As a physical therapist for seven years, I've treated my share of repetitive strain injuries. These injuries often have accompanying referral patterns due to trigger points. To disengage myofascial constraints, I've used several physical therapy techniques, including sustained stretching, coolant sprays, deep massage, heat, e-stim, ultrasound, laser, neuromuscular re-education, therapeutic exercise and stabilization training.

But after attending the three-year masters' program at Tri-State College of Acupuncture (TSCA) in New York, I learned that acupuncture can be a useful treatment adjunct. Not only is it less labor-intensive for practitioners than some other treatments, it's also a more precise and direct way of treating patients because it treats the cause of their problems, instead of manifested physical or emotional symptoms. The patient also generally reports a significant reduction in pain, numbness, postural strain and most commonly a sense of relaxation after their treatment.

TSCA's curriculum includes three acupuncture styles: Traditional Chinese Medicine (TCM); Japanese Acupuncture; and Acupuncture Physical Medicine (APM), which is unique to the TSCA curriculum. Mark Seem, PhD, director and founder of TSCA, developed the APM style, which emphasizes trigger point de-activation by following twitch responses and referral patterns. Japanese Acupuncture and this APM style blend the best with practitioners' adept palpation skills, making these disciplines easy for physical therapists to grasp.

Students' third-year TSCA clinical experience focuses on validating and de-constraining individual "holding patterns." These are unique, dysfunctional patterns that manifest in either a patient's soma (i.e., physical pain symptoms) or psyche (i.e., depression, anxiety). After clearly identifying patients' pattern(s), practitioners insert needles along meridian pathways directly into specific acu-points or into trigger points to teach the body to reconfigure and gain homeostasis.

Carrying these skills over to the clinic, I invited one of my PT patients with chronic cervical radiculopathic pain to experience acupuncture. She presented with upper trapezius tightness, a forward head posture, thoracic kyphosis with radiating pain, numbness along her ulnar nerve distribution, and muscular weakness that affected her dominant upper extremity and hand functions. Her symptoms worsened when she carried her pocketbook, and she also woke up each night with "dead arm."

During treatment, I isolated significant myofascial bands along muscular trigger point areas and recreated their referral sensation. Through specific palpation techniques, I first trapped the trigger points in the muscle. I then inserted needles with the intention of creating fasciculations that travel the path of the pain pattern.

While undergoing treatment, the patient reported feeling as if a warm liquid were pouring down her arm into her finger tips. This indicated that the needles were freeing up her adhesions and allowing energy, blood and fluids to flow correctly.

When she returned to the PT clinic a week later, she reported that her numbness and pain were gone. She also was sleeping soundly through the night without any symptoms of "dead arm." She even reported an increase in arm and hand proprioceptive control and increased finger dexterity.

I put her on a program that included cervical stabilization and postural re-education, with an emphasis on strengthening the agonists and lengthening the antagonists. At discharge, she presented with no pain or numbness, full function of her upper extremities, postural re-alignment and a balanced trunk.

Training a system to undo what it's been doing for years is challenging.

It becomes imperative to facilitate a neuromuscular, pro­prioceptive and length/tension balance to prevent the return of facial restrictions.

Using acupuncture with physical therapy can help clinicians to achieve this goal. These two approaches are perfect adjuncts to one another in the realm of pain control, myofascial release and rehabilitation.

Bianca Sermier, MS, LAc, PT, practices acupuncture and physical therapy at Sacred Space Acupuncture in New York.