Myofascial Meridian Stimulation Therapy
Myofascial Meridian Stimulation Therapy
(MMST)
經筋動穴針法
Korean Integrative Medicine Institute
Dr. Seonghyung Cho, M.D.
Myofascial Meridian Stimulation Therapy
MMST(筋經動穴針法) History
통증 치료에 있어 “HOW”가 아니라 “WHY”라는 하나의 접근 법으로서
MMST(經筋動穴針法)를 저의 스승이신 김일환 M.D.선생님의 도움아래
고안하게 되었습니다.
MMST(經筋動穴針法)는 근골격계와 자율신경병에 기인한 만성 통증에
있어 Acupuncture가 왜 동양의학에서만 받아들여지고 서양의학에서는
쉽게 받아들여지지 않는가에 대한 의문점에서부터 출발하게 되었습니다.
그 이유는 Acupuncture의 과학적 기전이 완전히 밝혀지지 않았기 때문
이며 실제 임상에서 Acupuncture를 사용하는 시술자들에게도 그 효과
자체가 수수께끼로 남아있기 때문입니다.
하지만 서양의학적 시각에서 Acupuncture 자체가 동양 철학과 밀접하게
연결되있다는 것을 분명 간과해서는 안될 것으로 보입니다.
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Myofascial Meridian Stimulation Therapy
ICMART 2004, 호주 시드니 Main Session논문 발표
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Myofascial Meridian Stimulation Therapy
ICMART 2005, 체코 프라하 좌장 및 Full Time Workshop
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Myofascial Meridian Stimulation Therapy
MMST(經筋動穴針法) Introduction
Western medicine: Myofascial
Oriental medicine: Meridian
Integrative approach: Stimulation Therapy
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Myofascial Meridian Stimulation Therapy
Western medicine: Myofascial
Myofascia라는 개념은 근막통증증후군(MPS)의 발통점(Trigger
Point)과 연관된 근막(Myofascia)을 의미하는 것이 아니라 우리 몸
전체에 두루 퍼져있는 해부학적 근막선들(Myofascial lines)의 연결
을 뜻하는 것입니다.
이러한 근막선들의 네트워크를 통해 인체의 긴장통합체(Biotensegrity)와 분절성 신경 체계(Segmental Nervous System)를 유
지할 수 있는 것입니다.
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Myofascial Meridian Stimulation Therapy
Oriental medicine: Meridian
Meridian이라는 개념은 움직임이나 자세를 통해서 근육을 따라
인체에 퍼져있는 경락(Meridian lines)의 변화를 통해 유지되는
네트워크 체계를 의미하는 것입니다.
동양의학에서 사용되는 주관적이거나 비객관적인 진단 방법을 지
양하고 이러한 움직임을 통한 경락의 네트워크 체계를 이용하여
보다 객관적으로 진단하는 것입니다.
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Myofascial Meridian Stimulation Therapy
Integrative approach: Stimulation Therapy
Stimulation Therapy라는 개념은 근막선(Myofascial line)의 해부학
적 구조와 경락의 경로(Meridian pathway)간에 상호 연관성과 분절
성 신경 체계를 통해 선택된 경혈점(Meridian point)을 다음과 같은
방법으로 자극을 하는 것입니다.
Acupuncture, Dry needling, Injection, Magnetic therapy,
Subcutaneous taped acupuncture, Myofascial release.
MMST(經筋動穴針法)는 이와 같이 임상의의 치료범위나 선호도에 따
라 치료방법을 결정할 수 있습니다.
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T.P(Trigger Point or Treatment Point) on
the MMST
Segmental facilitation에 의해 야기된 stress는 muscle imbalance를 통해 인체의
tensegrity를 무너뜨리게 된다.
그리고 이러한 유해성 자극 부위와 연속적으로 연결된 kinetic chain (myofascial
line)에 가장 취약한 부위가 발생된다.
이러한 부위에서 referred pain이나 hypertonic muscle 그리고 sympathetic
dysfunction 등과 같은 비정상적인 증상이 일어나는데 이를 T.P.(Trigger Point or
Treatment Point)이라 한다.
MMST(筋經動穴針法)에서는 이러한 T.P.를 서양 의학적인 concept을 기초로 하여
선택된 meridian point를 이용하여 치료를 한다.
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MMST(經筋動穴針法) Introduction
“古爲今用”을 통해 MMST(經筋動穴針法)는 동양
의학과 서양의학에 있어 장점을 포용하고 단점을
보완하여 진단과 치료를 할 수 있는 동서양 의학
의 통합적 접근법(Integrative approach)으로 이
루어졌습니다.
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A prospective view of the western
medicine
Stephen M. Levin :
Bio-tensegrity(tension + integrity) model
Thomas W. Myers :
Anatomy of myofascial connections
Autonomic nervous system and its relation to
voluntary nervous system
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Tensegrity(Tension +Integrity)
model
Compressio
n element
Bicycle wheels and similar structures with
compression elements floating in a continuous
tension network have been termed
“tensegrity”structures by Buckminster Fuller.
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Continuous
tension
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Bio-tensegrity (Tensegrity Biomechanics)
proposed by Stephen M. Levin
CT
Myofascial
tension strut
Compressio
n element
Continuous
tension
LS
He asserted the bio-tensegrity model that
the human body structure is maintained
by bony frame embedded in myofascial
tension strut just as a bicycle wheel
structure is maintained by reciprocal
tension of strut
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Similarity of Tensegrity model between human
and other structures
Tension
Icosahedron
model
All human structures are similar
to a tension icosahedron model
because of they are formed of
triangular truss type.
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Tension
Icosahedron
model
Myofascial Meridian Stimulation Therapy
The kinetic chain concept of biomechanics
Secondary:
The weakest link on
remote area
Tissue lesion or dysfunction
in tensegrity structure
Weakest link in
The same kinetic chain
Same kinetic chain or
myofascial tension line
Strain or
Limitation
Primary:
tissue lesion
Symptoms:
local inflammation
and pain
As a result, Pain or Limitation
on movement
Owing to ceaseless connection of the whole myofascia, a disorder in one region may
be expressed in the form of pain and limitation on certain movement in other part of
body mainly in the same kinetic chain(myofascial tension line)
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Definition of Kinetic Chain
Three system: Myofascial, Articular, Neural system
Work as an integrated functional unit to provide
structural and functional efficiency during
integrated activities.
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Why Kinetic Chain is so important
in MMST?
Efficiency of Movement and Posture:
tensegrity and alignment of kinetic chain
Dysfunction of tensegrity and alignment in any kinetic chain:
compensatory reaction for maintaining the balance of
kinetic chain -> serial distorsion pattern of kinetic chain
Compensatory reaction(excess adaptive potency (flexibility,
force, neuromuscular control) on tissue): tissue failure and
overload -> cumulative injury cycle -> symptom and sign
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Cause of kinetic chain dysfunction
Postural dysfunction
Joint dysfunction
Muscle imbalance
Decreased neuromuscular control
Myofascial adhesion and shortness
Decreased core strength
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Dysfunction mechanism
Altered length-tension relationship (Reciprocal Inhibition)
Altered force couple relationship (Synergistic Dominance)
Altered arthrokinematic relationship (Joint Dysfunction)
Result of these relationship:
->Altered neuromuscular control
->Decreased neuromuscular efficiency
->Tissue fatigue and failure
->Cumulative Injury Cycle
->Pain and other signs and symptoms
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Importance of optimum posture
and alignment on the MMST
Help to prevent serial distorsion pattern
Help to provide optimal shock absorption
Help to provide weight acceptance and transfer of force
during functional movement
Help to prevent the initiation of the cumulative injury cycle
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Ideal alignment and Optimum movement
Ideal alignment -> facilitate optimum movement
Malalignment due to repeated movement and sustained posture > joint or surrounding support system에 micro-trauma 유발 가능
성이 증가 (ex:spinal segment-> degenerative change)
자동차의 wheel movement -> wheel balance and good alignment
for optimum rotation ->자동차와 지지면 사이에 있는 타이어가 균일
하게 마모
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Good postural alignment
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Hypothetical concepts of Connective
tissue injury
Piezo(pressure)-electric charge
Interference field
Electromagnetic field
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Piezo(Pressure)-Electric charge
All the tissue of the body generate electrical fields when they are
compressed or stretched
Mechanical force -> structural deformation -> piezo-electric effect
Muscles are under a constant strain. And also the strain creates a
piezo-electric charge that runs through the fascia within and around
the muscle
On the body surface, the electrical resistance of strained
point(acupuncture point) is lower than in its surrounding area.
Low resistance point: meridian point, strained point, myofascial
trigger point
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Segmental superficial dry needling’s
MTrP(strained point) pain-relieving mechanism
Insertion of needle into tissue immediately overlying active pain-producing MTrP
Stimulation of A-delta sensory afferents
Direct arousal of activity in dorsal horn-situated enkephalinergic inhibitory interneuron
PLUS
Indirect stimulation of these as a result of creation of activity in a serotonergic descending
inhibitory system
AND
The creation of activity in the descending nonadrenergic system
Blockade of intra-dorsal horn passage of MTrP’s nociceptive information
Alleviation of MTrP pain
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Interference Field on tissue strain
During an injury or other imbalance, the
membrane is broken or disrupted. The
electrolytes pass freely into or out of the
membrane and walls
- +-+ -+ -+ - +
+
+
+
Cell,nerves,muscles,
vessels,others
Normal membrane
Bio-electrical Potential
Damage
++ ++
+
- - - +
+- - +
Interference field of nerves,
cells, muscles,
vessels & others
Disruption of membrane reverses
normal Bio-electrical Potential –
Dysfunction, Pain and Energy loss
result
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Electromagnetic Field
Extra-cellular matrix synthesis and repair are subject to regulation
both by chemical agent(cytokines and GF) and physical
agents,principally mechanical and electrical stimuli.
In soft tissue, alternating current electrical fields induce redistribution
of integral cell membrane proteins which could initiate signal
transduction cascades and cause a reorganization of cytoskeletal
structures.
All physical and mental functions are controlled by electromagnetic
fields produced by movement of electro-chemicals within the body.
When an injury occurs and tissue is damaged, positively charged ion
move to affected area, causing pain and swelling.
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Characteristics of Connective tissue
As a result,
Piezo-electric charges, Interference fields and
Electromagntic fields in connective tissue
resulting from constant strains can occur pain
and dysfunction in the body.
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fascial consideration
Surrounding, supporting, separating, wrapping of the body
Be surrounded from sole to skull as one soft tissue structure
Function:
~innervated by many nerve ending
~elastically contraction & relaxation
~muscle attachment
~support & fix for balance
~all exercise
~blood & lymphatic circulation
~change earlier than chronic degenerative disease
~chronic passive tissue congestion
~tissue congestion(formation of fibrotic tissue) d/t H ion increase in the joint area
~stress band in overloading area
~burning nature pain d/t stress injury
~inflammatory action
~mediator:transport of the body fluid & inflammatory substance
~surround the CNS
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Myofascial line :
Recently, a model suggested by Thomas W. Myers in his book Anatomy Trains try
to explain this concept of the myofascial tension line anatomically and to integrate
with meridian concept of TCM
Myofascial
tension strut
Bio-Tensegrity
network system in the body that controls
structure of posture and movement.
Superficial back line
Superficial front line
Lateral line
Spiral line
Deep front arm line
Superficial front arm line
Deep back arm line
Superficial back arm line
Functional line
Deep front line
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Relation between myofascial connections and
the kinetic chain concept on tensegrity
Dysfunction due to total myofascial connections-> limitation of movement
Sensitive tender point -> pain on remote area (압통점을 못 움직이도록 고정시키기
때문에 오히려 그 긴장도가 멀리 말초까지 뻗치게 됨)
주된 장해부위로부터 사지를 움직이려 할 때에 조직의 tensegrity 구조물들은 어떤 강도
의 감소 없이 그대로 힘을 전달 받아 우리 신체는 외부의 역학적 영향상태에 놓이게 되
는 것이다. 또한 한쪽이 고정된 상태에서 완전 가동운동을 일으키려 시도하면 인체는
보상작용을 하게 마련이다.
As a result, dysfunction in excess movement -> repeated stress (local
inflammation and pain) -> 발통 물질 and biomechanical failure
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Dysfunction according to Muscle
imbalance on movement
Nociceptive stimuli -> postural muscles (tight:facilitated) & phasic
muscles(weak:inhibited)
chain reaction -> imbalanced pattern and movement dysfunction
hypoxia -> ischemic state -> pain -> continue feed-back cycyle ->
hyperactivty on neural stimulation -> imbalance and dysfunction
신체의 한 부위가 반복적이고 만성적인 스트레스를 받을 때, 그 부위에 신경
구조들은 overexcitable되어져 아주 쉽게 활성화되고 hyperirritable해지는 경
향이 있다. -> “facilitation”
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Segmental facilitation by I.Korr
Spinal segment: not independently
Principal of reciprocity
-when the threshold of the segment is reached, all neurons will fire.
The segment in lesion has a lower threshold and is hyperreflexive.
“lens” for afferent input collecting facilitatory or inhibitory
afferents from segment above and below.
occur at areas of focus for postural stress(muscle imbalance),
trigger point, visceral problem
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In sequence of Segmental facilitation
in disturbed lesioned segment
Facilitation of the sensory pathways -> easier access to the
nervous system including the higher centers
Facilitation of motor pathways -> sustained muscular tensions,
exaggerated responses, postural asymmetries and limited &
painful motion.
Since the muscles have rich sensory as well as motor innervation,
under these condition, they and related tendons, ligaments, joint
capsules may become the source of relative intense and
unbalanced streams of impulses.
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The characteristics of the facilitated segment
Roots are overly sensitive or hair-triggered
:hyperactive ventral motor root -> intervertebral foramen -> join the
sympathetic nerve chain -> in a state of chronic overactivity, result
in damage to target organ
Produce a palpable change in tissue texture
:local paravertebral muscle & connective tissues develop a shoddy
feel
:joints in the area are less mobile
:the tissues are tender to touch
:often painfully irritable
Sympathetic system dysfunction
:changes in skin texture, sweat gland activity & capillary blood supply
to the skin
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Pathway of Sensory information
:Transmit information to spinal cord through dorsal horn
via ascending fibers to higher centers
via intrasegmental fibers to the anterior
horn(somatic nervous system)
via intrasegmental fibers to the lateral
horn(autonomic nervous system)
Transmission of sensory information through dorsal horn is modulated by
descending stimuli of high level and intersegmental reflex.
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Gray matter of Spinal cord
Anterior(Ventral) Horn:
cell bodies of somatic efferent nerve fibers
Posterior(Dorsal) Horn:
cell bodies of interneurons upon which afferent(sensory) neurons
terminate
Intermediated gray(Lateral Horn in the thoracic segments):
cell bodies of autonomic(sympathetic) efferent nerve fibers
Gray commissure ---- connection of left and right
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Anatomy of Autonomic
nervous system
Parasympathetic nervous system is
divided into cranial outflow and sacral
outflow
In sympathetic nervous system, the axon of
the sympathetic preganglionic neurons leave
the spinal cord with the ventral roots of the
eighth cervical to the second lumbar spinal
nerves.
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Division of Autonomic lateral horn
Medial column is comprised in cell bodies of preganglionic
fibers toward internal organs
Middle column is comprised in cell bodies of preganglionic
fibers toward trunk
Lateral column is comprised in cell bodies of preganglionic
fibers toward head and extremities
Three columns are related to secondary segmental modulations
through various and numerous interneurons.
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Secondary segmental relation
The MMST uses lateral column of lateral horn toward head and extremities related to
secondary segmental modulation
Segmental innervation:
lateral horn에 sympathetic
nervous system의 anatomy
Interconnection to lateral column of lateral horn:
lateral horn의 preganglionic cell body가 efferent
outflow를 따라 머리와 사지로 가는 effector의 segment
C8/T1/T2
C1/C2
T2/T3/T4
C3/C4
T5/T6
C5/C6
T7/T8/T9
C7/C8
T10/T11
L3/L4
T12/L1/L2
L5/S1/S2
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Somato-Visceral Point
Secondary segmental relation
We can explain that SomatoVisceral Points (SVP) for treating abnormal
somatovisceral reflex use the anatomy of autonomic nervous system
through extremities and head and the secondary segmental relation.
For example, In C5/6 dermatome area pain,
T5/T6 – C5/C6 : secondary segmental relation
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SomatoVisceral Points (SVP)
consisted of UB meridian points on
surrounding C8-L2 dermatome
area.according to secondary
segmental relation
Sympathetic nervous
system: C8~L2
UB line
Secondary segmental relation
Segmental
innervation
Interconnection to
lateral column of lateral
horn
Magnetic therapy on UB line
SomatoVisceral Points (SVP) consisted of .
C8/T1/T2
C1/C2
T2/T3/T4
C3/C4
T5/T6
C5/C6
T7/T8/T9
C7/C8
T10/T11
L3/L4
T12/L1/L2
L5/S1/S2
(paraspinal dermatome area)
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Somato-Visceral Point
vasodilation (decrease sympathetic tone )
C5/6
Secondary segmental relation
T5
T6
Magnetic therapy on UB line
(paraspinal dermatome area) onT5-6
In the selection of points for treating abnormal somatovisceral reflex on common C5
segment area, we used magnetic therapy on UB meridian line of trunk related to anatomy of
sympathetic nervous system and secondary segmental relation (C5/6-T5/6) instead of
using acupuncture needle. SomatoVisceral Points (SVP) consisted of UB meridian points on
surrounding T5-6 dermatome area. In using acupuncture needle on T5-6 segment of UB
meridian line, the blood vessel tone was increased on C5-6segment area. But in using
magnetic therapy, we found the blood vessel tone was not increased in our clinical
observation.
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Magnetic Therapy
The application of magnetic field to injured area helps to
restore the normal electromagnetic balance.
The magnetic field relaxes capillary walls, as well as
surrounding muscle and connective tissues, allowing for
increased blood flow.
More oxygen and nutrients are transferred to the injury site,
while pain and inflammatory-related electro-chemicals are
more efficiently removed.
The overall process restores the normal electromagnetic
balance of the area, relieving pain and inflammation and
promoting accelerated healing.
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Segmental innervation
If nociceptive stimuli occur in a certain segment, these stimuli will influence same innervated
segment (dermatome, myotome, sclerotome and viscerotome). As a result, referred pains,
hypertonic muscles, activated trigger points, trophic changes and autonomic symptoms such as
vasomotor symptoms can occur.
Dermatome, myotome and sclerotome derived from the same somite
embryologically have the same nervous pathway and a referral
common afferent pathway.
Relation with sclerotome and dermatome:
Anterior and posterior surface of plevis attached to iliolumbar ligament
accord with L2 sclerotome. Also, Area of referred pains in iliolumbar
ligament accords with L2 dermatome.
Referred pain pattern by ligament laxity follows the pattern of
segmental dysfunction.
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Somato-Somatic Point
Area in accordance with dermatome,
myotome and sclerotome
Treatment points in the MMST for abnormal somatosomaic reflex use
common segment area in accordance with dermatome, myotome
and sclerotome.
For example, In C5/6 dermatome area pain
C5/6 segment
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Somato-Somatic Point
In the selection of points for
treating abnormal somatosomaic
reflex on left shoulder pain, we
applied SSP to common C5 segment
area (dermatome,myotome and
sclerotome). These points
consisted of LU2, LI15 and TE14.
Also, we stimulated these points by
deep dry needling
Combined area of
dermatome,myotome
and sclerotome on C5/6
Stimulate meridian points (combined area of
dermatome,myotome and sclerotome on C5/6) by deep
dry needling
LU2
TE14
LI15
Deep dry needlingKorean Integrative
Stimulate skin, muscle and periosteum in order
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SomatoSomatic Point (SSP)
LU2,LI15,
TE14
Common Shoulder pain
Common Back pain
LI11,LU5,
TE9
GB30,BL60
LR8,KI10
ST36,GB34,
BL53
Common Knee pain
Deep dry needling
(combined area of dermatome, myotome, sclerotome)
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Common Back pain:Lumbar pain with/without gluteal pain
Primary: TL junction
syndrome
1.Acute problem: occur
suddemly
Compensatory
reaction
Secondary: Pain on LS
junction by ligament laxity
3.Typical facet locking
1.Chronic problem: TL problem
이후에 occur
2.LS junction부위에 pain:
-compensatory movement
-gluteus muscle에 T.P.
-hypersensitivity of greater
trochanter (sometimes)
2.Iliac crest의 허리볼기 지
역에 pain: neurotrophic
change of cellulalgia
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ASIS
Common Knee pain
Cellulalgic zone
Q
Q increase:
external torsion of
the proximal tibia
VMO와 Medial retinaculum의
작용에 의해 alignment 유지
Tenoperiosteal
hypersensitivity
ROM is not limited: Knee pain originated from the spine (L3-4)
1.cellulalgic zone: L3-4 dermatome around the knee
2.T.P.: Quadriceps femoris (Vastus medialis oblique)
3.Tenoperiosteal hypersensitivity: pes anserinus area
Korean Integrative Medicine Institute
Myofascial Meridian Stimulation Therapy
Common Shoulder pain
Relationship between biomechanical overload and painful
joints associated with MPS and muscle imbalance
Painful
joint
Trigger
point
Shortened
muscle
Inhibited
muscle
Faulty
posture
Faulty
movement
pattern
Cervicocranial
SCM
Suboccipitalis
DNFs
Head
forward
Neck flexion
Glenohumeral
Upper
Trapezius
Levator
scapulae or
subscapularis
Lower
trapezius
Rounded
shoulder
Scapulohumeral
rhythm
Upper ribs
Scalenes
Pectoralis
Diaphragm
Slumped
posture
Respiration
TMJ
Lateral
pterygoids
Masseter
Digastrics
Chin poke
Mouth
opening
Korean Integrative Medicine Institute
Myofascial Meridian Stimulation Therapy
Injection Site: Facet joint & ligament
UB line
TL junction problem
transitional zone
Knee pain originated from
the spine(L3-4)
GV line
LS junction problem:
ligament laxity
Korean Integrative Medicine Institute
Posterior primary
ramus의 medial
branch
Myofascial Meridian Stimulation Therapy
Spinal transitional zone
CO junction
CT junction
TL junction
LS junction
Junction에 variation이 존재
Korean Integrative Medicine Institute