Ying Zhang The First Affiliated Hospital of Guangzhou Medical University
Fu Hui Dong China Academy of Traditional Chinese Medicine Institute of Traumatology & Orthopedics
“Minimally Invasive Soft Tissue Technique” uses a needle with a flat, chisel like blade at the end called a ‘Pi needle’ (鈹針), to treat tissue lesions with special techniques. Pi needles penetrate the skin directly to the affected region, then mechanically reduce or decompress the tight fascial tissue, in order to improve pathological changes of nervous system, retention of body fluids and organ dysfunction caused by fascial tissue restrictions.This treatment method can restore the original structure and function of the tissues and organs. The theory of the treatment is based on human anatomy, physiology, pathology, biomechanics, and the minimally invasive techniques of traditional Chinese medicine (TCM), and it integrates acupuncture techniques from TCM, it is a modern version of a traditional diagnosis and treatment system.
Mechanisms of the Technique
Relieving tight fascial tissue: Muscular strain plays an important role in normal bone development. The shape, internal structure, and composition of bones are related to the magnitude and direction of the stress on the bone’s periosteal skin. In our growth and development this is normal. However, when we have physically matured and there is excessive continuous or repeated tensile stress and the muscle or tendon fibers are in a state of tension for a long time, they pull on the surface of the bone where they attach, resulting in stress related hyperplasia of the bone, as with so called “bone spurs” . This technique uses the flat needle to cut or loosen the high-pressure fascia tissue adhered to the bone surface, to change the direction and magni- tude of its force, in order to eliminate the source of the problem. The most clinically relevant disease of this type is “third lumbar transverse process syndrome”. This occurs when the third lumbar vertebra, which is the center of vertebral rotation and forward bending and has multiple muscle attachments, experiences long-term mechanical stress. The stress stimulates mechanical stress at the apex of the vertebrae’s transverse process, resulting in the third lumbar transverse process elongating and being longer than the other lumbar transverse processes. The treatment concept is to eliminate the tight fascial tissue attaching at the apex of the transverse process of the third lumbar vertebra, by using a flat head needle to cut off or reduce the tension.
Relieving pressure in osteo-fibrous canal: An osteo-fibrous tunnel is a canal composed of bone and connective tissue fibers. These structures can be divided into three types: an osteo- fibrous tunnel, a joint fibrous tunnel, and musculotendinous-fibrous tunnel. Nerves, blood vessels, and tendons travel through these areas, and the role of the tunnels is to protect and retain these vessels, nerves and tendons in movement. When something increases the pressure within the canal it can induced abnormal internal structure, and the nerves or vessels within in the canal can be compressed or irritated, producing clinical symptoms at the areas served by the nerves and vessels. This technique can release the tissue contracture and tension in the tunnel structure, reducing the internal pressure, and relieving symptoms. The most common disease caused by this type of structural change is occipital headache. When the structure of the posterior occipital tunnel is abnormal or the tension irritates the greater or lesser occipital nerves and arteries, it can cause pain in the innervated areas of the greater and lesser occipital nerves, producing an occipital headache. Understanding this concept makes clinical treatment simple. We just use a bladed needle to loosen the contracture of the tendon arch of the occipital tendon, reduce the tension on the arch of the occipital tendon, and eliminate the greater and lesser occipi- tal nerve irritation to relieve the neuralgia symptoms.
Editor’s Note: Thefollowing is relating to places where nerves pass over the edges ofbones through a combination ofa notch in the bone and a “tunnel” roofmade ofconnective tissue, like the passage ofthe occipital nerve where it crosses the nuchal like, or the cluneal nerves where they pass the ilia. This is broadened to include areas like the carpal tunnel (“jointfibrous tunnel” below), or compartments bounded entirely by muscle, like the “quadrilateral space”, the area in the armpit through which the brachial plexus passes.
Reduce interstitial tissue pressure: Within the human body, from structures as small as a cell, to a muscle or organ, up to areas as large as the entire skin of the human body, all of these form closed cavities, and are juxtaposed with one another. The pressure differences inside and outside these cavities maintain the structure and metabolism of the human body. Structural abnormalities, or chronic strain, etc., causes localized tissue disorders, leading to increased pressure within a cavity. In clinical settings, many types of soft tissue injuries belong to this category, such as osteofascial compartment syndrome, swelling leading to joint capsule pressure, intraosseous pressure, and even increased intracranial pressure, etc. The cutting needle can penetrate the cavity wall and reduce the pressure within the cavity, restoring balance to the local tissue metabolism, to achieve the purpose of reducing or relieving symptoms. The most common clinical headache, dizziness, nausea, and vomit- ing are caused by intracranial hypertension. Cervical spondylosis affects the circulation of intracranial fluid, and causes increased intracranial pressure. Clinically, the obstruction of intracranial fluid reflux can be relieved by loosening the soft tissue behind the pillow, thereby relieving clinical manifestations such as headache, dizziness, nausea, and vomiting.
Relieve adhesions between tissues Under normal circumstances, connective tissue layers have varying degrees of movement between them. When there is trauma, chronic strain, or surgical penetration and scarring, the available movement between the layers is often substantially reduced, affecting the functions of the adjacent structures, organs, nerves, blood vessels, etc. Such as restricted movement between the superficial and deep fascia, the joints, or even the organs when the visceral and parietal fascia are affected. Acupuncture manipulation can reduce the adhesion between tissue layers and restore them to a normal physiological state. The most common clinical manifestation of this is the postoperative scar. Scarring can induce the skin and subcutaneous tissue to adhere to one another, resulting in an obvious raised, stiff lesion on the skin. We use a cutting needle to break up the adhesion of the skin and subcutaneous tissue, and the deep incision line will flatten and soften in a short time, its color and hardness will normalize. In other cases, intestinal adhesion after abdominal surgery is also quite typical. This issue plagues surgeons today.
Indications
The technique is applicable to any part of the body for soft tissue injury or chronic strain, local tissue lesions such as soft tissue adhesions, fibrous contracture, increased internal pressure, cyst wall thickening and other pathological changes where non-surgical treatment is ineffective or symptoms recur after treatment.
a)Neck and lower back pain are caused by soft tissue injury, muscle tension at the back of neck leads to cervical dislocation, resulting in the clinical manifestations of nerve root type, verte- bral artery type, and sympathetic cervical spondylosis. Pi needle can relieve the tense and contracted muscles at the back of the neck, combined with TCM bone setting manipulation.
b)3rd lumbar vertebrae transverse process syndrome, calcaneal spur, knee intercondylar protuberance hyperplasia.
c)Bone fiber entrapment of cubital tunnel, tarsal tunnel, ulnar tunnel, and carpal tunnel, resulting in clinical syndromes, like migraine, tenosynovitis, frozen shoulder, cervical and lumbar nerve roots caused by entrapment or extrusion disease.
d)Ganglion cysts, joint pain caused by increased intra-articular pressure, synovitis, bursitis, and myofascitis of various parts of the body, such as ischial tuberosity bursitis, calcaneal tuberosi-ty bursitis, etc.
e)Local tissue adhesions, scars caused by trauma, strain, and surgery. Such as tennis elbow, Levator scapulae syndrome, and sequelae of bone and joint diseases (rheumatism, ankylosing spondylitis, gout, avascular necrosis of bone joint, fibrous stiffness of limb joints, etc.).
Contraindications
a)Patients with fever and infection
b)Patient with hemophilia or with blood coagulation disorders
c)Severe visceral disease attack period, diabetes, mental illness patients
d)Physically weak and uncooperative
e)Patients with infection or redness, swelling, heat, pain, or abscess at the site to be needled
f)The diagnosis is not clear, or there are pathological changes, or changes to the local anatomical structure due to surgery or malformation complicating the procedure.
g)The needled site is close to important organs and cannot pro- tect them
Treatment
Acupuncture needles Bladed needles, the diameter and length of which can be selected according to the location and pathological changes.Typical range is 0.35-0.50mm by 25-50mm.
Treatment procedure
Patient position: Depending on the location of the lesion and the method of operation
Needle insertion site: Select the appropriate point according to the lesion site and operation technique. One should avoid insertion too close to vulnerable organs and tissues
Needle insertion method: “Two fast and one slow” method is used; the “two fast” is the rapid insertion and removal of the needle to reduce local pain. When the needle blade reaches the subcutaneous area, the needle needs to be inserted slowly. When necessary, the needle tip can be shaken to stimulate the surrounding sensitive tissues (Nerves, blood vessels, etc.) to produce reflexive avoidance and reduce unnecessary damage to tissues
Needle blade orientation: The blade of the needle should be oriented parallel to the direction of the fibers at various levels in the anatomical area. This is done to avoid unintentional trauma to important tissues.
3.Treatment methods
Longitudinal dredging method: the needle blade is parallel to tissue fiber direction and worked back and forth, in order to free adhesions between tissues. This is mainly applicable to the adhesion between tissues.
Horizontal loosening method: the needle blade is perpendicular to the tissue fibers at the site, and is manipulated to cut tense muscle or tendon fibers or connective tissue. It is mainly applied to reducing the compression in osteo fibrous tunnels.
Cutting method: the needle blade is advanced to the area of the adhesive scar tissue, and different directions and depths are selected for cutting, to reduce the area and degree of tissue adhesion and accelerate the absorption of local lesion tissue as the microtrauma is repaired.
Penetrating and peeling method: the acupuncture needle reaches between the tissues, and then the adhesion between the tissues is separated in a sweeping motion by the blade. This method is mainly suitable for cases where the adhesion area is large but not serious.
Perforation decompression method: When the needle blade reaches the lesion, it punctures the cystic wall or fascia of the lesion, or enlarges the incision as necessary, to accelerate the metabolism and absorption of fluid accumulations. This method is mostly used for intracapsular decompression.
Precautions
As this technique has developed a basic theory and there has been technical research of the concept of minimally invasive soft tissue techniques, it has almost lost its original relationship with acupuncture, which has been replaced by a conceptual framework of closed tension reduction and decompression technology. As this is essentially a surgical intervention, the treatment room should have certain requirements, and the operator must master certain aseptic techniques.
Although the technique is derived from acupuncture, which already has the function of reducing tension and decompression, it additionally requires a deep understanding of local ana- tomical structure, physiology, pathology and histology of the human body, an understanding of imaging basics, and a special knowledge of orthopedics and traumatology.
For the technique to be effective, the doctor must not only understand the medical aspects and have experience, but they must also pay attention to the patient’s reaction to the treat- ment, as it is a very important indicator of effectiveness of the method. If the treatment is to be successfully completed coop- eration between doctors and patients is essential.
Precision is a requirement of the technique, so the operator must make a clear diagnosis, specify the location, patholo- gy, and have a detailed plan of treatment, identifying methods to avoid injury to adjacent tissues and structures. Otherwise, in addition to affecting its therapeutic benefit, it will cause unnecessary damage or postoperative complications.
In recent decades, this technique has become favored by many TCM practitioners who specialize in pain management because of its efficacy in pain relief. I would like to use this article for their reference.
