Hello, everyone. Welcome to the American Acupuncture Council podcast. My name is Matt Callison. I’m with my colleague and dear friend, Brian Lau. Hello, welcome. We’re here to talk about Chondromalacia and Patellofemoral Syndrome. A Jingjin Perspective, because this is only 30 minutes. We’re not going to have a lot of time to be extremely thorough, but hopefully the, what we’re going to be talking about in this short presentation will hope to provide content that can be used to enhance the practitioners current treatments for these conditions, and also possibly excite the practitioner to learn more.
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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.
So why don’t we jump right into the information I want to introduce you to Brian is going to get started with, uh, with, uh, a video that we’ve been working very hard on, right? Yeah. Well, first of all, as you can see, there’s a warning screen up. Uh, this video coming up is from a recent dissection. Uh, Matt and I did a
As preparation for the Sports Medicine Acupuncture certification, uh, module three, uh, anatomy, palpation and cadaver lab is the first two days of module three. When we do the program, we usually, well, we always prepare the cadaver specimen beforehand as part of that whole two day experience. Students come in and they’re able to, um, work with the cadaver during the cadaver lab portion of that class. And then that evening we stay after prepare the cadaver for the next day, a different view, different depth, maybe from prone to supine. They come in they’re there. They’re able to see that, uh, prepared specimen the second day as part of the experience for the two day lab. So now with COVID, we’re having a transition to some of the classes being online and webinar-based based. We have an upcoming one in October. So this is one of the videos that we produced for the anatomy palpation cadaver lab coming up in October.
Uh, the experience is a little bit different in some ways I think it’s potentially better because the students get a chance to see some of the dissection, some of the process that we’re doing, but at the same time, they’re not there for the experience live, but there’s, there’s pluses and minuses. So this is a video from the upcoming class. We’re not going to be able to play the entire video, but, um, it’ll supplement the discussion of what we’re doing today, which is on Chondromalacia and Patellofemoral Syndrome. I’m going to go in and play the first part of the video. So there’s a little bit of a, uh, animation to set the stage about how the patella tracks. So you’ll see that coming up in just a moment.
Let me see. Sorry. I didn’t have the video started. It should start in just a second. Now, here it goes. So what’s, you’re seeing there’s patella is not on the bone is set up with a supine position and this is going to highlight the trochlear groove. That’s where the patella tracks, the patella should come in and just a moment, and you’ll see how it sits over this patellar groove of the femur. So the patella tracks during flection and extension along that patellar or trochlear groove, and that’s partly held in place, or at least, um, that movement is, is controlled by the guy wires of the spleen and the stomachs and new channels. And if there’s balance in those channels, well then of course, that’s going to allow the patella to track along that trochlear groove. So a common situation very frequently in clinic when people are having problems with patellar tracking, leading to pain, is the stomach send new channel, especially the lateral quadriceps, the vastus lateralis pulls accessibly and the spleen send you a channel is weak and not doing quite the, the amount of work
Or the load that’s necessary. So what happens is then the spleen fails to lift the patella. Paul’s lateral. We’ll talk more about that as we go through the presentation, I’m going to go back to that place. Let me get back to that moment. And now we’ll see that on the cadaver specimen.
There we go.
This video is showing the quadriceps three of the quadriceps. We’ll be showing the vastest intermediate in a separate video for this video. You see the rectus femoris muscle, the rectus femoris attaches to the patella blends in all the way down to the tibial tuberosity. You’ve got the vastus lateralis attaches to the lateral lip of the femur, attaches to the lateral aspect of the femur blends in with the fibers of the rectus femoris and attaches to the tibial tuberosity. Then you have the vastus medialis, here’s the longitudinal fibers of the vastus medialis and the vastus medialis has oblique fibers. As it comes down, attaches to the medial aspect of the patella blends in with the other quadriceps to attach to the two tuberosity. As we learned in the previous lectures, you have the spleen channel affecting the vastus medialis. You have the stomach channel affecting the vastus lateralis.
We need to have an even pool between these two muscles so that the patella can evenly run evenly, go through the entire trochlear groove, a common imbalance between these muscles between these channels will pull the patella lateral and superior causing condor, Malaysia and patellofemoral syndrome. In other videos, you’ll see lateral retina curriculum needling for that also surround the dragon needle technique around the patella that can help with that condition. The rectus femoris you can see as a bipartite muscle. That means it has a linear Alba. So this Linea Alba runs down the center of the patella with all right, little summary of what we’re looking at, Matt. Yeah. I just want to say something really quick. I’m not quite sure we’re having technical difficulties because on my view, it looks really, really blurred that videos is crystal clear with the resolution that we normally have that was really blurry.
Um, Brian, are you seeing the same thing as a blur on your end to look fine on my end, but it might be that I’m looking at the screen that it’s playing on. Well, maybe it’s my glasses. Let me take a look. Sorry about that. You guys, um, patellofemoral syndrome will frequently present with a lateral glide and or lateral tilting of the patella. This is what we were discussing, how the stomach send you channel that vastus lateralis pulling up on that lateral aspect of the patella and the spleen channel weekends is unable to guide that of the patella. So it starts to tilt as you can see to the lateral side. So this malposition can lead to increased pain and also deterioration of the patellar cartilage, which would be also another name for chondromalacia patella and what’s next or Brian.
So the patellar tracking injuries causing pain can lead to positive valuations, such as with using Clark’s sign. Clark sign is a very good test. It’s a test that causes pain. So you have to make sure that you’re doing it very gently. What you’re doing is you’re forcing the patella actually into that trochlear groove. And if there’s chondral Malaysia, if there’s that sand underneath that patella, then you can only imagine for those people that don’t have it, what that’s going to feel like when you’re actually trying to get that patella to grind against the bone. And that’s what Clark’s sign is. So it’s, it’s a very good test, but you have to use a lot of sensitivity with it, cause it can really hurt the patient quite a bit of that gross feeling. Yeah, it is. Yeah, it is. It’s your purpose, Brian. My take on Eli’s test toss test, uh, Eli’s test and Thomas test will utilize test specifically.
Uh, the, the patient is prone and you’re bringing their heel to their behind and you’re seeing Morris is able to fully lengthen. And if it’s shortened, then what it does is as they get into the extreme of me, flection that shortened rec fem starts to Paul acceptance excessively on the phenomena bone and it drives the nominate bone up. So it’s really simply a test to see if the rec fem is able to folly lengthen. If it’s not, then that indicates an overactive and block short rec fem part of the stomach’s in your channel. And that would be really good information that that would lead you to, um, wanting to reduce tension along the rec fem and along the stomachs and new channel Thomas test test for multiple things. Um, in this context for this lecture, it’s another test that will test for a quadricep length.
So it’s a, it gives you another way of looking at if the quadriceps is a group or overactive, uh, it does also test for so as shortness Elio. So as shortness, another channel send you another lecture, uh, potentially, um, Sartorious shortening part of the spleen sinew channel also kind of less related to the patellar tracking in this case, but it does test for other things, but in our context for today, it’s really about the quadriceps. So these are two excellent tests to test for overactivity in the quadriceps. Eli’s more specifically on the rec fem, um, places suit by patients. So I’ll take this next bullet. Um, as we know, when the leg is extended, it’s easy for the practitioner to move the patella cause it’s mobile. So in this particular test, if we go into knee flection of about 20 or 30 degrees, that adds a little bit of tension that Battelle announced a little bit tighter into that trickle your groove.
Now we can push on the patella from side to side motion. This is a kinder, gentler test and Clark sign. So you may want to use this one test first to see if that’s positive, then you won’t have to use Clark sign. Um, this, this test is actually really reliable, at least for me, uh, next assess the tightness of ladder retina and live in the knee. So place the suit by a patient in a straight leg position with a quadriceps, relax, the practitioner lifts the lateral edge of the patella away from the lateral, from Macondo, a tightness or inability to raise the lateral edge. Approximately 15 degrees indicates a tight lateral retina macula, but of course, you’re going to compare it to that, to the opposite side. So you’re going to palpate the patella and get your thumbs to start working up underneath that lateral edge of the patella, soften the tissue a little bit, take maybe 20, 30 seconds to do it, and then lift that patella. If that patella on that lateral side, doesn’t lift more than 15 degrees. That’s a positive side for that, that stomach send you channel tightening down that lateral retina macula just is a, usually a cold stagnation in that region pulling down on that area. So this is the reason why we have a needle technique going into that region, which also is a moxibustion is also applicable with that. Brian want to say anything or move to the next slide?
I’ll just add a little quick something. Uh, so these are all of course Western orthopedic tests, but since we’re looking at it from the perspective of the sinew channels, all of these to some extent are channel tests also. So, um, this test testing for the lateral retina curriculum in the video coming up, you’ll see how that lateral retina baculum is part of and continuous with the deep fascia of the thigh and how the stomach’s in new channel polling excessively through, especially the vastus lateralis can add extra tension into that lateral reticulum. So it’s part of a continuous chain from the thigh into the knee. So when you’re testing that you’re testing the stomach, as Matt mentioned, you’re testing the stomach’s in your channel. So you’re getting a little bit of a window into the stomach GI. So depending on what other signs and symptoms you found from your evaluation in this case, your TCM evaluation, you can put that information, uh, along with what you’re finding with this more palpation and the assessment of the knee. You know, maybe the person has acid reflux or some other, you know, rebellious stomach GI signs. And you’re feeling that excessive tightness on the vastus lateralis you’re lifting the Batalla, the Batalla doesn’t pull and doesn’t move away from that lateral surface. So well, so it’s pulled lateral. So that would all start to paint a picture both from a local orthopedic standpoint, but also from the whole body holistic approach from TCM. Good to put them two together.
Yeah, totally agree that that’s the lesson. I think we learned in first year of acupuncture school, how the meridians, the channels are connected to the organs and when you’re really looking for that, you can find that you’re absolutely right. Brian, a lot of that with the gallbladder channel as well. Sure. Cool. All right, well let’s keep moving. All right. So this is the needle technique using two, three inch needles going through the retina baculum, um, this is a needle technique that you want to make sure that it travels just underneath the subcutaneous fascia, the subcutaneous adipose layer, and just scraping along that lateral [inaudible] for many patients, if you start to angle oblique with this needle technique, it’s going to hurt very bad. So this is a needle technique that you want to practice on somebody that can handle needle stimulation. Don’t try this on a patient for the first time.
If you practice this needle technique, first, if you go too deep, it’s going to cause a lot of pain. If you, if you have that needle ride between the superficial fascia and the deep fascia, just underneath the adipose and before the muscle layer and the retina and that joint capsule just slide it right along that practice. At first two needle side by side work really well and moxibustion, or electricity can work that blue.is stomach 36. So what you’re doing is you’re aiming those needles towards, so at 36, yeah. And the, uh, the two needles. Now you might’ve said this, but I didn’t hear it myself. Uh, those are three inch needles that are better, um, shown there. And you’ll see that actually in the next cadaver video. So right now you can kind of look through the skin and picture it, but pretty soon you want to have the picture and you’ll be able to see it a little bit more clearly in terms of what the target tissue is.
Right. I don’t know if you wanted to mention anything or maybe it’s just simply saying that that surgical techniques are to, to release this lateral retina macula, which is kind of an extreme version, but this is the same tissue that, uh, the needles are working with the soften and release that ladder. [inaudible] in a way that doesn’t, uh, what’s better to not have to go under the knife if you can. So this is a, uh, a really an excellent technique that would, um, kind of parallel, I guess, some of the more aggressive surgical techniques. And it’d be part of a comprehensive picture of the other needles being used in this whole treatment and myofascial work and exercises and stretching. And even guash is, it’s a tissue that is pliable. You can get it to stretch. Um, it just takes some time to be able to do it, but absolutely you can get really good results with this and the myofascial techniques and yet everything else that we do.
Alright, so surround the dragon needle technique. We’re going to be seeing this in the video, coming up on a cadaver specimen, usually seven needles. You’re just going around the patella itself. Your goal is trying to get underneath that Battelle. It’s a way of getting the retina macular tissue, that tissue all around that patella to actually communicate and loosen up as much as possible, but you can use Eastham on those needles, or you can also use moxa with it. These needles will be in addition to other spleen and stomach CGU channel dysfunction. And of course we’re treating the foot and the hip, anytime that there’s a deep problem buts that’s for a conversation for another day. Yeah, yeah. Those are one and a half inch needles. So you’re not trying to drive the needle as far as you can, under the Batalla. You’re just trying to get, uh, get the needle in the space between the patella and that the trochlear groove basically to also, you know, work on some of that fixed pain side of, of where there’s a degeneration of that, the patella cartilage, right? So we are ready to look back at the cadaver image. I’m going to cue it up to the point that we’ll take it from there. So we’ll see those needle techniques on a cadaver prepared cadaver specimen. So that’ll give us a little better view, especially the red Nakheel and you’ll be able to directly see that tissue. So again, if you’re sensitive to cadaver images, then maybe you look away for this portion. But, um, I think it’s, uh, all of us being medical professionals, it should be fine.
So let me queue it up. Give me just a moment. There we go. The lateral and medial retina baculum of the knee are part of the stomach and spleen sinew channels. Respectively here, we see an acupuncture needle inserted into the lateral retina curriculum. We teach a technique and assessment and treatment to address this target tissue. This is a surround the dragon needle technique for the patella uses for condor Malaysia, patella, we’ll be using seven needles going around the patella. The first two needles will be on the lateral side would be the first one. The second one will be on the medial side, located halfway between the superior pole and the inferior pole. The goal is to get the needle underneath the patella, as far as possible.
Each one of these needles is directed toward the underside of the patella. This needle technique is performed when the leg is, has knee extension, not a pillow underneath it all, but knee extension flat on the table, you can also apply electrical stimulation on this, or you can also do direct from ox or right onto the patella. Brian, can you freeze that for a second? Here? We can get a better before the MFR. Yeah, yeah, that’s good. Is it on the, uh, surround the dragon? Uh, I’ll get it back there. Alright. Okay guys. Um, so let me just discuss this. So the needles that you have going from, uh, the two inferior needles, I think you probably have already figured that out one is going into the medial. She on the other one is going into the lateral Sheehan or stomach 35, the needles that are on the medial and lateral side, those are inserted halfway between the superior border and the inferior border of the patella, lifting that patella up to the side and inserting the needle under you do that on medial lateral sides. The remaining three needles, two of them will be on the superior medial border. I’m sorry. One will be on the superior medial border and the other one will be on a superior lateral border. Again, the intention to go underneath the patella, the last needle at extra point, Hadeen going underneath or going through the tendon and underneath the patella there. Hopefully that was helpful.
All right. So we’ll play then and look at the myofascial techniques that can be used afterwards. These are working also directly with retina curriculum.
Oops. Sorry about that. Hold that back. Ah, why is that? There it goes.
Alright. So we’re going to be seeing now manufacturer release technique, moving there
Better look at these fibers tissue structures with stabilize the patella, the hands are mobilizing the retina macula on each side to show their influence on the position of the patella.
So you can see how that lateral superior allowed a border. The patella is now straighter.
Now with the superficial fascia removed, we can see how these tissues connect to the deep fascia of the thigh and the respect of channels in use.
Can you see doing this myofascia release technique after you’ve done the needling because the needling is changing the tissue density and the force changing the perception, and then you physically use your fingers to move that tissue re encourage them.
Marshall will give a better view of the underlying muscles of these channels and use and their relationship to patellar balance. All right. I shot, right? Yeah. So you got to also see two different depths with the superficial fascia removed. You get a little better view of how continuous that retina macular tissue is on the medial and lateral side with the deep fascia and how the pole from the stomach and spleen channel would also, um, have something to do with, in terms of too much Paul, on the stomach’s in your channel with Paul excessively on that lateral retina baculum so reducing at the, especially the motor point of the vastus lateralis would be helpful along the stomach’s in your channel. And then if there was weakness and an inability at sort of a lessening of Paul on the spleen side, then you could use this, the vastus medialis motor point to help bring cheetah, bring a little bit of tone to that, uh, vastus medialis to compliment the treatment. So those two are working in coordination with each other when they’re imbalanced.
I brought you want to go over that short exercise?
Uh, I think, go ahead, Matt. Matt, why don’t you take that one?
All right. So here we have the, uh, just, uh, you can use a small foam roll or you can use a towel. That’s gonna be rolled up about four inches or so sometimes five or six. And it just depends on the density of that towel. Go ahead and put it underneath the knee. You want to have the patient go ahead and place their fingers over spleen 10 or extra point by Chong, low two or three fingers would be great. You have the person seated just like this and then have them focus on contracting the vastus medialis oblique fibers when they are, when they’re trying to press their knee into the pillow or into the towel. So with knee injuries and patellofemoral syndrome and lots of different knee injuries, the vastus lateralis is going to fire before the vastest media out. So bleak and that’s backward.
Let me say that again. The vastus lateralis will fire before the vastest media, so bleak and in the muscle firing sequence that’s backward. So again, it really supports that stomach gene gen Xs, spleen T deficiency here. So let’s have that have that patient do this exercise after you’ve just treated the stomach and spleen gene gin, and also did your myofascia release. And you’re giving this one exercise just that small protocol can help a lot of patients about all, obviously it depends on how the severity of the injury, but this is really giving you a good little package to be able to start working with these kinds of conditions. Again, emphasize that the patient is getting that bass as media. So bleak fibers to fire before the vastus lateralis, when they’re going into knee extension, right?
Yeah. Just for those who maybe haven’t looked at the anatomy as closely, the vastus medialis, the medial quadriceps, that kind of tear shaped muscle on the medial side of the thigh, um, is a muscle, but the, a VMO, the vastus medialis oblique are the fibers that start as there as the more inferior fibers that, that take more of an oblique direction as they sort of angle towards the patella. So when you get higher up in the muscle, the fibers are a little bit more straight up and down a little bit more longitudinal, but the lower fibers then start to angle and they’re more oblique. So that’s what the, the abbreviation BMO vastus medialis oblique is same muscle, just the oblique fibers.
Well, Brian, I think that’s our last slide on this conversation, but, um, is there anything else that you want to cover as a closing for this Brian?
Uh, no, no. I can look through some of the, uh, chats. I know there’ll be some questions. I just, again, like distress, I’ve already said it. Matt said it, but, um, you know, a lot of folks who haven’t had a lot of orthopedic, uh, experience as they start to transition more into orthopedic work, uh, for TCM practitioners, it’s very easy to sorta see it as sort of a different world. You know what I mean? It’s, it’s, uh, all of a sudden Western orthopedic tasks, we’re doing Clark sign, we’re doing, uh, Eli’s, we’re doing,
We’re talking about patellar tracking. We’re talking about a lot of very Western type concepts, but the goal, one of, one of our goals, at least in sports medicine acupuncture, is to really bridge those two, those two worlds. So when you’re looking at the, especially this Indian channel relationship, it all is very specific work that we were showing more local work, but it’s part of the big picture. Again, looking at the song, food, looking at the, if we had more time, we could talk about how the hip and the foot position relate to it. And there’s other channel relationships that’ll go with that that are better part of the big picture. So, um, it’s really just taking information you have and applying it in a, in a slightly different context, but don’t lose sight of the information you do have, cause it’s such a powerful medicine to really put together with this more orthopedic approach.
Yeah. Excuse me. I agree. So for the TCM practitioner, all of those different syndromes that have knee pain as a sign and a symptom, that’s something to look at kidney cheat efficiency, kidney inefficiency, liver, cheese stagnation, especially with peasants Ryan problems and medial, knee pain, all of those things apply. So we treat the patient with our TCM diagnosis and then we add this sports medicine on top of it. Yeah. And we’ve been doing this for a while now, so we’re getting pretty good at it. So hopefully you guys can be able to come check out our webinars. We want to thank the American Acupuncture. Do you have something else to add Matt real quick? Okay. I’ll think those guys afterwards, um, the, the surround the patellar needle technique, Matt showed the two, uh, Sean points. Um, so that’s a little bit more of a angling under the patella.
If you go to the YouTube channel for sports medicine acupuncture, there’s also a video that has the knee and much more flection and showing more of a needling more towards the [inaudible] direction to, to access the, um, uh, anterior cruciate ligament or a different direction to access the medial and lateral meniscus. So the reason I’m bringing that up, it’s not really part of this class, but just understand that these same point different needle directions are gonna specifically target different target tissues. So it might help, uh, start to bring it a little bit more into a full picture. If you wanted to check out it’s another cadaver video that you can see on our, uh, uh, YouTube channel. Yeah. And that will also be in our webinar coming up in October. Okay. Now, now you can think, yeah, we want to thank the American acupuncture council very much for having us in this sports acupuncture podcast. You guys thank you for listening. We appreciate you very, very much. Um, next week we have Laura or the American acupuncture council has Lauren Brown coming in to discuss things. So that’s going to be fantastic if you have not heard Lorne Brown speak, um, you should check it out. Lorne is a very incredible practitioner and an academic as well. It’s a really nice blend. Thanks very much. You guys. Thanks, Brian. Really appreciate you. Thank you. See everybody.
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