts at self-treatment should be a working knowledge of the area to be treated, especially with regard to the musculature, nerves, glands and vessels.

[edit] Risks

Treatment, whether by self or by a professional, has some inherent dangers. It may lead to damage of soft tissue and other organs. The trigger points in the upper quadratus lumborum, for instance, are very close to the kidneys and poorly administered treatment (particularly injections) may lead to kidney damage. Likewise, treating the masseter muscle may damage the salivary glands superficial to this muscle. Furthermore, some experts believe trigger points may develop as a protective measure against unstable joints.

[edit] History

Trigger points have been a subject of study by a small number of doctors for several decades although this has not become part of mainstream medicine. The existence of tender areas and zones of

induration in muscles has been recognized in medicine for many years and was described as muscular rheumatism or fibrositis in English; German terms included myogelose and myalgie. However, there was little agreement about what they meant. Important work was carried out by J. H. Kellgren at University College Hospital, London, in the 1930s and, independently, by Michael Gutstein in Berlin and Michael Kelly in Australia.[19] The latter two workers continued to publish into the 1950s and 1960s. Kellgren conducted experiments in which he injected hypertonic saline into healthy volunteers and showed that this gave rise to zones of referred extremity pain.

Today, much treatment of trigger points and their pain complexes are handled by myofascial trigger point therapists, massage therapists, physical therapists, osteopaths, occupational therapists, myotherapists, Certified Athletic Trainer some naturopaths, chiropractors, dentists and acupuncturists, and other hands-on somatic practitioners who have had experience or training in the field of neuromuscular therapy (NMT).

[edit] Janet G. Travell, MD

It was, however, an American physician, Janet G. Travell, who was responsible for the most detailed and important work. Her work treating US President John F. Kennedy's back pain was so successful that she was asked to be the first female Personal Physician to the President.[20] She published more than 40 papers between 1942 and 1990 and in 1983 the first volume of The Trigger Point Manual appeared; this was followed by the second volume in 1992. In her later years Travell collaborated extensively with her colleague David Simons. A third edition is has been published by Simons and his wife, both of whom have survived Travell.

The trigger point concept remains unknown to most doctors and is not generally taught in medical school curricula. Among physicians, typically only physiatrists (physicians specializing in physical medicine and rehabilitation) are well versed in trigger point diagnosis and therapy. Other health professionals, such as physiotherapists, osteopaths, chiropractors, massage therapists and structural integrators are generally more aware of these ideas and many of them make use of trigger points in their clinical work[21][22].

Travell and Simons' seminal work on the subject, Myofascial Pain and Dysfunction: The Trigger Point Manual[1], states the following:

Around 75% of pain clinic patients have a trigger point as the sole source of their pain.

Arthritis is often cited as the cause for pain even though pain is not always concomitant with arthritis. The real culprit may be a trigger point, normally activated by a certain activity involving the muscles used in the motion, by chronically bad posture, bad mechanics, repetitive motion, structural deficiencies such as a lower limb length inequality or a small hemipelvis, or nutritional deficiencies.

The following conditions are also frequently misdiagnosed as the cause of pain when trigger points are the true cause: carpal tunnel syndrome, bursitis, tendinitis, angina pectoris, and sciatic symptoms, along with many other pain problems.

[edit] See also

Pressure point

[edit] References

This article includes a list of references, related reading or external links, but its sources remain unclear because it lacks inline citations. Please improve this article by introducing more precise citations where appropriate. (May 2009)

1. ^ a b c d Travell, Janet; Simons David; Simons Lois (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual (2 vol. set, 2nd Ed.). USA: Lippincott Williams & Williams. ISBN 0-683-08363-5.

2. ^ a b Tough EA, White AR, Richards S, Campbell J (March–April 2007). "Variability of criteria used to diagnose myofascial trigger point pain syndrome–evidence from a review of the literature". Clin J Pain 23 (3): 278–86. doi:10.1097/AJP.0b013e31802fda7c. PMID 17314589.

3. ̂ Gerwin RD, Shannon S, Hong CZ, Hubbard D, Gevirtz R (Jan 1997). "Interrater reliability in myofascial trigger point examination". Pain 69 (1–2): 65–73. doi:10.1016/S0304-3959(96)03248-4. PMID 9060014.

4. ̂ Jantos M (June 2007). "Understanding chronic pelvic pain". Pelviperineology 26 (2). ISSN 1973–4913. OCLC 263367710. http://www.pelviperineology.org/practical/chronic_pelvic_pain.html. Full open-access article

5. ̂ Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N (2009 Jan). "Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature". Clin J Pain 25 (1): 80–9. doi:10.1097/AJP.0b013e31817e13b6. PMID 19158550.

6. ^ a b Chen Q, Bensamoun S, Basford JR, Thompson JM, An KN (December 2007). "Identification and quantification of myofascial taut bands with magnetic resonance elastography". Archives of Physical Medicine and Rehabilitation 88 (12): 1658–61. doi:10.1016/j.apmr.2007.07.020. PMID 18047882. http://www.med.nyu.edu/pmr/residency/resources/general%20MSK%20and%20Pain/MRE%20and%20trigger%20points.pdf.

7. ̂ Davies Clair, Davies Amber (2004). The trigger point therapy workbook : your self-treatment guide for pain relief (2nd ed.). Oakland, California: New Harbinger Publications. p. 323. ISBN 9781572243750.

8. ̂ Simons DG (2008). "New views of myofascial trigger points: etiology and diagnosis". Archives of Physical Medicine and Rehabilitation 89 (1): 157–9. doi:10.1016/j.apmr.2007.11.016. PMID 18164347.

9. ̂ Shah JP, Danoff JV, Desai MJ, et al. (2008). "Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points". Archives of Physical Medicine and Rehabilitation 89 (1): 16–23. doi:10.1016/j.apmr.2007.10.018. PMID 18164325.

10. ̂ Hong CZ (June 2000). "Myofascial trigger points: pathophysiology and correlation with acupuncture points". Acupunct Med 18 (1): 41–47. doi:10.1136/aim.18.1.41. }}

11. ̂ Melzack R, Stillwell DM, Fox EJ (February 1977). "Trigger points and acupuncture points for pain: correlations and implications". Pain 3 (1): 3–23. PMID 69288. http://www.medaku.com/images/TRIGGERPOINTS_MELZACK.pdf.

12. ̂ Dorsher PT (May 2006). "Trigger points and acupuncture points: anatomic and clinical correlations". Medical Acupuncture 17 (3). http://www.medicalacupuncture.org/aama_marf/journal/vol17_3/article_3.html.

13. ̂ Dorsher PT (July 2009). "Myofascial referred-pain data provide physiologic evidence of acupuncture meridians". J Pain 10 (7): 723–31. doi:10.1016/j.jpain.2008.12.010. PMID 19409857.

14. ̂ Hsueh TC, Cheng PT, Kuan TS, Hong CZ (November–December 1997). "The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points". American Journal of Physical Medicine & Rehabilitation 76 (6): 471–6. doi:10.1097/00002060-199711000-00007. PMID 9431265. http://www.amjphysmedrehab.com/pt/re/ajpmr/abstract.00002060-199711000-00007.htm.

15. ̂ "Fibromyalgia: diagnosis and treatment". Bandolier (90). August 2001. ISSN 1353-9906. http://www.medicine.ox.ac.uk/bandolier/band90/b90-2.html.

16. ̂ Ge HY, Nie H, Madeleine P, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L (2009-12-15). "Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome". Pain 147 (1-3): 233–40. doi:10.1016/j.pain.2009.09.019. PMID 19819074.

17. ̂ Brezinschek HP (2008 December). "[Mechanisms of muscle pain : significance of trigger points and tender points]" (in German). Z Rheumatol 67 (8): 653–4, 656–7. doi:10.1007/s00393-008-0353-y. PMID 19015861.

18. ̂ "Trigger point injection". Non-Surgical Orthopaedic & Spine Center. October 2006. Archived from the original on 2006-10-26.

http://web.archive.org/web/20061026111155/http://www.lowbackpain.com/trigger.html. Retrieved 2007-04-07.

19. ̂ Wilson VP (2003). "Janet G. Travell, MD: A Daughter's Recollection". Tex Heart Inst J 30 (1): 8–12. PMID 12638664.

20. ̂ Bagg JE (2003). "The President's physician". Tex Heart Inst J 30 (1): 1–2. PMID 12638662.

21. ̂ Alvarez DJ, Rockwell PG (February 2002). "Trigger points: diagnosis and management". Am Fam Physician 65 (4): 653–60. PMID 11871683. http://www.aafp.org/afp/20020215/653.html.

22. ̂ Dynamic Chiropractic

[edit] External links

Trigger Point Pain Guide

Referred Pain Symptom Guide

Trigger Point Maps & Charts

Retrieved from "http://en.wikipedia.org/wiki/Trigger_point"

Categories: Soft tissue disorders | Injuries | Massage therapy

Hidden categories: Wikipedia articles needing cleanup from August 2009 | All articles needing cleanup | All pages needing cleanup | All articles with unsourced statements | Articles with unsourced statements from March 2010 | Articles lacking in-text citations from May 2009 | All articles lacking in-text citations

Personal tools

Log in / create account

Namespaces

Article

Discussion

Variants

Views

Read

Edit

View history

Actions

Search

Navigation

Main page

Contents

Featured content

Current events

Random article

Donate to Wikipedia

Interaction

Help

About Wikipedia

Community portal

Recent changes

Contact Wikipedia

Toolbox

What links here

Related changes

Upload file

Special pages

Permanent link

Cite this page

Print/export

Special:Search

Search

Create a book

Download as PDF

Printable version

Languages

Deutsch

فارسی

日本語

Svenska

中文

This page was last modified on 12 February 2011 at 05:09.

Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. See Terms of Use for details.Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.

Contact us

Privacy policy

About Wikipedia

Disclaimers

B est m atches f or t rigger p oint t herapy

M any p ractitioners o f c hiropractic a nd m assage t herapy f ind

t he m odel u seful, b ut t he m edical c ommunity a t l arge h

as n ot e mbraced t rigger p oint t herapy. J ump t o t ext »

Pressure pointFrom Wikipedia, the free encyclopediaJump to: navigation, search For other uses, see Pressure point (disambiguation).

This article has multiple issues. Please help improve it or discuss these issues on the talk page.

It is missing citations or footnotes. Please help improve it by adding inline citations. Tagged since February 2009.

It may contain original research or unverifiable claims. Tagged since February 2009.

Pressure point (穴位)

Chinese name

Chinese 穴位

[show]Transliterations

Japanese name

Kanji 急所

Kana きゅうしょ

[show]Transliterations

A pressure point (Japanese: kyūsho 急所 "vital point, tender spot";[1] Chinese: 穴位; Malayalam marmam) in the field of martial arts refers to an area on the human body that may produce significant pain or other effects when manipulated in a specific manner. Techniques of attacks on pressure points are called, Hyol Do Bup (Hangul: 혈도법; 穴道法) in Korean martial arts, such as Hapkido, Sin Moo Hapkido, Han Mu Do, and kyūsho-jutsu (Japanese: きゅうしょじゅつ) in various styles of Japanese martial arts, such as Jujutsu, Aikido, Tenjin Shinyō-ryū, Daitō-ryū Aiki-jūjutsu, Kotō-ryū, Gōjū-ryū, Sekiguchi-ryū, Yōshin-ryū, Kuma-ryū, Kōga-ryū and Karate.

The concept of pressure points is present in old school (17th century) Japanese martial arts and is claimed to have an even earlier history; in a 1942 article in the Shin Budo magazine, Takuma Hisa Sensei asserted the existence of a tradition attributing the first development of pressure-point attacks to Shinra Saburō Minamoto no Yoshimitsu (1045–1127).[2]

Hancock and Higashi (1905) published a book which pointed out a number of vital points in Japanese martial arts.[3]

Exaggerated accounts of pressure-point fighting have appeared in Chinese Wuxia fiction, and became known by the name of Dim Mak or "Death Touch" in western popular culture from the 1960s. One of the best known uses of pressure-point fighting was known to Trekkies as the "Vulcan nerve pinch." While it is undisputed that there are sensitive points on the human body where even comparatively weak pressure may induce significant pain or serious injury, the association of kyūsho with esotericist notions of qi, acupuncture or reflexology is controversial.[4]

Contents

[hide]

1 Types o 1.1 Pain o 1.2 Blood and blood pressure o 1.3 Break o 1.4 Hyper-extension o 1.5 Concussion o 1.6 Energy

2 See also 3 References

Types

The nervous system more or less follows the Chinese meridians.

There are several types of pressure points - each is applied differently and each creates a different effect. "Pain points", for example, use tendons, ligaments, and muscles - the goal to temporarily immobilize the target, or at the very least to distract them. Reflex points produce involuntary movements, for example causing the hand to release its grip, the knees to buckle, or the target to gag, or even for the person to be knocked unconscious.[5] Most pressure points are located on pathways on the nervous system.

Pain

Some pressure points produce pain when struck, pressed, or rubbed depending on the point itself. These are also referred to as nerve centers. While the distraction of pain might offer sufficient advantage in a fight or escape, additionally the body has a Pain withdrawal reflex whereby it reacts to pain by moving away from the source.[6] Martial artists can make use of this through minimal effort.[7] Applying pressure to the collar bone from above will cause the subject to move downwards, whereas poking them upwards in the gap between the ear and neck will make their body want to move upwards. Pressure to the shoulder causes that side of the body to move back. A jab to the abdomen in the middle of the stomach will cause some people to twist around, away from the pain. A rapid impact - say from an elbow or fist - to the solar plexus can easily knock all the air straight out of a victim, leaving them gasping for air and unable to move. Some points react more violently to pain from changes in the pressure (rubbing) rather than constant pressure. Applying pressure to the nose or temple will also cause significant pain. Some other of these

pressure points are: eyes, ears, throat, elbow joint, wrist, back of hand, collar bone, solar plexus, ribs, between shoulder blades, kidneys, groin, upper inner thigh, knee, shin, instep and Achilles tendon.

Blood and blood pressure

The baroreceptors in the carotid artery are pressure-sensitive, supplying the brain with information to control systemic blood pressure. Pressure against this region will send signals which indicate that blood pressure is too high and lead to a lowering of blood pressure.[8] Therefore striking this area can cause unconsciousness using the same mechanism, also relying on the force being transmitted to the reticular activating system.[9]

Break

There are certain areas which are likely to lead to a break if struck properly, such as the "floating ribs", the philtrum, and the side of the knee.

Hyper-extension

There are joints that when struck, can be hyper-extended and even tear. This is a technique which can cause permanent damage to one's opponent. There are two types:

Brute force: This takes advantage of the vulnerability of the strike point, usually a joint, thereby causing the damage.

Golgi organs : A relatively gentle strike to the Golgi tendon at the back of the elbow, for example, triggers a reflex which immediately relaxes that tendon allowing the elbow to bend more easily in the wrong direction. If this is immediately followed by a solid strike to the elbow joint, the elbow can be broken with significantly less effort than through brute force.

Concussion

The brain is a sensitive organ which floats in a fluid (cerebrospinal fluid). This safety mechanism allows the head to take substantial impact without resulting in concussion, but can still cause permanent brain damage. However, according to some[which?] martial arts, a blow can be delivered using techniques in a way that effectively eliminates such protections, thus causing disorientation or instantaneous knockout. The most commonly taught technique involves a strike just below the occipital ridge, at the correct angle in the correct direction. Another well known point with this effect is the chin or lower jaw, giving rise to the boxing expression: a "glass jaw".[10] The same effect of knocking somebody unconscious may be achieved by using the edge of the hand (palm-up) to apply a sharp strike to the carotid artery.

Energy

Further information: Dim Mak and George Dillman

Some believe there are energy channels (acupuncture meridians) which allow Qi (life-force) to flow through the body. Acupuncture is the best known use of the meridian system. Traditional Chinese medicine practices are largely based on the idea that meridians are specific pathway lines in the human body, along which are found many hundreds of acupressure points. There is no physically verifiable anatomical or histological basis for the existence of Qi, acupuncture points or meridians.[4][11]

According to these theories, attacks will impact the flow of Qi, and thus the body. Therefore pressing, seizing or striking these points with specific intent and at certain angles is believed to cause either a heightening or diminishing of Qi circulation in the body. Arts such as Bak Mei and Bok Foo Pai utilize this strategy almost exclusively in combat.[citation needed]

See also

Chin na Marmam

References

1. ̂ Andrew Nathaniel Nelson, The Original Modern Reader's Japanese-English Character Dictionary, Tuttle Publishing, 2004, p.399. [1]

2. ̂ Takuma Hisa Sensei, Shin Budo magazine, November 1942. republished as Hisa, Takuma (Summer 1990). "Daito-Ryu Aiki Budo". Aiki News 85. http://www.aikidojournal.com/article.php?articleID=497. Retrieved 2007-07-18. "Yoshimitsu [...] dissected corpses brought back from wars in order to explore human anatomy and mastered a decisive counter-technique as well as discovering lethal atemi. Yoshimitsu then mastered a technique for killing with a single blow. Through such great efforts, he mastered the essence of aiki and discovered the secret techniques of Aiki Budo. Therefore, Yoshimitsu is the person who is credited with being the founder of the original school of Daito-ryu."

3. ̂ Hancock, H. Irving and Higashi, Katsukuma, The complete Kano Jiu-Jitsu (Judo), New York, G. P. Putnam & Sons, 1905.

4. ^ a b Felix Mann: "...acupuncture points are no more real than the black spots that a drunkard sees in front of his eyes." (Mann F. Reinventing Acupuncture: A New Concept of Ancient Medicine. Butterworth Heinemann, London, 1996,14.), quoted by Matthew Bauer in Chinese Medicine Times, vol 1 issue 4, Aug. 2006, "The Final Days of Traditional Beliefs? - Part One"

5. ̂ Types of pressure points used in martial arts from Pressthepoint.com[unreliable source?]

6. ̂ "nociceptive withdrawal reflex"7. ̂ Pain & Pain Withdrawal Reflexes8. ̂ A medical view of dim-mak[unreliable source?]

9. ̂ The Complete Book of Light Force Knockouts by Bruce Miller10. ̂ Boxing and the Glass Jaw11. ̂ NIH Consensus Development Program (November 3–5, 1997). "Acupuncture --Consensus

Development Conference Statement". National Institutes of Health. http://consensus.nih.gov/1997/1997Acupuncture107html.htm. Retrieved 2007-07-17.

[hide]v · d · e Hapkido Origin Korean martial arts · Daitō-ryū Aiki-jūjutsu · Jujutsu · Yusul

StylesCombat Hapkido · GongKwon Yusul · Hankido · Hapki yusul · Shinsei Hapkido · Sin Moo Hapkido · Hapki Kochido Musool

InnovatorsChoi Yong-Sool · Seo Bok-Seob · Ji Han-Jae · Kim Moo-Hong · Han Bong-soo · Myung Jae-Nam · Myung Kwang-Sik · Hwang In-Shik · Kim Yoon-Sang · Oh Se-Lim

Organizations

Korea Hapkido Federation · International H.K.D Federation · International H.K.D Games · Jaenam Musul Won Foundation

RelatedAiki · Aikido · Tang Soo Do · Kong Soo Do · Han Mu Do · Hankumdo · Kuk Sool Won · Pressure point · Acupressure · Hyol Do Bup

Practitioners

Retrieved from "http://en.wikipedia.org/wiki/Pressure_point"Categories: Martial art techniques | Martial arts termsHidden categories: All articles lacking reliable references | Articles lacking reliable references from July 2009 | Articles with unsourced statements from February 2009 | All articles with unsourced statements | Articles that may contain original research from February 2009 | Articles containing Chinese language text | Articles containing Japanese language text | Articles containing non-English language text | Articles containing Korean language text | All articles with specifically marked weasel-worded phrases | Articles with specifically marked weasel-worded phrases from August 2010 | Articles with unsourced statements from October 2008

Personal tools

Log in / create account

Namespaces

Article Discussion

Variants

Views

Read View source View history

Actions

Search

Navigation

Special:Search

Search

Main page Contents Featured content Current events Random article Donate to Wikipedia

Interaction

Help About Wikipedia Community portal Recent changes Contact Wikipedia

Toolbox

What links here Related changes Upload file Special pages Permanent link Cite this page

Print/export

Create a book Download as PDF Printable version

Languages

Deutsch Français עברית

This page was last modified on 14 February 2011 at 21:55. Text is available under the Creative Commons Attribution-ShareAlike License;

additional terms may apply. See Terms of Use for details.Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.

Contact us

Privacy policy About Wikipedia Disclaimers