Rhomboid Pain Relief: Are Trigger Points Necessary? Put The Myofascial Bible to The Test

Travell JG' et al's books on TrPs & Pain is the bible in mysofasical world, which claims TrPs (or MTrPs) cause and are central to the myofascial pain. So there came “trigger point therapy”. But under scientific testing, such a therapy has advanced to nowhere in the last 80 years since the term "trigger points" was coined in 1940s.

Are TrPs necessary? Jay Shah, a senior physiatrist in the NIH Clinical Center, among many critical thinkers, questioned the 80 years old tenet (Shah J et al, 2015).

The Answer to The Question

The answer is “hidden” in an ancient healing art – the acupuncture practiced 2000 years ago in China - Neijing acupuncture, which works for pain (not limited to myofascial pain) like a magic bullet: precisely shut down the pain at any spot on the body, with instant effect at 95% certainty, no MtrPs whatsoever as defined in the said bible involved.

Put the Bible to The Test: Rhomboid Pain As A Case

The bible claims at least 3 TrPs are related to rhomboid pain, which are located in rhomboid muscle close to the medial border of scapula bone. If indeed “TrPs cause and are central to the myofascial pain”, then we can anticipate that the intervention not targeting any of these 3 MTrPs will not work, or work very poorly for rhomboid pain.

The Design of The Test

We will treat rhomboid pain by avoiding doing anything which may cause a stimulus to any of the 3 TrPs in rhomboid muscle. If the test can effectively relieve rhomboid pain consistently and reliably, we should be able to conclude that the bible book MTrPs are not necessary for treatment of rhomboid pain.

Different Types of Rhomboid Pain

Rhomboid pain is the pain located at the medial border of scapula bone roughly at the level of thoracic vertebrae T3 to T6. Each patient may have different rhomboid pain depending on the precise location of the pain along the medial border of scapula bone: It may be at the level of T3, T4, … or T6. Or the pain area is big which spreads from T1 to T6, or covers any combination such as T1 + T2, T1 + T2 + T3, T2 + T3, ….

Practically, we can divide the area where rhomboid pain may happen into 4 sub-regions (A, B, C and D) as show in Figure 2.

Body Regions Containing Magic Points for Rhomboid Pain

In Neijing acupuncture, there are no “one size fit all” precisely-defined points for any specific health condition. Instead, the most effective points are identified case by case for each specific location of pain or other health conditions.

For each specific rhomboid pain, namely, T3 level pain, T4 level pain, …. until T6 level pain, there are at least hundred body regions far away from rhomboid muscle where you can identify some points which, once pricked or poked by a needle, a lancet, a toothpick, a finger, or even a car key, can produce a pain relieving effect for rhomboid pain, to different effects on a continuum (0.1% to 100%).

Among these 100ish body regions, there are at least 8 where you can find points which are magically powerful for rhomboid pain relief. Upon a needle insertion into any one of these points, patients will feel instant improvement (> 50% pain reduction) within 5 seconds at 95% of certainty.

Note, within 5 seconds at 95% of certainty! But not within weeks, months or years at merely 17 % to 20ish % of certainty (placebo effect or slightly better than placebo) when patients are treated with TrP-guided dry needling or TrP-guided Ischemic compression therapies (as shown in thousands of RCTs in the last few decades).

So, you have at least 8 powerful optional body regions to treat each specific rhomboid pain. If the 1st you tried does not completely erase the pain, you can add a needle to the 2nd optional region. If some pain still remains, you can add the 3rd option, and so on and on. Keep going this way, you can knock out the rhomboid pain completely in less than 10 minutes. Note, less than 10 minutes! Not less than weeks, months, or even years!

How Many Sessions Required

Depending on the severity and/or chronicity of the initial condition, the pain may come back in a few days or a few weeks. For a moderate rhomboid pain which has been there for 1 to 2 years, 4 to 10 sessions at twice per week would eliminate the pain permanently. If the rhomboid pain is job-related, such as sitting hunched at computer for too long every day, continuing maintenance at once or twice per month may be required.

No Fixed Magic Points Exist

The points for needle insertion are inserted far away from rhomboid muscle. So the magic effect from these points has nothing to do with the 3 bible book TrPs which are located in rhomboid muscle.

Where are the magic points for rhomboid pain located? They are located at least in 8 regions on 4 limbs. One region at forearm is shown in Figure 3 below.

Note the precise location of the points for needle insertion in each region changes with every patient. “One size fits all” precisely-defined points like those in TCM acupuncture textbooks do not exist for rhomboid pain (actually for any pain or any health conditions).

A magically powerful point for rhomboid pain can only be identified on a case by case basis with palpation (slowly but firmly & gradually apply pressure against the skin with the tip of your thumb or an item like a cotton swab). You can image the size of a magic point is the size of a nocieptor terminal (1 mm2).

Note, if patients have multiple health conditions, the pressure points you see under your palpation may not be necessarily related to rhomboid pain. They may indicate different health conditions. In the case of forearm as an optional region, the pressure pain there can also indicate leg pain, abdominal condition, or neck condition, or head issues ..... In such cases, you need to rule out other possibilities first. With your experience of using Huangdi Neijing acupuncture growing, your ability of ruling out the irrelevant and pin down the relevant will also grow.

As a reader of this post, if you do not want to spend 10 years in building up your own experience but prefer being "spoon fed" for every thing, wait for my on-coming e-tutorial and e-Book on "Everything about A Magic Bullet for Rhomboid Pain").

Science Goes Nowhere on Blind Beliefs

“Science is the belief in the ignorance of experts…” (Richard Feynman, Quantum Physicist). Science does not move forward if we blindly accept everything of what we see, hear or read (including this post). Instead, we need to keep thinking, testing and retesting.

In this info-swamping era, always be skeptic. Do your test & re-test on what this post is telling you.

References

Shah JP et al, PM R. 2015 Jul;7(7):746-761.

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