Richard Hazel Motor Point Acupuncture Interview
Q: Rich, we are really excited to host your workshop in Amsterdam on May 11-12th 2019. Can you tell us a bit how you got into this field?
RH: I’m excited to bring Motor Point Acupuncture to Amsterdam. I actually didn’t know about motor points until I got to Pacific College in New York where I was expecting to get the same Chinese Medicine Acupuncture master’s degree as everyone else. But there was a new Orthopedic & Sports Medicine Acupuncture program that got my interest because I knew that treating pain was going to be the primary focus of my future practice. My own issues with low back pain led me to acupuncture and I wanted to help others to not suffer the debilitating pain that I had experienced.
Q: I got into the program and that’s where I learned about trigger points and motor points. Our curriculum covered manual muscle testing, functional assessment, postural assessment and how to locate and treat motor points with acupuncture to quickly relieve pain.
RH: There is an ongoing debate about dry needling and acupuncture in the US. Most TCM practitioners in Europe don’t know much about it. Can you explain a bit what exactly it is that you are teaching and how it is different from other methods?
Q: Most dry needling is Trigger Point Dry Needling. It’s based on the work of Dr. Janet Travell and some others like Dr. Karel Lewit. It is primarily focused on treating tight painful bands of muscle that can refer pain to different areas of the body and will restrict muscle elasticity and will often cause joint dysfunction.It can be an uncomfortable treatment for the patient because the needle needs to be inserted at the most painful part of the trigger point in order to neutralize the pain and symptoms.
RH: What I teach is different from what people who do Dry Needling are doing. Well, I should say that until very recently it was different. It turns out that some of the big organizations that teach Dry Needling have seen what we are doing with Motor Point Acupuncture and now they have something called Advanced Neurofunctional Dry Needling which is their name for Motor Point Acupuncture.
Motor Point Acupuncture can be as gentle as the practitioner wants. It usually involves just inserting a needle into the motor point (where the motor nerve attaches to the surface of the muscle) and then applies some electric stimulation with a pointer device like the Pointer Excel or Pointer Plus in order to make the muscle contract and relax. That contraction will “reset” the muscle so that it’s more elastic and flexible which will quickly restore joint function and reduce pain and inflammation.
Q: What’s the difference between trigger point and motor point needling?
RH: Both can look similar at times. Sometimes we want to make the muscle fasciculate (twitch) by needling the motor point so if you’re just watching you need the practitioner moving the needling around in the area which may look like we are working on a trigger point.
But needling a trigger point requires finding a tight, painful area and needling it with a pecking movement. We are pecking on the tight band to hyper-excite the trigger point so that it will twitch and release and we need to be needling the most painful area of the trigger point in order to be the most effective so it can be uncomfortable for the patient. I should say that sometimes it’s necessary to treat trigger points, but in my experience, over 90% of the time, an issue can be resolved by just using the more gentle Motor Point Acupuncture approach.
If I’m manipulating the needle in a motor point in order to get a twitch so that the muscle length and tension will be reset, it doesn’t hurt the patient most of the time. I should say, it doesn’t hurt any more frequently than any other style of acupuncture hurts. Of course there are times when we bump against a vessel and it can sting, but it’s not worse than any other style that goes into the muscle.
If the practitioner will be using a pointer device to deliver electric stimulation to the needle, there is no need to get any twitch response. They can just insert the needle and add some e-stim.
Q: What is your method particular good at treating?
RH: I believe we can treat any form of musculoskeletal pain or mobility issue that is due to over-use or posture. There are of course cases where the person has neglected the issue for so many years or decades that our treatment will not be 100% effective for them, but even in tough cases I believe we can make changes that will be noticeable.
For acute injury or chronic injury and failed recovery after surgery, I believe Motor Point Acupuncture should be the first option and not the last, as it seems to be right now.
Q: What does a standard treatment look like? How much time does it take? How many needles? Etc.
RH: Most new patients are told that we won’t know how many treatments they will need until we see how they respond to the first. I do it that way because some people heal faster than others and I can’t rely on age, size or activity level to know for sure. The youngest and healthiest people certainly do respond the fastest but I’ve seen cases where a young person has several different issues that can take some time.
I expect an acute case to be resolved in 1-3 weekly sessions and a chronic case to need about 6 treatments before we can move them to once every 2 weeks and then hopefully to once every month as maintenance. It really can vary based on the patient and their desire to do some work at home. Motivated patients do well very quickly. Someone with an autoimmune condition may need to see me every 2 weeks for as long as they can and we hope to get them to once per month, which I have seen frequently.
My treatments are one hour with one patient. I need that time to treat the whole person. We can’t just treat the area that hurts. Most of the time we are treating some other area that is causing a dysfunctional movement pattern or a postural issue which leads to that pain. So I will be treating the posterior chain, and the anterior, and some points are treating with the patient on their side. Once they are in for just maintenance we have less to do and they get more time to relax with needles.
Q: Nowadays people can buy books and get their hands on pdfs about Motor Points. There are many videos available online, why should people come to a live training?
RH: A person can’t learn to needle properly or safely from a video. Can you imagine learning Chinese Medicine Acupuncture from videos? It’s the same for Motor Point Acupuncture.
The perspective and angle is not good in a video and the skill needs to be developed by hands-on palpation of the muscles and a tactile sensation at the end of the needle. We are practicing a hand skill in our seminars. Anyone who has attended realizes quickly that what you see in a video by someone who has been treating motor points for years is not as easy when they are doing it themselves. When I insert a needle and I get the motor point on the first insertion, it may seem like it will be that way for everyone, but it has taken me years to be able to insert needles quickly and to still get the motor point accurately.
Acupuncturists also often need help with their anatomy. It’s one thing to know what muscle you want to treat, but when you are with a patient, their body is perhaps different in size or shape than what you saw on YouTube, so now what?
Hands-on practice is essential to being able to distinguish one muscle from the next. So many people can feel a person’s neck and correctly identify to the heads of the SCM, the medial scalene and the levator scapulae without some guidance. And if they can, do they know what direction to needle so they don’t hit any major arteries or the jugular veins?
These things need to be done with guidance and some quick tips that will make it easier in the clinic.
Q: Could you tell us a bit about upper/lower cross syndrome and why it’s so important?
RH: Upper Crossed and Lower Crossed syndromes were identified by Dr. Vladimir Janda. He was a neurologist who specialized in rehabilitation which took into consideration the musculoskeletal system, skeletal system and the nervous system. Dr. Janda recognized that all humans are prone to these postural issues.
Upper Crossed syndrome is a combination of tight and weak muscles. The neck flexors and the mid-back scapular stabilizers get weak and the neck extensors, the levator scapulae and the pectoralis minor get tight. This can lead to a forward head placement, neck pain, shoulder pain, mid-back pain and headaches.
Lower Crossed syndrome is a combination of tight and weak hip and low back and abdominal muscles that put the pelvis on an anterior tilt that puts stress on the low back and can lead to low back pain, hip pain, knee pain and can increase the forward head placement of the Upper Crossed Syndrome.
By using motor points and some easy corrective exercise we can greatly improve these postural issues. These are the conditions that most physical therapists are working to correct when they have patients with neck, shoulder, back, hip or knee pain so we can greatly improve their progress in PT with Motor Point Acupuncture.
Q: People are usually excited about motor/trigger point then they get scared with all the pain referral charts of the different muscles. Is this technique hard? Can you mix it with what you already do?
RH: I try to break things down so that it’s not so scary. If you learn one muscle at a time the way we do in our seminars, it’s easy to grasp and learn. I find that people who have only taken one seminar are getting excellent results, even on complex cases and on issues that were not covered in the seminar because they are learning diagnostic skills and the theories that help them to apply their knowledge to any issue and find a way to successfully treat.
I intentionally do not teach Chinese Medicine theory in my seminars because I don’t believe acupuncturists need me to teach them something they are already experts on. I keep it very focused on Motor Point Acupuncture and I like to tell people they should blend their own style with this style however they want. I’m not a guru and I don’t tell people how to think or how to treat. I teach people what works and I teach people from my personal clinical experience and then encourage them to do what they like and change what they don’t like.
Q: Some people are afraid of the palpation skills and the complexity of assessment regarding orthopedic acupuncture. What would you say to those people?
RH: Trying something new can feel uncomfortable, but we try to create a learning environment where we support everyone at the level they are at and we want to help them improve their skills. Once they get with a partner and start palpation and needling they gain confidence. Seeing their own success in the seminar gives them confidence that they can get these skills. I’m very happy to see such a high percentage of the people who have attended my seminars are actually using what they learned and expanding their interest in orthopedic acupuncture. I have seen practitioners of 10, 15, 20 years completely change their practice to Motor Point Acupuncture because they see such amazing results. It gives them a new spark of excitement and passion for acupuncture and reminds them why they chose this important career.
Q: Can this technique be of use to those who don’t want to use e-stim?
RH: When I first learned Motor Point Acupuncture in school we didn’t use e-stim at all. We would get the twitch response that is necessary to get the best results and that would be all we did. I would get great results in the school clinic without any use of e-stim on most patients, so you can absolutely get good results without e-stim as long as you are getting the twitch response, which can take some hands-on training and some persistence as it is a skill.
Essential Motor Points + Upper/Lower Crossed Syndromes
Do you want to stand out from the crowd of acupuncturists and create a niche practice? Are you working with (professional) athletes? Would you like to become an expert in treating musculoskeletal disorders with Motor Point Acupuncture? Then this seminar from May 11th-12th 2019 with Richard Hazel is definitely for you! Sign up today, only 20 spots available!