He who treats the site of pain is lost.
– Karel Lewit
Treat area and system, not the points.
– Yun-tao Ma
As a sports medicine physician I was always intrigued by the complexity of the human body and this has led me into a lifelong journey. As a clinician with a busy practice it is always a challenge to find the solutions for those in need (our patients) and still to stay motivated to learn more, while at the same time not to be skin-deep with your knowledge, sharpen your skills, but the main thing, from my point of view is to keep the child’s attitude to life-curiosity.
Athletes are very conscious about their bodies-their main tool for the challenges of professional career, life and victory. People who are active in sports are often also very active in their social and business lives. In these cases, the physician’s situation becomes tricky due to a number of factors. such individuals have no time for full treatment. There is no place for the treatment strategy known in the medical profession as ex juvantibus–— meaning that what works tells you what’s wrong. especially during the competition season, there is no time for second attempts. If your initial treatment fails, these patients will never approach you again.
so as a doctor you have to understand pathology, functional anatomy, some of the biomechanics, diet and even more important—how to stay healthy, while pushing the body to the limits. To quote Philip Maffetone: health is the optimal interplay of the organs. I like this expression, which is very simple, easy to comprehend and yet so complex. My search for answers first led me to Prague, Czech school of Manual Medicine. It was a blessing to learn the art of manipulative therapy under guidance of Jan Vacek (one of the best manipulators in Czech republic) and later to pass the last instructors course taught by world famous teachers, the grands of manual medicine, Prof. Karel Lewit (1916-2014) and Prof. Vladimir Janda (1928-2002). Later, I studied original german school of biological medicine-homotoxicology. still it was not enough. The needling therapy or acupuncture was always somewhere in my brainstem. still to grasp the rational core of the complex philosophical background for my medically trained brain was a bit complicated. Too many questions not a lot of logical answers. Oriental wisdom says that when a student is ready, a teacher appears. so when I found myself among the students in Dr Yun-tao Ma’s integrative dry needling course, I thought I was dreaming. Here I got my answers, but as well new questions. As already stated by many that biomedicalization of the old needling art opens new possibilities for curious medical practitioners. The universality of Integrative dry needling lies in the fact that the same method can treat and prevent the same soft tissue pain or dysfunction. The systemic approach is needed for both physiologic and biomechanic balance.
statistics say that almost 85 percent of everyday pain and disability are caused by soft tissue pathology. Many clinicians will agree that today the functional pathology became very complex. As I say no more textbook cases and no more straight forward or shortcut solutions. We sit too much, often push our bodies into horrible postures, and our diet inadequate. static strain is disastrous for us. even in the gym we continue to sit and in doing so we disrespect the need for proper movement. Our exercises routinely train not the whole body, but focus on single joints or muscles. so it is of paramount importance to stress proper movement, but not fitness or performance. Let’s remember golden words of gray cook—first move well, then move often. Because of the complexity of our body when we treat locally, let’s think
globally-such an understanding is of major importance especially when dealing with the chronic injuries and complex pathologies. It is my personal opinion that a simplified concept based on myofascial chains (Vleeming et al. 1995, Myers 2001) prevails in the field of sports medicine. It can not be overemphasized that for really complex approaches practitioners have to use interactions of the three systems for chain reactions: articular, muscular, neurological (Page et al. 2010). so current knowledge of the importance of developmental kinesiology (Vojta 1992, Kolar 2006), movement pattern analysis (Janda 1979) and other causes of chain reactions such as dysfunction of the diaphragm, system of the deep stabilizers (Lewit 2010) ought to be incorporated into the treatment protocols.
The successful practice of any kind of reflex therapy (manipulative therapy, needling therapies etc) heavily depends on precise diagnosis. clinical (orthodox) diagnosis is only part of the picture, to practice any kind of the needling therapy with maximum efficacy one needs to know how to shape up and complement it with functional (working) diagnosis. even in treatment of the chronic internal diseases it may be important, so there is a need to stress it once more. Therapists need to bear in mind those active fields of disturbance (e.g. scars, foci of chronic inflammation (tonsillitis, tooth problems and etc. (B. strittmatter)) may ruin even well planned therapy. even more so when treating pain in locomotor system. If we rely only on instrumental methods of investigation (as often is seen now), diagnosis and treatment of locomotor system will have disturbing vagueness. Medical imaging methods are more useful for differential diagnostic purposes. so it is about our ability to examine the moving parts of the body and their interrelations.
Function and its disturbances are rarely confined to one site or structure, therefore diagnosis must con- sider the locomotor system as a whole (K. Lewit, 1999). It is paramount to remember that the body always reacts as a complex structure. recognition of those clinical entities will dictate different, but much more effective approach when using dry needling therapy. It is useful to remember that inflammation never will be local, because of the immune system reactions and the interactions of the extracellular matrix (A. Pischinger). dr. Yun-tao Ma has developed very unique systematic understanding and approach in dry needling techniques. His approach seems simple, but is very complex, so it is my opinion that the modern term of simplexity will perfectly stand for the core. We have to realize that gaining and analyzing the empirical facts and scientific evidence, we are taking the needling method from a point to an area and to the system. This new book brings us deeper understanding of how dry needling works, and why area and system, but not the point? The reader will find an explanation of the mechanisms how needling reduces the inflammation through re-balancing between vasodilation and vasoconstriction. In 19th century dr. Alexander Zalmanov wrote his remarkable “secrets and wisdom of the human body” (1958), “Miracle of Life” (1960) and “Thousand ways to recover” (1965) ,where he stressed the importance of capillary therapy. so with this new work of dr Yun-tao Ma in our hands we will rediscover the importance of the pathology of microcirculation in soft tissue pain and dysfunction. From this viewpoint of microcirculation, when we treat soft tissue, we treat the area to restore the healthy balance of the microcirculation of the area, not the point. Our method is to needle the area, and point is just part of it. The concept of central sensitization is explained from the clinical viewpoint. All local pain, if it becomes chronic, causes both central sensitization and more peripheral sensitization. so the systemic needling method to de-sensitize the peripheral nervous system is recommended as the treatment. We treat the system, not just needle a few points.
Because of the sound principles of the neurophysiology this text is based on, many searching curious medical minds will be tempted to try it on their own. The understanding and techniques are still evolving, so there is a very exciting yet challenging road in front of us. We have to evolve as an art based on science, realizing limitations of trendy now-a-days evidence based medicine approach. For me, dry needling in treatment is as versatile as kettle bells in fitness. needling provides a foundation for further procedure of physical medicine. After needling, all the manipulation and movement therapies will be more efficient.
As practitioner and clinician I am perfectly aware of the complexity of the topic and my limitations of knowledge, so with trembling hands and excitement in my eyes I am ready to immerse myself into
this new book.
Our journey has just started.
– Dalius Barcauscas, , Lithuanian Olympic team Chief Physician (and eternal student)