You've probably heard about the boy who wrote" The Equator is a menagerie lion running around the Earth". Well, I have crossed the Equator several times and not seen a lion, or a line, for that matter. But that is not to say it does not exist. Lines of latitude and longitude are not visible on the Earth's surface either, but they are useful when navigating. Meridians are notional lines connecting acupuncture points on the body. Critics of acupuncture sometimes claim that meridians do not exist because they cannot be demonstrated when dissecting a cadaver the way nerves and blood vessels can be. They are functional, not structural. Acupuncture points can be identified by differences in electrical resistance of the skin compared to surrounding areas. Trigger points cannot be be demonstrated in a cadaver either, as they disappear on death. 

Possessing a curious mind and a strong desire to make sense of the differences between Eastern and Western medicine, I appreciated the work of various Western-trained physicians who have demonstrated that many acupuncture points correlate well with known anatomical structures such as motor end-points (where nerves stimulate muscles), sites were nerves pierce fascia - where the nerves can be constricted by shearing forces, or where they exit through openings in bones. About 75% of the most common trigger points are also acupuncture points. The classical tender points required for a diagnosis of fibromyalgia are also acupuncture points. 

Fascia is the thick white firm connective tissue which separates muscles, surrounds the brain and nerves, envelopes the organs and delineates the different compartments in the body. Recently I re-read (it was that good!) a fascinating book: The Spark in the Machine - How the Science of Acupuncture Explains the Mysteries of Western Medicine by Dr Daniel Keown. Dr Keown is an emergency room physician and acupuncturist in the UK who relates a number of successful case reports of acupuncture treatment in the ER.  But the most interesting aspect of the book is how he shows how acupuncture meridians correlate with the embryological development of different anatomical structures in the body, particularly fascial lines. East meets West in embryology. 

When bringing up Eastern medical concepts among medical colleagues one sometimes feels as though one is entering tiger country. Perhaps some latitude could be given to different ways of approaching the same human condition. 

Pain Neutralization Technique (PNT) refers to a group of treatments developed by an acupuncturist/chiropractor in Denver, Dr Stephen Kaufman, for the treatment of a variety of painful conditions. They are simple, painless, effective and safe and do not involve medications or injections. No need for needles! 

Most of the techniques can be explained through understanding how muscular trigger points can be swiftly released by specific pressure points and stretches. No painful deep tissue massage is involved. A few techniques are best understood according to Chinese Medicine concepts. 

After a standard examination of function and range of movement the therapist examines the muscles and soft tissues for tenderness.  The most basic technique involves first identifying a tender trigger point and then applying specific stretches across the muscle or neighbouring muscles which instantly switch off the pain. The release is held for 20 seconds to make it "stick". One then proceeds to the next tender point. Not everybody responds to this treatment but when they do, the technique can be incorporated into the physical examination in such a way that when the exam is completed the pain is gone and function is restored. The presence of muscular pain limits movement because the body tries to protect itself by tensing up. Normal movement is usually restored once the pain is relieved. 

Most people require several visits to prevent it from recurring, especially if they have habitual postures or activities which perpetuate the muscular pain or re-injure the tissue,  but occasionally one treatment is sufficient.

Here are a few examples of the many people who find this helpful:

• a lady came in with a stiff wrist and painful forearm after having her cast removed following treatment for a Colle's fracture of the wrist. I was concerned that a tight cast may have affected her circulation in her arm but when she was examined she was found to have tender muscles at several points in her forearm. PNT was applied to each tender point and within a few minutes her stiffness and pain were gone and her wrist movement had returned to normal. 
• a fit patient who works out regularly at the gym presented with low-back pain and pain across her shoulders. She could only bend her back a few inches and she had a lot of muscular tension in her shoulders. Each tender point was released, several PNT techniques were applied to her lower back and hip muscles, and a few minutes later she could put her hands flat on the floor when bending her back. 
• a lady fell at work on her outstretched hand and came in complaining of wrist pain. In fact, she had tender points in her wrist, forearm, upper arm and shoulder. PNT was applied systematically to each area  and her pain was gone by the end of the visit. 
• a gentleman came in with plantar fasciitis after a walking tour around Europe. He had tenderness in the sole of his foot, heel, and in his calf muscles. PNT was applied across the plantar fascia and calf muscles and his painful limp resolved. Most patients with this condition need trigger point injections, exercises and muscular stretches, or obtain expensive orthotics, but his was one of a number of instances in which PNT alone was sufficient. 

Clearly these techniques cannot cure serious diseases but myofascial pain often responds very quickly. We often start with PNT when treating muscular pain; if it is effective, then no other treatment may be needed. If not, then further testing and other options are available.