Infraspinatus respiratory reflex

Infraspinatus respiratory reflex

Dear Colleagues:

The history of neural therapy is intertwined with the history of procaine, whether we date it from Spiess's report of its anti-inflammatory properties in 1906, the Huneke brothers' cure of their sister's migraines in the 1920s, or Franz Huneke's first elicitation of a lightning reaction in 1941. The caine anaesthetics' unique ability to cause lasting improvement long after their anaesthetic effect has worn off has been an endless source of fascination for everyone who has used it in this manner. 

Although neural therapists have a natural affection for procaine, (the "King of medicines" according to Dosch), procaine hardly belongs to neural therapists alone. Procaine was studied extensively by clinicians in the early 20th century (Leriche, Ricker, Vishnevski, Speransky and others) who knew nothing about neural therapy. Drawing on this literature, Irwin Korr, the great neurophysiologist of osteopathy, in 1949 challenged the osteopathic procession to look at procaine as a means of extending the reach of manipulative therapy.  Janet Travell's life work was the identification and study of muscle trigger points.  She recognized procaine as an efficient means of  "turning off" irritable trigger points. There are doubtless many others who have independently discovered procaine's seemingly magical properties in treating chronic pain.

At the recent Mid-winter neural therapy retreat, Jeff Harris ND, alerted us to another application of procaine from "outside" of neural therapy. This is the discovery by the lateHarry Philibert MD of Louisiana of the "Infraspinatus Respiratory Reflex", a trigger point in the infraspinatus muscle closely connected to respiratory difficulty, especially asthma.  According to John L Wilson, of a series of 4000 asthmatic patients 85% experienced substantial improvement with treatment of this trigger point with a caine anaesthetic.  Treatment can also be helpful in treating other respiratory conditions and shoulder pain.  

The trigger point is located medially, close to the medial border of the scapula. A tender nodule should be felt and possibly a narrow band of tight muscle fibres extending from it. Injection is the same as of any other muscle trigger point, directly into the most tender spot. Janet Travell would have recommended stretching of the infraspinatus muscle immediately after the injection, but I am not sure if this was Dr. Philibert's recommendation also.   

I was surprised to find no mention of this trigger point in Travell and Simon's classic text "The Trigger Point Manual".Travell described a "burp button", a trigger point in the posterior abdominal wall musculature that elicits a loud burp with even light touch! (It is usually found in proper little old ladies. I have seen only a couple of these in my 44 years of practicing medicine.) Travell also described a variety of other somatovisceral trigger points including a cough TP, a hiccup TP and other points creating disturbance in the bladder and gastrointestinal organs.

On a personal note, this winter for the first time I experienced an attack of exercise-induced asthma, while cross country skiing up a steep hill, in very deep snow and in below 0°F (-18°C) temperatures.  Needless to say my lungs and shoulder muscles were pushed to the max.  I returned home immediately, alarmed by wheezing and shortness of breath, a completely new experience for me. It subsided, but on another cross-country skiing venture a week later, the wheezing returned. I have enjoyed cross-country skiing all my life, so this was bad news indeed.

During the retreat at which Dr. Harris lectured on the Infraspinatus Respiratory Reflex, a colleague checked and indeed found a trigger point in my right medial infraspinatus muscle.  It was treated with a Tenscam device (procaine would no doubt have given the same result).  I felt an immediate relaxation of my lungs and have since skied numerous times in this long cold winter, with not a touch of wheezing.   

Procaine injections over the chest wall to treat lung disease and lung interference fields are well-established in neural therapy.  Descriptions can be found in my book (pp.172-173), in a past newsletter http://www.neuraltherapybook.com/newsletters/  (Vol.4, No.2, 2009) and in the Dosch manuals.  Interestingly Speransky's only publication after his monumental A Basis for the Theory of Medicine was a report during the second World War of treating Russian soldiers with pneumonia by injecting blebs of procaine over the upper back (Speransky AD: Experimental and clinical lobar pneumonia. Am. Rev. Soviet Med. 2:22-27, Oct. 1944). I do not believe this article can be found on-line, but for those interested I will send a copy as an email attachment on request.

My guess is that neural therapists have unknowingly treated the Infraspinatus Respiratory Reflex point many times over the years as part of segmental therapy of the lungs.  However Dr. Philibert's discovery offers an elegant and more targeted alternative method of achieving the same result.

The Infraspinatus Respiratory Reflex trigger point has been known for over 15 years.  I would be interested to know if any neural therapists have been using it and how treatment compares with standard lung segmental therapy.

The Neural Therapy in Practice newsletter was intended as a complement to Dr. Kidd's book, Neural Therapy: Applied Neurophysiology and Other Topics, which is still available for sale through Amazon.